Abstract
Background:Type II SLAP tears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can also occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral-biceps complex repair, and labral debridement with biceps tenodesis or tenotomy.Objective:To review the existing literature on the management of Type II SLAP tears and provide clinical recommendations based on patient age and activity level.Methods:A review of the existing literature through October 2017 investigating the management of Type II SLAP tears was performed. Emphasis was placed on distinguishing the outcomes based on age and activity level to provide an appropriate treatment algorithm.Results:Patients with Type II SLAP tears should first be trialed with non-operative management and many patients will have a successful result with ability to return to their respective sports or activities. Surgical management should be considered if non-operative management does not provide symptomatic relief. Young, athletic, or high-demand patients should be treated with a SLAP repair while biceps tenodesis should be considered for older or worker’s compensation patients. Patients undergoing revision surgery for a failed SLAP repair should be managed with biceps tenodesis.Conclusion:Type II SLAP tears remain a difficult pathology to manage clinically, but the treatment indications are narrowing. The age and activity algorithm described in this review provides an effective method of managing this complex clinical condition.
Highlights
Tears of the Superior Labrum-Biceps Complex (SLBC) were first described by Andrews et al [1] as Superior Labrum Anterior to Posterior (SLAP) tears
All patients should first be trialed with non-operative treatment. This decision-making is in the context that incidental labral abnormalities are common by MRI, and the natural history of the neglected-labral tear is not associated with the development of other relevant pathology that can otherwise be prevented with early treatment
Franceschi et al [27] found patients with a rotator cuff tear in the presence of a SLAP tear who received bicep tenotomy performed better in terms improvement of UCLA scores (10.1 to 32.1) compared to the patients who received SLAP repair (10.4 to 27.9). Another cohort study demonstrated greater improvement in function in terms of ASES (88.6 versus 80.4) and UCLA scores (29.6 versus 26.0) when patients underwent biceps tenotomy instead of slap repair when the patient had large to massive cuff tears [73]. In many of these studies the patient cohorts were older than 50 years of age, which could skew outcomes against SLAP repairs, we still recommend patients with concomitant pathology be treated with bicep tenodesis or tenotomy unless the patient is a young athlete or high demand patient
Summary
Type II SLAP tears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral-biceps complex repair, and labral debridement with biceps tenodesis or tenotomy
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