Failure of SLAP Tear Repair and the Management of Long Head of Biceps Pathology

Abstract

SLAP (superior labrum anterior-posterior) tears are a source of shoulder pain encountered by the orthopedic surgeon. These injuries are most frequently seen in young patients, notably overhead throwing athletes, in addition to older patients, commonly degenerative tears. Treatment of SLAP lesions initially consists of conservative measures including throwing rest, and physical therapy, especially in younger overhead throwing athletes. Operative treatment interventions include arthroscopic labral debridement alone, arthroscopic debridement with bicep anchor/labral repair, or arthroscopic debridement with biceps tenotomy or tenodesis. Patients over 40 years old are often treated with biceps tenotomy compared to tenodesis alone. Younger patients, especially overhead athletes less than 40 are typically treated with SLAP repair. Debate remains between the use of long head of biceps tenotomy compared to biceps tenodesis, either mini open (subpectoral) or arthroscopic (suprapectoral) tenodesis. This chapter will focus on the failure of SLAP repair and subsequent management, in addition to the role of biceps tenotomy versus tenodesis in the role of management of this pathology, either as the primary procedure or as an adjunct to repair.