Is arthroscopic repair superior to biceps tenotomy and tenodesis for type II SLAP lesions? A meta-analysis of RCTs and observational studies

Yi-Ming Ren,Tao Yang,Meng-Qiang Tian,Yun-Bo Sun,Yuan-Hui Duan,Wei-Yu Hou

doi:10.1186/s13018-019-1096-y

Yi-Ming Ren, Tao Yang + Show 4 more

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https://doi.org/10.1186/s13018-019-1096-y

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Abstract

ObjectiveLabral repair and biceps tenotomy and tenodesis are routine operations for type II superior labrum anterior posterior (SLAP) lesion of the shoulder, but evidence of their superiority is lacking. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic repair versus biceps tenotomy and tenodesis intervention.MethodsThe eight studies were acquired from PubMed, Medline, Embase, CNKI, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan 5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration’s Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias.ResultsEight studies including two randomized controlled trials (RCTs) and six observational studies were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of UCLA score, SST score, and complications showed that the differences were not statistically significant between the two interventions. The difference of ASES score and satisfaction rate was statistically significant between arthroscopic repair and biceps tenotomy and tenodesis intervention, and arthroscopic biceps tenotomy and tenodesis treatment was more effective. Sensitivity analysis proved the stability of the pooled results, and there were too less included articles to verify the publication bias.ConclusionsBoth arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions. Arthroscopic biceps tenotomy and tenodesis treatment provides better clinical outcome in ASES score and satisfaction rate and comparable complications compared with arthroscopic repair treatment. In view of the heterogeneity and confounding factors, whether these conclusions are applicable should be further determined in future studies.

Highlights

The glenoid labrum plays important roles in contributing to stability of the shoulder [1]
Inclusive criteria of published studies Types of studies We considered all published and unpublished studies covering randomized controlled trials (RCTs) and
Summary of main results In this study, we identified two RCTs and six observational studies for investigating the clinical outcomes of arthroscopic repair versus biceps tenotomy and tenodesis intervention

Summary

Introduction

The glenoid labrum plays important roles in contributing to stability of the shoulder [1]. The superior glenoid labrum of the shoulder joint, which is related to the intraarticular insertion of the long head of the biceps tendon, is a common site of injury and degeneration [2–4]. When this biceps-labral complex of the glenoid labrum hurts, it caused severe damage to the stability of the shoulder joint, causing instability and pain of the shoulder [5]. Release of the biceps tendon (tenodesis and tenotomy) is increasingly used as an alternative to SLAP repairs in select patients, but the evidence for it is weak [11] It is still unclear which patients would benefit from either procedure

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