SLAP Tears in the Throwing Shoulder: A Review of the Current Concepts in Management and Outcomes

Abstract

A symptomatic tear involving the superior labrum (SLAP) has long been considered one of the most devastating injuries to the career of an overhead throwing athlete. Historically, return to play and previous level of performance outcomes have been unsatisfactory in this challenging population. As a result, there is a significant interest in studying this topic in terms of management and associated outcomes. This review aims to critically evaluate the existing literature and give an overview of the current concepts. The authors found that despite significant advancements in treatment, outcomes after sustaining a SLAP Tear in overhead throwers remain poor. The overall return to play (RTP) rate for baseball players is greater than 60% with the subset of throwers managed surgically experiencing a 50%-60% RTP rate. Arthroscopic repair with suture anchors is the gold standard for operative repair but recently, biceps tenodesis has emerged as an excellent option for surgical management in active patients and athletes. However, the results remain inadequate in baseball pitchers. The current recommendations for managing SLAP tears suggest that arthroscopic repair should be the primary operative management following failure of conservative treatment. Biceps tenodesis is an excellent primary surgical option in older patients and athletes with biceps tendon pathology, but should be reserved for revision procedures in overhead throwers.