Treatment of Type Two Slap Lesion With Anatomic Suture Anchor Repair Without Biceps Tenotomy Or Tenodesis.

Chadwick C Prodromos,Ji Young Baik,Alexander Dawes,Susan Finkle

doi:10.2174/1874325001812010324

Abstract

Background:Poor results after repair of type 2 SLAP tears are relatively common and some have reported better results after biceps tenodesis or tenotomy than repair. In addition, some believe that the long head of the biceps is expendable. Therefore, many now favor biceps tenotomy or tenodesis over biceps anchor repair either in all patients or in older patients, reserving SLAP lesion repair only for young athletes.Hypothesis:We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out.Methods:All patients with type 2 SLAP lesion repair by the senior author since he began repairing them with suture anchors were prospectively evaluated. Patients with more than one other concomitant procedure, simultaneous rotator cuff repair or worker’s compensation status were excluded.Results:77% of patients were available for minimum two year followup. No patient had subsequent surgery or manipulation under anesthesis as a result of their SLAP repair. Standardized shoulder test score increased by 4 points. Mean SANE score decreased from 53 pre-op to 14 post-op. Results were the same in those over versus under 40 years of age.Conclusion:Anatomic repair of Type 2 SLAP lesions at the biceps anchor without biceps tenodesis or tenotomy can produce good results in patients of all ages.

Highlights

The glenoid labrum was originally thought to be composed of fibrous tissue until it was shown to be fibrocartilaginous by Prodromos et al [1] indicating that it is at least partially loaded in compression as well as tension
Hypothesis: We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out
Because reported unsatisfactory results after surgical treatment are relatively common [3 - 5], it has become customary for surgeons to perform biceps tenodesis or tenotomy instead of labral repair, in patients

Summary

Introduction

The glenoid labrum was originally thought to be composed of fibrous tissue until it was shown to be fibrocartilaginous by Prodromos et al [1] indicating that it is at least partially loaded in compression as well as tension. The treatment of type 2 labral tears with detachment of the biceps anchor (SLAP lesions), as defined by Stephen Snyder [2] is controversial. Because reported unsatisfactory results after surgical treatment are relatively common [3 - 5], it has become customary for surgeons to perform biceps tenodesis or tenotomy instead of labral repair, in patients. While some studies have seemed to indicate that the long head of the biceps is “expendable” [10], we are not convinced. Poor results after repair of type 2 SLAP tears are relatively common and some have reported better results after biceps tenodesis or tenotomy than repair. Many favor biceps tenotomy or tenodesis over biceps anchor repair either in all patients or in older patients, reserving SLAP lesion repair only for young athletes. Hypothesis: We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out

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Methods

Results

Discussion

Conclusion