Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years (original) (raw)
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The American Journal of Sports Medicine, 2009
Glenoid labral tears involving the long head of the biceps were initially described by Andrews et al 2 in 1985, who noted an association between these lesions and overhead sports activities. In 1990, Snyder et al 33 further classified these labral tears and coined the term "SLAP lesion" for superiorlabrum-anterior-and-posterior (SLAP) lesion. Their prevalence varies depending on the patient population studied but has been reported to be between 1.2% and 23%. However, their cause is often uncertain. Other than a distinct traumatic event, sporting activities are the most common cause of SLAP lesions. Type II SLAP lesions correspond to a detached biceps anchor from the superior glenoid, accounting for the majority of described SLAP lesions (41%) and occur most commonly in overhead athletes. 4,23,32,33 Although such lesions are often associated with other shoulder injuries such as rotator cuff tears, glenohumeral instability, or Background: Overhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair.
The archives of bone and joint surgery, 2020
Background To retrospectively review surgical outcomes of prospectively collected data on a series of patients who underwent revision of a type II SLAP repair to arthroscopic biceps tenodesis due to an unsuccessful outcome. Methods A retrospective review was performed on a cohort of patients who underwent arthroscopic biceps tenodesis for a failed type II SLAP repair from 2010 to 2014. Range of motion (ROM) in four planes was measured pre-and postoperatively. In addition, all patients completed the American Shoulder Elbow Surgeons (ASES) standardized shoulder assessment form, the Visual Analogue Scale (VAS) for pain, and the Short Form-12 (SF-12) scores. Results Overall, 26 patients met inclusion criteria. All 26 patients were available for follow-up at a minimum of two years (100% follow-up). The mean age of the patients was 37(range 26-54), 85% were male, and 58% were overhead laborers. Clinical as well as statistical improvement was noted following tenodesis across all outcome me...
The American journal of sports medicine, 2014
Surgical repair remains the gold standard for most type II and type IV superior labral anterior and posterior (SLAP) lesions that fail nonoperative management. However, most recently, there have been data demonstrating unacceptably high failure rates with primary repair of type II SLAP lesions. Biceps tenodesis may offer an acceptable, if not better, alternative to primary repair of SLAP lesions. Subpectoral biceps tenodesis provides satisfactory, reproducible outcomes for the treatment of type II and type IV SLAP lesions. Case series; Level of evidence, 4. Patients who underwent subpectoral biceps tenodesis and labral debridement for type II and type IV SLAP lesions by a single board-certified shoulder surgeon from 2006 to 2012 were evaluated. Exclusion criteria included those patients who underwent biceps tenodesis with an associated rotator cuff repair, anterior labral repair, or posterior labral repair. Outcome measures included the visual analog scale (VAS) for pain, the Americ...
Orthopaedic Journal of Sports Medicine, 2020
Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis locati...
The American journal of sports medicine, 2014
While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis. To compare the clinical outcomes of open subpectoral biceps tenodesis (OSPBT) and arthroscopic suprapectoral biceps tenodesis (ASPBT). Our null hypothesis was that both methods would yield satisfactory results with regard to shoulder and biceps function, postoperative shoulder scores, pain relief, and complications. Cohort study; Level of evidence, 3. Patients who underwent either ASPBT or OSPBT for isolated superior labrum or long head of the biceps lesions with a minimum follow-up of 2 years were evaluated with several validated clinical outcome measures and physical examinations including range of motion and strength. Between 2007 and 2011, a total of 82 patients met all inclusion and excl...
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014
The purpose of this study was to evaluate the incidence of residual pain, outcomes, and the revision rate of arthroscopic proximal biceps tenodesis high in the groove at the articular margin of the humeral head by interference screw fixation. Seven surgeons pooled data on patients who underwent an arthroscopic biceps tenodesis at the articular margin by interference screw fixation. All patients had a minimum of 50 weeks' follow-up. Preoperative and postoperative patient data including visual analog scale scores (obtained by all surgeons), objective shoulder scores (Simple Shoulder Test and University of California, Los Angeles scores obtained by 2 and 4 surgeons, respectively), and need for revision surgery (obtained by all surgeons) were retrospectively analyzed, the results are reported, and statistical analysis was performed. After the application of our exclusion criteria, 1,083 patients were included in the analysis. The mean follow-up period was 136 weeks. The overall revi...
Journal of Shoulder and Elbow Surgery, 2012
Hypothesis: Biomechanical studies have shown increased glenohumeral translation and loading of the long head biceps (LHB) tendon after superior labrum anterior to posterior (SLAP) tears. This may explain some of the typical clinical findings, including the prevalence of humeral chondral lesions, after SLAP lesions. The first hypothesis was that SLAP repair could restore the original glenohumeral translation and reduce the increased LHB load after SLAP lesions. The second hypothesis was that SLAP repair after LHB tenotomy could significantly reduce the increased glenohumeral translation. Materials and methods: Biomechanical testing was performed on 21 fresh frozen human cadaveric shoulders with an intact shoulder girdle using a sensor-guided industrial robot to apply 20 N of compression in the joint and 50 N translational force at 0 , 30 , and 60 of abduction. LHB loading was measured by a load-cell with 5 N and 25 N preload. Type IIC SLAP lesions were created arthroscopically, and a standardized SLAP repair was done combined with or without LHB tenotomy. Results: No significant difference of glenohumeral translation and increased LHB load in SLAP repair compared with the intact shoulder was observed under 5 N and 25 LHB preload, except for anterior translation under 25 N LHB preload. After LHB tenotomy after SLAP lesions, no significant difference of translation was observed with or without SLAP repair. Conclusions: SLAP repair without associated LHB tenotomy helps normalize glenohumeral translation and LHB loading. The stabilizing effect of the SLAP complex is dependent on the LHB. After biceps tenotomy, SLAP repair does not affect glenohumeral translation. Institutional Review Board approval was not necessary for this laboratory study.
Role of the superior labrum after biceps tenodesis in glenohumeral stability
Journal of Shoulder and Elbow Surgery, 2014
Background: Little is known about the role that a torn superior labrum (SLAP) plays in glenohumeral stability after biceps tenodesis. This biomechanical study evaluated the contribution of a type II SLAP lesion to glenohumeral translation in the presence of biceps tenodesis. The authors hypothesize that subsequent to biceps tenodesis, a torn superior labrum does not affect glenohumeral stability and therefore does not require anatomic repair in an overhead throwing athlete. Methods: Baseline anterior, posterior, and abduction and maximal external rotation glenohumeral translation data were collected from 20 cadaveric shoulders. Translation testing was repeated after the creation of anterior (n ¼ 10) and posterior (n ¼ 10) type II SLAP lesions. Translation re-evaluation after biceps tenodesis was performed for each specimen. Finally, anatomic SLAP lesion repair and testing were performed. Results: Anterior and posterior SLAP lesions led to significant increases in glenohumeral translation in all directions (P < .0125). Biceps tenodesis showed no significance in stability compared with SLAP alone (P > .0125). Arthroscopic repair of anterior SLAP lesions did not restore anterior translation compared with the baseline state (P ¼ .0011) but did restore posterior (P ¼ .823) and abduction and maximal external rotation (P ¼ .806) translations. Repair of posterior SLAP lesions demonstrated no statistical difference compared with the baseline state (P > .0125). Conclusions: With no detrimental effect on glenohumeral stability in the presence of a SLAP lesion, biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears. However, biceps tenodesis should be considered with caution as the primary treatment of SLAP lesions in overhead throwing athletes secondary to its inability to completely restore translational stability.