Repair of superior labral tears anterior to posterior (SLAP) lesions has become an increasingly common procedure, despite the low incidence rates reported in the literature. As the incidence of these procedures increases, the surgeons will be increasingly confronted with patients with painful shoulders after SLAP repair. Persistent pain after SLAP repair is multifactorial; careful preoperative workup is necessary to elucidate the cause of pain. Simple failure of the prior SLAP repair will rarely be the cause of persistent pain. Use of tacks is especially worrisome, and suture anchor repair is preferable. Articular cartilage injuries because of either bioabsorbable or metal hardware will often create significant residual disability. Recent literature suggests that older patients may be better served by primary biceps tenodesis rather than SLAP repair.