Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions

Am J Sports Med. 2014 Sep;42(9):2128-35. doi: 10.1177/0363546514540273. Epub 2014 Jul 22.


Background: 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.

Hypothesis: Subpectoral biceps tenodesis provides satisfactory, reproducible outcomes for the treatment of type II and type IV SLAP lesions.

Study design: Case series; Level of evidence, 4.

Methods: 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 American Shoulder and Elbow Surgeons (ASES) score, and demographic data.

Results: Between 2006 and 2012, a total of 36 subpectoral biceps tenodesis procedures were performed in 33 patients for type II or IV SLAP lesions. Twenty-six patients with 29 shoulder surgeries were available for follow-up. The average age was 46.7 years, with 16 male and 10 female patients participating in the study. The average follow-up was 40.17 months. There was a significant improvement in ASES and VAS scores: 48.1 and 6.4 preoperatively compared with 87.5 and 1.5 postoperatively, respectively (P < .001). There was no significant difference based on SLAP lesion type, patient age, or patient sex. Of 29 shoulders, 26 (89.66%) were able to return to the previous level of activity.

Conclusion: This study adds to the evolving literature supporting biceps tenodesis as a viable treatment for type II and IV SLAP lesions. Patient age had no effect on the outcomes. Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears.

Keywords: SLAP tear; arthroscopic surgery; biceps tenodesis; outcomes.

MeSH terms

  • Adult
  • Aged
  • Arthroscopy / methods
  • Bursitis / surgery
  • Debridement
  • Device Removal
  • Elbow Joint / injuries*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / injuries
  • Muscle, Skeletal / surgery*
  • Pain Measurement
  • Prospective Studies
  • Range of Motion, Articular
  • Reoperation
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries
  • Rupture / surgery
  • Shoulder Injuries*
  • Tendon Injuries / surgery*
  • Tenodesis / methods*
  • Treatment Outcome