Combined SLAP repair and biceps tenodesis for superior labral anterior-posterior tears.

PURPOSE: Long-head biceps tenodesis has been suggested as an alternative to superior labral anterior-posterior (SLAP) repair. However, an unrepaired superior labral tear may increase glenohumeral translation, and thus, labral repair may be considered in the setting of biceps tenodesis. METHODS: Patients who underwent tenodesis, SLAP repair, or combined tenodesis and labral repair for SLAP tears were included. The indication for combined tenodesis and labral repair was biceps tendonitis in the setting of a SLAP lesion with labral instability. Demographics, range of motion, return to work, return to sport, American Shoulder and Elbow Surgeons (ASES) scores, and visual analogue pain scale (VAS) scores were recorded. RESULTS: Eighty-six patients were included: 18 underwent combined tenodesis and labral repair, 45 underwent SLAP repair alone, and 23 underwent tenodesis alone. There were no significant differences in rates of return to pre-operative level of play (n.s.) or return to full duties at work (n.s.). These groups differed significantly in ASES scores (p = 0.015) and VAS scores (p = 0.019) with combined tenodesis and labral repair patients having lower scores than patients undergoing either tenodesis or SLAP repair alone. A subgroup analysis of patients who did not have Worker's Compensation claims demonstrated similar results with significant differences in ASES scores, which were lowest among the combined tenodesis and labral repair cohort (p = 0.045). CONCLUSIONS: High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and SLAP repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis. LEVEL OF EVIDENCE: Treatment, Level III.

Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears.

BACKGROUND: Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhand throwers. Treatment outcomes remain unpredictable, with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis. HYPOTHESIS: Labral repair more closely restores neuromuscular control and motion during the overhand pitch than tenodesis of the long head of the biceps. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen pitchers, including 7 uninjured controls, 6 players pitching after SLAP repair, and 5 players pitching after subpectoral biceps tenodesis (BT), underwent simultaneous surface electromyographic measurement at 1500 Hz and motion analysis at 120 Hz with a 14-camera markerless motion analysis system and high-speed video (120 Hz) to confirm accurate motion tracking. Patients had undergone surgery at least 1 year previously and had returned to pitching with a painless shoulder. RESULTS: No significant differences were observed in the long head of the biceps muscle, short head of the biceps muscle, deltoid, infraspinatus, or latissimus activity between controls, patients after SLAP repair, and patients after BT. The variability from pitch to pitch for each study participant was similar between groups. Based on visual inspection of the activity time plots, BT appeared to more closely restore the normal pattern of muscular activation within the long head of the biceps muscle than did SLAP repair. There were no significant differences between controls and postoperative patients in the majority of pitching kinematics; however, pitchers after SLAP repair showed significantly altered patterns of thoracic rotation (P = .034) compared with controls and were significantly less likely to fall into previously published normal values for lead knee flexion at front foot contact (P = .019). CONCLUSION: While both BT and SLAP repair can restore physiologic neuromuscular control, pitchers who undergo SLAP repair may exhibit altered patterns of thoracic rotation when compared with controls and pitchers who undergo BT. CLINICAL RELEVANCE: While both tenodesis and SLAP repair can restore physiologic neuromuscular control, SLAP repair may alter pitching biomechanics.