Factors influencing operative time in arthroscopic rotator cuff repair: a comparison of knotless single-row vs. transosseous equivalent dual-row techniques.

BACKGROUND: Despite the widespread use of arthroscopic rotator cuff repair (aRCR), there remains considerable debate on the benefits of a dual-row vs. a single-row (SR) repair technique. This study compares operative time of a knotless SR technique with transosseous equivalent (TOE) dual-row technique for aRCR and defines patient-specific factors that affect operative time. METHODS: Data from 118 patients who underwent aRCR with a knotless SR technique was compared with data from 95 patients who underwent aRCR with a TOE technique by a single surgeon between 2014 and 2018. Baseline patient demographic information and operative time were recorded and compared between the 2 groups. Subgroup analysis was performed to determine if demographic information or tear size influenced operative time. RESULTS: The average operative time in the SR group was 75.68 minutes and the average operative time in the TOE group was 89.24 minutes (P < .001). When controlling for all concomitant procedures, the operative time in the TOE group was 8.1 minutes longer than the SR group (P = .029). Average tear size in an anterior-posterior direction was larger in the TOE group vs. the SR group, 26.09 mm vs. 15.18 mm (P < .001). CONCLUSION: When controlling for concomitant procedures, a knotless, TOE dual-row technique for aRCR adds an average of 8 minutes' operative time compared with a knotless SR technique. This was despite a significantly larger tear size in the TOE group.

Two fixation methods for acromioclavicular joint reduction during coracoclavicular ligament reconstruction: a biomechanical analysis.

One specimen from each of six pairs of cadaveric shoulders underwent a semitendinosus coracoclavicular ligament reconstruction with a hook plate used for acromioclavicular joint reduction, while on the other specimen a polydioxanone (PDS) suture braid was utilized. Cyclical loading followed by maximal load-to-failure testing was performed. Displacement during cyclical loading, loads to 50% and 100% displacement, stiffness, and maximal load to failure were determined for all specimens. Results showed that the locking hook plate allowed significantly less displacement of the coracoclavicular interval during cyclical loading (3.41 vs. 9.67 mm, p = .0081) and withstood significantly higher loads before both 50% (225.5 vs. 107.7 N, p = .0197) and 100% displacement (410.6 vs. 240.1 N, p = .0077). The locking hook plate was found to be significantly stiffer than the PDS suture braid (28.2 vs. 18.4 N/mm, p = .0029), but there was no difference in maximal load to failure between the two fixation methods (hook plate, 434.4 N; PDS, 476.7 N; p = .76).

Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years.

Purpose: To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases. Methods: All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR. Results: Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5 years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P = .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P = .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P = .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ2 = 7.9, P = .02.). Conclusions: Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished. Level of Evidence: Level IV, therapeutic case series.

A biomechanical analysis of point of failure during lateral-row tensioning in transosseous-equivalent rotator cuff repair.

PURPOSE: The purpose of this study was to determine the maximum load and point of failure of the construct during tensioning of the lateral row of a transosseous-equivalent (TOE) rotator cuff repair. METHODS: In 6 fresh-frozen human shoulders, a TOE rotator cuff repair was performed, with 1 suture from each medial anchor passed through the tendon and tied in a horizontal mattress pattern. One of 2 limbs from each of 2 medial anchors was pulled laterally over the tendon. After preparation of the lateral bone for anchor placement, the 2 limbs were passed through the polyether ether ketone (PEEK) eyelet of a knotless anchor and tied to a tensiometer. The lateral anchor was placed into the prepared bone tunnel but not fully seated. Tensioning of the lateral-row repair was simulated by pulling the tensiometer to tighten the suture limbs as they passed through the eyelet of the knotless anchor. The mode of failure and maximum tension were recorded. The procedure was then repeated for the second lateral-row anchor. RESULTS: The mean load to failure during lateral-row placement in the TOE model was 80.8 ± 21.0 N (median, 83 N; range, 27.2 to 115.8 N). There was no statistically significant difference between load to failure during lateral-row tensioning for the anterior and posterior anchors (P = .84). Each of the 12 constructs failed at the eyelet of the lateral anchor. Retrieval analysis showed no failure of the medial anchors, no medial suture cutout through the rotator cuff tendon, and no signs of gapping at the repair site. CONCLUSIONS: Our results suggest that the medial-row repair does not appear vulnerable during tensioning of the lateral row of a TOE rotator cuff repair with the implants tested. However, surgeons should exercise caution when tensioning the lateral row, especially when lateral-row anchors with PEEK eyelets are implemented. CLINICAL RELEVANCE: For this repair construct, the findings suggest that although the medial row is not vulnerable during lateral-row tensioning of a TOE rotator cuff repair, lateral-row anchors with PEEK eyelets appear vulnerable to early failure.

Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method.

Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method. Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method. Study Design: Controlled laboratory study. Methods: Sixty-five scapulae underwent computed tomography (CT) scanning with an optimal shoulder CT-positioning protocol. Glenoid version was measured on CT images of the full scapula using the Friedman method. We developed a measurement method (named the Robertson method) based on the glenoid vault version from partial scapula images, with a correction angle subtracted from the articular-surface-glenoid vault measurement. Comparison with the Friedman method defined the accuracy of the Robertson method. Three observers tested inter- and intraobserver reliability of the Robertson method. Accuracy was statistically evaluated with t tests and reliability with the intraclass correlation coefficient (ICC). Results: The statistical distribution of glenoid version was similar to published data,-0.5° ± 3° [mean ± SD]. The initial measurement using the Robertson method resulted in a more retroverted angle compared with the Friedman method, and a correction angle of 7° was then applied. After this adjustment, the difference between the 2 methods was nonsignificant (0.1° ± 4°; P > .65). Reliability of the Robertson method was excellent, as the interrater ICC was 0.77, the standard error of measurement (SEM) was 1.1° with P < .001. The intrarater ICC ranged between 0.84 and 0.92, the SEM ranged between 0.9° and 1.2° with P < .01. Conclusion: A validated glenoid version measurement method is now available for current clinical shoulder CT protocols that reliably create Friedman-equivalent values. Clinical Relevance: Friedman-equivalent values may be made from common clinical CTs of the shoulder and compared with prior and future Friedman measurements of the scapula.

Anterior cruciate ligament femoral tunnel drilling through anteromedial portal: axial plane drill angle affects tunnel length.

PURPOSE: The purpose of this study was to correlate femoral tunnel length with axial drilling angle through the anteromedial portal. METHODS: Ten anatomically correct Sawbones knee models (Pacific Research Laboratories, Vashon, WA) were used for this study. With the knee flexed to 120°, tunnels were drilled through a simulated anterior medial portal with a custom outrigger guide. The guide provided consistently reproducible drilling angles of 20°, 40°, and 60° in the axial plane. Femoral tunnel lengths were recorded for each knee at each drilling angle. A 1-way analysis of variance (α = .05) was conducted to compare tunnel length in the 3 groups. Multiple comparisons were conducted by use of a Tukey post hoc test. RESULTS: The mean femoral tunnel lengths at 20°, 40°, and 60° were 37.0 mm, 36.9 mm, and 32.3 mm, respectively. The tunnels drilled at 20° and 40° were significantly longer than the 60° group (P < .001). CONCLUSIONS: Our findings suggest that drilling femoral tunnels through an anteromedial portal at an axial angle of 20° or 40° produces longer femoral tunnels than with an axial drilling angle of 60°. CLINICAL RELEVANCE: On the basis of this study, we recommend a 40° angle when approaching the lateral wall during femoral tunnel drilling through the anteromedial portal to optimize tunnel length while avoiding the acute angle and oblique entry of a 20° angle.

Transfer of the latissimus dorsi as a salvage procedure for failed debridement and attempted repair of massive rotator cuff tears.

Seven patients who had a previously failed attempt at debridement and repair of a massive rotator cuff tear were managed with latissimus dorsi transfer. Patient age averaged 63 years and average follow-up was 31 months. All patients were evaluated with shoulder radiographs, Constant and Murley Scores, UCLA Shoulder Score, visual analog pain score, range of motion, and the Short Shoulder Form. Modest improvement was noted in forward flexion and abduction. Significant improvement was noted in shoulder function. Transfer of the latissimus dorsi as salvage for a previously failed repair of a massive rotator cuff tear is effective in providing pain relief and improving shoulder function.

Scapular kinematics during supraspinatus rehabilitation exercise: a comparison of full-can versus empty-can techniques.

BACKGROUND: Supraspinatus strengthening is an important component of shoulder rehabilitation. Previous work has determined that the full-can and empty-can exercises elicit the greatest amount of supraspinatus activity. However, scapular kinematics has not been considered when prescribing supraspinatus exercises. HYPOTHESIS: Scapular downward rotation, internal rotation, and anterior tipping during the empty-can exercise are increased when compared with the full-can exercise. STUDY DESIGN: Descriptive laboratory study. METHODS: Twenty participants performed full-can and empty-can exercises while an electromagnetic tracking system was used to collect three-dimensional scapular kinematic data. Scapular angles at 30 degrees, 60 degrees, and 90 degrees of the ascending and descending phases of humeral elevation were compared using 2-way repeated measures analysis of variance. RESULTS: There was more scapular anterior tipping and internal rotation during the empty-can exercise at all sampled humeral elevation angles except at 30 degrees of the descending phase for anterior/posterior tipping (P < .05). CONCLUSION: Scapular anterior tipping and internal rotation are increased during the empty-can exercise, whereas scapular upward rotation was not different between exercises. CLINICAL RELEVANCE: Increased scapular internal rotation and anterior tipping decrease the volume of the supraspinatus outlet during the empty-can exercise. When maintenance of the subacromial space is important, use of the full-can exercise seems most appropriate for selective strengthening of the supraspinatus muscle.

Suture plication, thermal shrinkage, and sclerosing agents: effects on rat patellar tendon length and biomechanical strength.

BACKGROUND: Shortening or tightening of dense, collagenous tissues is often desirable in the treatment of laxity. PURPOSE: To compare the effect of stress-protection suture, radiofrequency thermal shrinkage combined with stress-protection suture, and a 5% sodium morrhuate sclerosing injection on the length and biomechanical strength of the rat patellar tendon. HYPOTHESIS: Sclerosing agents will increase tendon mechanical strength. Thermal shrinkage combined with stress-protection suture and stress-protection suture only will cause a short-term decrease in tendon strength. All 3 methods will produce equivalent shortening of the tendon. STUDY DESIGN: Controlled laboratory study. METHODS: Forty-six female retired breeder rats were split into 4 groups, each receiving 1 of the 3 aforementioned treatments plus a control group that received a saline injection. After 4 weeks' survival, the length and biomechanical properties of the patellar tendons were measured and compared to the contralateral untreated tendon. RESULTS: Rats treated with stress-protection suture had shorter tendons. Radiofrequency thermal shrinkage combined with stress-protection suture yielded tendons that were both shorter and stronger than were the untreated contralateral tendons. The sodium morrhuate-injected tendons were stronger whereas the saline-treated tendons were weaker than were their respective untreated contralateral tendons. CONCLUSION: Surgical stress-protection suture without radiofrequency shrinkage is most effective at shortening the length of the rat patellar tendon, whereas radiofrequency thermal shrinkage combined with stress-protection suture as well as sodium morrhuate are effective at increasing the strength of rat patellar tendons. CLINICAL RELEVANCE: Judicious use of thermal shrinkage in combination with stress protection may improve ligament strength and decrease laxity.

The HAGL lesion: an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments.

Glenoid avulsion of the capsulolabral complex and associated capsular laxity are well-described results of traumatic anterior dislocation. A less common consequence of traumatic anterior instability is the humeral avulsion of the glenohumeral ligaments (HAGL) lesion. An understanding of the arthroscopic pathoanatomy of the HAGL lesion will assist the surgeon in recognizing this uncommon entity. We describe a suture anchor technique for arthroscopic repair of HAGL lesions that anatomically reapproximates the torn edge of the glenohumeral ligament complex to its humeral head insertion. The technique is technically straightforward and does not require special equipment beyond that typical for arthroscopic labral repairs.

Biceps Tenodesis for Type II SLAP Tears.

Tears of the superior glenoid labrum are a common cause of shoulder pain and disability, especially in overhead athletes such as pitchers, swimmers, and volleyball players. Type II SLAP lesions have been the most clinically important superior labral pathology, and the management of this lesion has been a very controversial topic. Currently, there are no high level studies in the literature to guide treatment. While the few level 3 and level 4 evidence studies that are available following arthroscopic repair of type II SLAP lesions all report reasonable overall patient satisfaction, persistent postoperative pain is common and associated with a low return to pre-injury level of sports participation. There has been a recent school of thought that biceps tenodesis, which maintains the length-tension relationship of the long head of biceps, should be the procedure of choice for patients with isolated type II SLAP lesions. The current paper reviews the role biceps tenodesis plays in the management of type II SLAP tears.

Thermal microdebridement does not affect the time zero biomechanical properties of human patellar tendons.

BACKGROUND: Thermal microdebridement for the treatment of chronic tendinopathy has recently been introduced. The effect of thermal microdebridement on the biomechanical properties of human tendons, however, remains unknown. HYPOTHESIS: Thermal microdebridement does not affect the biomechanical properties of human patellar tendons in a cadaveric model at the time of initial treatment. STUDY DESIGN: Controlled laboratory study. METHODS: The central 15 mm of 12 matched, human (mean age, 71 years; 8 male, 4 female), fresh-frozen patellar tendons was divided into 3 equal 5-mm specimens. The treatment group (n = 12) underwent thermal microdebridement with a radiofrequency probe. A sham treatment group (n = 12) underwent insertion of a deactivated probe. The control group (n = 12) underwent no treatment. After treatment, each specimen was tested to failure in a servo-hydraulic materials testing machine at an elongation rate of 3 mm/s. One-way repeated measures analysis of variance was used to determine differences between groups. RESULTS: No significant difference in ultimate stress at failure, elastic modulus, strain energy density, or strain at maximum load was found between the groups. The ultimate stress at failure for the treatment, sham, and control groups was 61.0, 66.7, and 63.0 MPa, respectively (P = .653), and the strain at maximum load was 0.12, 0.11, and 0.09, respectively (P = .279). CONCLUSIONS: Thermal microdebridement does not affect the biomechanical properties of cadaveric human patellar tendons at the time of initial treatment. CLINICAL RELEVANCE: It may be safe to proceed with aggressive rehabilitation after thermal microdebridement of the patellar tendon. However, the results in this cadaveric model should be interpreted with caution. Additional studies using an in vivo model will be required to completely assess the effects of thermal microdebridement on the biomechanical properties of human patellar tendons.

Nandrolone decanoate and load increase remodeling and strength in human supraspinatus bioartificial tendons.

BACKGROUND: To date, no studies document the effect of anabolic steroids on rotator cuff tendons. STUDY DESIGN: Controlled laboratory study. HYPOTHESIS: Anabolic steroids enhance remodeling and improve the biomechanical properties of bioartificially engineered human supraspinatus tendons. METHODS: Bioartificial tendons were treated with either nandrolone decanoate (nonload, steroid, n = 18), loading (load, nonsteroid, n = 18), or both (load, steroid, n = 18). A control group received no treatment (nonload, nonsteroid [NLNS], n = 18). Bioartificial tendons' remodeling was assessed by daily scanning, cytoskeletal organization by staining, matrix metalloproteinase-3 levels by ELISA assay, and biomechanical properties by load-to-failure testing. RESULTS: The load, steroid group showed the greatest remodeling and the best organized actin cytoskeleton. Matrix metallo-proteinase-3 levels in the load, steroid group were greater than those of the nonload, nonsteroid group (P <.05). Ultimate stress and ultimate strain in the load, steroid group were greater than those of the nonload, nonsteroid and nonload, steroid groups (P <.05). The strain energy density in the load, steroid group was greater when compared to other groups (P <.05). CONCLUSIONS: Nandrolone decanoate and load acted synergistically to increase matrix remodeling and biomechanical properties of bioartificial tendons. CLINICAL RELEVANCE: Data suggest anabolic steroids may enhance production of bioartificial tendons and rotator cuff tendon healing in vitro. More research is necessary before such clinical use is recommended.

Relationship of the axillary nerve to the proximal screws of a flexible humeral nail system: an anatomic study.

OBJECTIVE: To investigate the risk of axillary nerve injury during placement of the proximal interlock and tension screws of the Synthes Titanium Flexible Humeral Nail System (Synthes, Paoli, PA). DESIGN: Cadaver study. MAIN OUTCOME MEASURE: Anatomic relationships. METHODS: A titanium flexible humeral nail was inserted in an antegrade manner in 10 fresh-frozen cadaver shoulders. Proximal interlock and tension screws were inserted. The axillary nerve was carefully exposed, and the distance from the center of the nerve to each screw was measured. RESULTS: In 8 of 10 specimens, the nerve traversed the interval between the proximal interlock screw and the tension screw. The average distance from the axillary nerve to the closer of the two proximal screws was 2.6 mm. The proximal interlock screw transected the axillary nerve in one specimen. CONCLUSIONS: There is significant risk to the axillary nerve when inserting the proximal interlock screw and the tension screw of this flexible humeral nail system. We recommend blunt dissection through the deltoid, direct visualization of the lateral humeral cortex, and use of a soft tissue protection sleeve when predrilling and placing these screws.

Arthroscopic rotator interval repair and anterior portal closure: an alternative technique.

The rotator interval capsule has been implicated as an important restraint to shoulder subluxation, and plays an important role in shoulder stability. Anterior portal placement during arthroscopic shoulder instability repair violates the interval capsule and compromises the biomechanical integrity of the rotator interval. The following is a technique for interval capsule repair. Using an 18-gauge needle via the anterior portal, a monofilament suture is passed through the capsule just above the subscapularis. A Penetrator suture retriever (Arthrex, Naples, FL) is passed high into the capsule just anterior to the biceps. The intra-articular end of the suture is then removed from the superior aspect of the interval capsule. The suture limbs are then tied into the portal onto the anterior capsule. The technique is advantageous because it may be repeated as needed until appropriate interval plication has been achieved. Furthermore, it does not require an interval portal through which to pass the suture. It appears to be a safe, effective, and reproducible technique for arthroscopic rotator interval closure.

Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture plication and thermal capsulorrhaphy.

PURPOSE: The purpose of this study was to objectively assess glenohumeral volume changes after arthroscopic suture plication, arthroscopic thermal capsulorrhaphy, and combined suture and thermal treatment. TYPE OF STUDY: Cadaveric study. METHODS: Five matched pairs of cadaver shoulders were treated with either thermal capsulorrhaphy (n = 5) or arthroscopic suture plication (n = 5). The shoulders treated with plication were then treated with thermal capsulorrhaphy to form a combined treatment group (plication and thermal). Preoperative and postoperative glenohumeral volume measurements were obtained, and the techniques were statistically compared with a 1-factor analysis of variance. RESULTS: All 3 procedures produced marked decreases in glenohumeral capsular volume. Suture plication reduced intra-articular volume an average of 19.0%. Thermal capsulorrhaphy resulted in a mean capsular volume reduction of 33.4%. Combined treatment with suture plication and thermal capsulorrhaphy reduced glenohumeral volume an average of 41.0%. Both thermal capsulorrhaphy and the combined treatment produced significantly greater reduction in glenohumeral volume than plication alone (P <.0001). Although combined suture plication and thermal capsulorrhaphy resulted in greater reduction in capsular volume than thermal capsulorrhaphy alone, the differences were not statistically significant. CONCLUSIONS: Our results indicate that arthroscopic suture plication and thermal capsulorrhaphy are both effective in reducing glenohumeral intra-articular volume. Thermal capsulorrhaphy alone or in combination with suture plication led to significantly greater reduction in capsular volume when compared with isolated suture plication.

The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players.

Between 1986 and 1997, 25 active National Football League (NFL) players underwent microfracture to treat full-thickness chondral lesions. Average follow-up was 4.5 years (range: 2-13 years). Preoperative and postoperative data were rated according to symptoms (4 = severe, 1 = none), function (5 = unable to perform, 1 = no limitations), and activity level (10 = full activity, 1 = unable to perform). Nineteen (76%) players returned to football the season following microfracture. Six players retired for various reasons. At follow-up, pain, swelling, running, cutting, and squatting improved. Activities of daily living, strenuous work, and strenuous sport levels also improved. Those who returned to play averaged 4.6 seasons of participation (range: 1-13 seasons) and 56 games (range: 2-183 games) after microfracture. Nine (36%) players continue active participation in the NFL. Results of microfracture to resurface full-thickness chondral lesions in high-demand NFL players are encouraging. Microfracture is safe, effective, and appears to improve symptoms, function, and activity levels in NFL players.

Evaluating and managing muscle contusions and myositis ossificans.

Muscle contusions almost always completely heal, but sometimes they give rise to hematomas or myositis ossificans. Warning signs of severe quadriceps contusion include marked decreased knee range of motion and a sympathetic knee effusion. Management consists of rest, cooling, compression, and elevation. Corticosteroids should be avoided, but nonsteroidal anti-inflammatory drugs may reduce edema and the risk of myositis ossificans. Rehabilitation protocols that include early flexion exercise can hasten recovery and decrease the likelihood of myositis ossificans. Asymptomatic myositis ossificans needs no treatment, but when it is associated with decreased range of motion, muscle atrophy, and continued pain, lesions may be excised after they mature.

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

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.