Outcomes of Arthroscopic Biceps Tenodesis for the Treatment of Failed Type II SLAP Repair: A Minimum 2-Year Follow-Up

Document Type : RESEARCH PAPER


1 Rowan University School of Osteopathic Medicine, Stratford, NJ, USA

2 University of Massachusetts Memorial Medical Center, Worcester, MA, USA


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 measurements
(p <0.01). Additionally, ROM improved in all four planes (p <0.01). The rate of return to work was 85% with workers’
compensation status leading to inferior outcomes. Two complications were noted which required an additional surgery.
Conclusion: Arthroscopic biceps tenodesis demonstrates to be an effective treatment for a failed type II SLAP repair
with improved patient satisfaction, pain relief, and range of motion at two-years follow-up with a low complication rate.
Level of evidence: III


Main Subjects

1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid
labrum tears related to the long head of the biceps.
Am J Sports Med. 1985; 13(5):337-41.
2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman
MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;
3. Snyder SJ, Banas MP, Karzel RP. An analysis of 140
injuries to the superior glenoid labrum. J Shoulder
Elbow Surg. 1995; 4(4):243-8.
4. Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien
SJ, Altchek DW, et al. Outcomes of isolated type II
SLAP lesions treated with arthroscopic fixation
using a bioabsorbable tack. Arthroscopy. 2006;
5. Provencher MT, McCormick F, Dewing C, McIntire
S, Solomon D. A prospective analysis of 179 type
2 superior labrum anterior and posterior repairs:
outcomes and factors associated with success and
failure. Am J Sports Med. 2013; 41(4):880-6.
6. Gupta AK, Bruce B, Klosterman EL, McCormick F,
Harris J, Romeo AA. Subpectoral biceps tenodesis
for failed type II SLAP repair. Orthopedics. 2013;
7. Kim SH, Ha KI, Kim SH, Choi HJ. Results of arthroscopic
treatment of superior labral lesions. J Bone Joint Surg
Am. 2002; 84(6):981-5.
8. Stetson WB, Snyder SJ, Karzel RP, Banas MP, Rahhal SE.
Long-term clinical follow-up of isolated SLAP lesions
of the shoulder. Arthroscopy. 1996; 12(3):351-2.
9. Katz LM, Hsu S, Miller SL, Richmond JC, Khetia E,
Kohli N, et al. Poor outcomes after SLAP repair:
descriptive analysis and prognosis. Arthroscopy.
2009; 25(8):849-55.
10. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia
D, Bicknell R. Arthroscopic treatment of isolated type
II SLAP lesions: biceps tenodesis as an alternative to
reinsertion. Am J Sports Med. 2009; 37(5):929-36.
11. Sayde WM, Cohen SB, Ciccotti MG, Dodson CC. Return
to play after type II superior labral anterior-posterior
lesion repairs in athletes: a systematic review. Clin
Orthop Relat Res. 2012; 470(6):1595-600.
12. Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti
MG, Cohen SB. Results of arthroscopic repair of
type II superior labral anterior posterior lesions in
overhead athletes: assessment of return to preinjury
playing level and satisfaction. Am J Sports Med. 2011;
13. Onyekwelu I, Khatib O, Zuckerman JD, Rokito AS, Kwon
YW. The rising incidence of arthroscopic superior
labrum anterior and posterior (SLAP) repairs. J
Shoulder Elbow Surg. 2012; 21(6):728-31.
14. Abbot AE, Li X, Busconi BD. Arthroscopic treatment of
concomitant superior labral anterior posterior (SLAP)
lesions and rotator cuff tears in patients over the age
of 45 years. Am J Sports Med. 2009; 37(7):1358-62.
15. Kim SJ, Lee IS, Kim SH, Woo CM, Chun YM. Arthroscopic
repair of concomitant type II SLAP lesions in large to
massive rotator cuff tears: comparison with biceps 
tenotomy. Am J Sports Med. 2012; 40(12):2786-93.
16. Werner BC, Pehlivan HC, Hart JM, Lyons ML, Gilmore
CJ, Garrett CB, et al. Biceps tenodesis is a viable option
for salvage of failed SLAP repair. J Shoulder Elbow
Surg. 2014; 23(8):e179-84.
17. Byram IR, Dunn WR, Kuhn JE. Humeral head abrasion:
an association with failed superior labrum anterior
posterior repairs. J Shoulder Elbow Surg. 2011;
18. McCormick F, Nwachukwu BU, Solomon D, Dewing
C, Golijanin P, Gross DJ, et al. The efficacy of biceps
tenodesis in the treatment of failed superior labral
anterior posterior repairs. Am J Sports Med. 2014;
19. Park S, Glousman RE. Outcomes of revision
arthroscopic type II superior labral anterior posterior
repairs. Am J Sports Med. 2011; 39(6):1290-4.
20. Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of
biceps tenotomy for treatment of pathology of the
long head of the biceps Brachii. J Shoulder Elbow
Surg. 2001; 10(3):247-9.
21. Michener LA, McClure PW, Sennett BJ. American
shoulder and elbow surgeons standardized shoulder
assessment form, patient self-report section:
reliability, validity, and responsiveness. J Shoulder
Elbow Surg. 2002; 11(6):587-94.
22. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli
N, Denaro V. No advantages in repairing a type II
superior labrum anterior and posterior (SLAP) lesion
when associated with rotator cuff repair in patients
over age 50: a randomized controlled trial. Am J
Sports Med. 2008; 36(2):247-53.
23. Alpert JM, Wuerz TH, O’Donnell TF, Carroll KM,
Brucker NN, Gill TJ. The effect of age on the outcomes
of arthroscopic repair of type II superior labral
anterior and posterior lesions. Am J Sports Med.
2010; 38(11):2299-303.
24. Friedman JL, FitzPatrick JL, Rylander LS, Bennett
C, Vidal AF, McCarty EC. Biceps tenotomy versus
tenodesis in active patients younger than 55 years: is
there a difference in strength and outcomes? Orthop J
Sports Med. 2015; 3(2):1-6.