Subpectoral biceps tenodesis for failed type II SLAP repair

Abstract

Objectives: Superior Labrum Anterior-Posterior (SLAP) lesions are a common cause of shoulder pain, however, their diagnosis, classification, and treatment remains controversial. The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis as a salvage intervention for failed type II SLAP repair. We hypothesized that patients undergoing subpectoral biceps tenodesis for failed type II SLAP tears will demonstrate improved subjective and objective outcomes at a mean two-year follow-up. Methods: A retrospective review of prospectively collected data was performed on patients who underwent subpectoral biceps tenodesis for failed type II SLAP repair by a single surgeon between 2008 and 2010. Primary outcome measures included Visual Analog Scale (VAS), American Shoulder and Elbow Score (ASES), and Short Form-12 (SF-12) score. Secondary outcome variables included Simple Shoulder Test (SST) and Single Assessment Numeric Evaluation (SANE) Score. Demographic and intraoperative information was recorded for each patient (Table 1). A paired t-test was performed, with a P-value less than 0.05 considered statistically significant. Results: Eleven patients met the study criteria (mean age 40.2, range 22-54). Of these patients, nine completed post-operative surveys (82%) at a mean 26 month follow-up (range 15 to 49 months). Mean VAS scores improved from 4.1 to 2.5 (p=0.03), SST from 5.4 to 9.3 (p=0.005), ASES from 54.5 to 78.0 (p=0.002), and SANE score from 42.5 to 70.4 (p=0.001). SF-12 total improved from 30.5 to 36.1(p=0.06). Furthemore, the improvement in the VAS pain, ASES, and SST scores exceeded the reported minimally clinical important differences (MCID), suggesting that this intervention provided meaningful improvement for the patients (Table 2). There were no failures, perioperative, or postoperative complications, and no patients required additional surgery. Conclusion: The findings suggest that patients who undergo subpectoral biceps tenodesis as a salvage procedure for failed type II SLAP repair demonstrate improved results. To our knowledge, the results for this procedure utilized for this indication have not been reported in the literature. Larger scale comparative studies are required to further justify this technique.