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Consider the biceps tenodesis after SLAP repair
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WAILEA, Hawaii – The management of superior labral injuries in the overhead athlete is an emerging area of research, according to a presenter at Orthopedics Today Hawaii 2012 here.
“We have figured out elbow injuries rather well, but we are still struggling with these superior labral injuries. We know from a variety of reports that the expected outcome can be quite variable,” Anthony A. Romeo, MD, said.
Recent studies have reported a return to pre-injury level of athletic participation following SLAP tears ranging from 22% to 84%. Romeo said that when taking care of the overhead athlete, whether it is a baseball athlete or otherwise, surgeons should define the lesion first. He also noted that a slight labral injury does not necessarily require surgical management.
“There is a role for the nonoperative management of individuals who have superior labral injuries, and you have to keep that in mind. If one fails our nonoperative management, then we do a SLAP repair, particularly in a high-level athlete. If they do not do well after the SLAP repair, then we consider biceps tenodesis as a management for this and that actually works well,” Romeo said.
He said studies have shown that biceps tenodesis does not have any significant deleterious effects on glenohumeral stability when there was a SLAP lesion. Repair of anterior-based SLAP lesions are more likely to do well and has the potential use as a revision procedure for patients with persistent pain.
“The hard part is that we are trying to figure out now who in the patient group do we do [a] biceps tenodesis [on] from the beginning,” Romeo said. “That individual would be someone who presents with many of the similar symptoms, mostly all anterior shoulder pain and biceps-related pain, with minimal or no superior labral pathology. Even in a young patient, we would consider biceps tenodesis.”
Romeo said ongoing basic science studies will provide more information within the next 1 year to 2 years.
Reference:
- Romeo AA. SLAP repair and biceps tenodesis: Decision making and technique. Presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
- Disclosure: Romeo receives royalties from and is a consultant for Arthrex, and receives miscellaneous support from Arthrex, DJOrtho, basic science/research support from Arthrex, Smith & Nephew, Ossur, Miomed, DJOrtho, Conmed Linvatech and Athletico.
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