Arthroscopic Treatment of Type II Superior Labral Anterior to Posterior (SLAP) Lesions in a Younger Population: Traditional Repair versus Biceps Tenodesis with Accelerated Rehabilitation

OBJECTIVES: Biceps tenodesis is a viable surgical alternative to repair for type II SLAP lesions in an older population; however, its efficacy in a younger population is not well studied. The objective of this study was to compare clinical outcomes between arthroscopic biceps tenodesis and labral repair for type II SLAP lesions in a young active population. METHODS: Patients aged 15 to 40 who underwent primary arthroscopic shoulder surgery for type II SLAP tear between 2009 and 2015 with either a suprapectoral biceps tenodesis or labral repair were included in the study. Shoulders with intraarticular chondral damage, full thickness rotator cuff tear or rotator cuff repair, labral repair outside of the superior labrum, bony subacromial decompression, and acromioclavicular joint resection were excluded. Patient-reported outcomes (PRO) pre-operatively and at a minimum of one year after surgery were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand Sports/Performing Arts Module (DASH-sport), visual analog scale (VAS) for pain, and patient satisfaction. Complications and reoperation rates were also recorded. Statistical comparisons between the two groups were performed using the student t-test and chi-squared test with an alpha level of 0.05 indicating statistical significance. RESULTS: Fifty-three patients were available for follow-up at an average of 3.2 years (range: 1.0-6.5 years). Twenty underwent biceps tenodesis and 33 underwent repair. Pre-operatively, there were no significant differences in mean ASES, DASH-sport, and VAS between biceps tenodesis and repair groups. Both groups had significant postoperative improvement in all PROs, and the average amount of change from preoperative to postoperative scores between the two groups was not significantly different for any of the PRO scores. Post-operatively, there were no significant differences in mean ASES, DASH-sport, VAS, and satisfaction between biceps tenodesis and repair groups (ASES: biceps tenodesis 87.1 vs. repair 86.9, P=0.97; DASH-sport: 17.0 vs. 19.5, P=0.75; VAS: 1.8 vs. 1.6, P=0.73; Satisfaction: 8.6 vs. 8.2, P=0.45). Rate of return to pre-injury level of play in sport/physical activity was also similar between groups (biceps tenodesis 55% vs. repair 50%, P=0.73). In the repair group, there was one minor complication involving a superficial paresthesia, and one other patient required reoperation (capsular release) after two years for persistent difficulty throwing in softball. There were no complications or reoperations in the biceps tenodesis group. CONCLUSION: In a young active population, biceps tenodesis may be a viable surgical alternative for type II SLAP lesions and may facilitate earlier return to activity compared to repair. Further research, particularly prospective randomized studies with longer time to follow-up, is warranted given the limitations of this preliminary study.