ARTHROSCOPIC TREATMENT OF TYPE II SLAP LESIONS: BICEPS TENODESIS AS A FUNCTIONAL ALTERNATIVE TO REINSERTION

Abstract

The purpose of this study was to review the results of biceps tenodesis and biceps reinsertion in the treatment of type II SLAP lesions.

We conducted a retrospective cohort study of a continuous series of patients. Only isolated type II SLAP lesions were included: twenty-five cases from January 2000 to April 2004. Exclusion criteria included associated instability, rotator cuff rupture and previous shoulder surgery. Ten patients (ten men) with an average age of thirty-seven years (range, 19–57) had a reinsertion of the long head of the biceps tendon (LHB) to the labrum with two suture anchors. Fifteen patients (nine men and six women) with an average age of fifty-two years (range, 28–64) underwent biceps tenodesis in the bicipital groove. All patients were reviewed by an independent examiner.

In the reattachment group, the average follow-up was thirty-five months (range, 24–69); three patients underwent subsequent biceps tenodesis for persistent pain, three others were disappointed because of an inability to return to their previous level of sport, and the remaining four were very satisfied. The average Constant score improved from sixty-five to eighty-three points. In the tenodesis group, the average follow-up was thirty-four months (range, 24–68). No patient required revision surgery. Subjectively, one patient was disappointed (atypical residual pain), two were satisfied and twelve were very satisfied. All patients returned to their previous level of sports, and the average Constant score improved from fifty-nine to eighty-nine points.

The results of labral reattachment were disappointing in comparison to biceps tenodesis. Thus, arthroscopic biceps tenodesis can be considered as an effective alternative to reattachment in the treatment of isolated type II SLAP lesions. By moving the origin of the biceps to an extra-articular position, we eliminated the traction on the superior labrum and the source of pain; furthermore, range of motion and strength are unaltered allowing for a return to a pre-surgical level of activity.