This study adds to the evolving literature supporting biceps tenodesis as a viable treatment for type II and IV SLAP lesions. Patient age had no effect on the outcomes. Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears.

Objectives:The long head of the biceps tendon is a frequent pain generator within the shoulder. It is subjected to trauma and wear within the glenohumeral joint and within the intertubercular groove. Tenodesis of this tendon is a common treatment option for patients experiencing biceps tendon related pain. There are several different techniques to perform this procedure. Proximal intra-articular tenodesis can be performed but leaves the tendon within the intertubercular groove. Alternatively, suprapectoral tenodesis can be performed removing the tendon from the bicipital groove and sheath while avoiding conversion to an open procedure. Further, suprapectoral tenodesis limits complications associated with an open distally based incision. Several studies have compared these techniques to tenotomy or open-subpectoral tenodesis. This is the first study to directly compare patient outcomes between intra-articular and suprapectoral bicep tenodeses.Methods:Retrospective review of patients undergoing intra-articular or suprapectoral arthroscopic biceps tenodesis from 2010 - 2015. Clinical outcomes were measured at set intervals post-operatively (3 months, 6 months, and 12 months) and compared to pre-operative scores. Outcome measures included short form-12, both physical (PSF) and mental (MSF) component scores, and the American Shoulder and Elbow Surgeons score (ASES).Results:A total of 96 patients were available for this study, 43 had intra-articular tenodesis and 56 had suprapectoral tenodesis. There was no difference in functional outcomes between intra and extra articular biceps tenodesis at 1-year post-operative. The intra-articular group had a quicker improvement in scores with the greatest increase at 3 months post-operatively, specifically in PSF group (p=0.016): however, this difference leveled off at 1-year follow up (p=0.238). The intra-articular group had greater absolute scores at all measured time points, but not significantly. Both groups showed improvement in all outcome measures and there was found to be no difference in changes for ASES, PSF, or MSF (p=0.262, p=0.489, and p=0.907 respectively).Conclusion:This study demonstrates that both intra-articular and surpapectoral techniques are acceptable options for biceps tenodesis. Despite leaving the biceps tendon within the glenohumeral joint and intertubercular groove, the intra-articular technique offers similar improvement in outcome measures to the suprapectoral technique.

Objectives:Despite unsatisfactory outcomes in middle aged patients with SLAP lesions, surgical repair remains the gold standard for most Type II and Type IV SLAP lesions. Given recent data demonstrating higher SLAP repair failure rates in this subset of patients, biceps tenodesis may offer an excellent alternative. To our knowledge, only one study has investigated biceps tenodesis as an alternative to SLAP repair. This study investigates that subpectoral biceps tenodesis provides satisfactory outcomes for the treatment of Type II and Type IV SLAP lesions in middle aged patients.Methods:Patients who were older than 18 years old and underwent subpectoral biceps tenodesis for isolated Type II or Type IV SLAP lesions by a single board certified shoulder surgeon from 2006-2012 were included. Exclusion criteria included those patients with Type II or Type IV SLAP lesions who underwent biceps tenodesis with rotator cuff repair, Bankart repair, or labral repair. Outcome measures included Visual Analog Pain Scale (VAS), American Shoulder and Elbow Surgeons Scores (ASES), and demographic data.Results:Between 2006-2012, 33 patients underwent 36 subpectoral biceps tenodesis for isolated Type II or Type IV SLAP lesions by a single board certified shoulder surgeon. 26 patients with 29 shoulder surgeries consented to participate in the study. Average age was 46.7 years with 16 males and 10 females participating in the study. Average follow up was 29.3 months. A statistically significant improvement in ASES and VAS scores were found with an average of 48.1 and 6.4 preoperatively and an average of 87.5 and 1.5 post-operatively (p < .001). There was no statistically significant difference noted based on SLAP lesion type, age, activity level, or gender. 26 of 29 shoulders (89.65%) were able to return to their previous activity.Conclusion:Our study is able to confirm that biceps tenodesis results in statistically significant improvement in pain and functional outcomes for Type II and IV SLAP lesions. The results of biceps tenodesis for Type II and IV SLAP lesions is comparable to historical data. Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to SLAP repair in middle aged patients.

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