Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Sandler, Alexis B.; Baird, M.; Dunn, John C.; Parnes, Nata

doi:10.1016/j.asmr.2022.07.004

Cited by 5 publications

(9 citation statements)

References 39 publications

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“…Table 1 shows the probability of transition states based on a meta-analysis of 274 patients (169 after SLAP repair and 105 after biceps tenodesis) younger than 40 years with 1 year of follow-up. 25 In this patient population, 72.6% (45/62) of patients returned to sports after biceps tenodesis compared to 59.2% (71/120) after SLAP repair, with a marginal statistical significance (odds ratio [OR], 0.54 [95% CI, 0.26-1.09]; P = .09). Surgical complications were reported in 1.4% (3/208) of patients, with no significant difference between SLAP repair and biceps tenodesis (OR, 1.17 [95% CI, 0.14-9.90]; P = .88).…”

Section: Resultsmentioning

confidence: 85%

“…Limitations of our index systematic review that was used to calculate Markov data include limited data availability, lack of standardization among age categories, variable follow-up times, inclusion of a small number of type III and IV SLAP lesions, and incomplete qualitative descriptions of return to sports. 25 The greatest limitation of Markov analysis lies in its nonspecific assessment of postoperative pathways and the consequent gross estimation of recovery benchmarks. The value assessment is further limited by incomplete data with a lack of concrete values for indirect costs, coupled with a wide range of cost estimates.…”

Section: Discussionmentioning

confidence: 99%

“…16 Our index systematic review demonstrated a higher rate of return to sport in patients with biceps tenodesis (72.6%) compared to SLAP repair (59.2%), with a marginally significant increase in the likelihood of return to sport after biceps tenodesis (OR, 1.85 [95% CI, 0.91-3.85]; P = .09). 25 Rates of return to play among baseball pitchers are extremely variable and cited to range from 22% to 64% after SLAP repair, with notably detrimental changes in pitching biomechanics and nonpitching performance statistics. 11,15,16 Biceps tenodesis yields similarly disappointing outcomes, with a return to sport rate of 35% in baseball players and 17% in pitchers 4 ; however, an investigation of return to pitching after SLAP repair versus biceps tenodesis demonstrated equivalent pitching kinematics and physiological neuromuscular control with both procedures, with more closely maintained prior pitching kinematics, specifically thoracic rotation, after biceps tenodesis.…”

Section: Discussionmentioning

confidence: 99%

“…Transition state probabilities were obtained through an index systematic review and meta-analysis of studies 9 , 12 , 23 , 30 comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. 25 Health state utility and cost values were calculated based on methods in the existing literature, with direct costs from Centers for Medicare and Medicaid Services physician fee schedules for 2022 6 , 18 and indirect costs from the following previously published formula 22 : Productivity loss = (Missed work days/Expected work days per week) × Weekly median income × (1 – Unemployment). Median income data were obtained from the Bureau of Labor Statistics for 2021 28 and unemployment data from the Federal Reserve Bank.…”

Section: Methodsmentioning

confidence: 99%

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SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Sandler

Childs

Dunn

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. Hypothesis: In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Results: Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. Conclusion: In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.

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Section: Resultsmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Sandler

Childs

Dunn

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…The biceps tendon represents a known pain generator, and many patients with superior labral abnormalities who undergo SLAP repair eventually require revision tenodesis. 10,27,31 These findings suggest that removing pain-generating tissue with simultaneous tenodesis at the time of posterior labral repair may help to alleviate pain and increase function in appropriately selected patients. Furthermore, this finding aligns with existing literature, as combined biceps tenodesis and posterior labral repair has been demonstrated to produce favorable outcomes in patients with type VIII SLAP lesions.…”

Section: Discussionmentioning

confidence: 94%

Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Posterior Labral Repair for Posterior Glenohumeral Instability

Scanaliato,

Green,

Sandler

et al. 2024

Am J Sports Med

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Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder pain and dysfunction among young, active populations. Outcomes after posterior stabilization procedures are commonly assessed using patient-reported outcome measures including the Single Assessment Numeric Evaluation (SANE), the Rowe instability score, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale (VAS) for pain. The clinical significance thresholds for these measures after arthroscopic posterior labral repair (aPLR), however, remain undefined. Purpose: We aimed to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the SANE, Rowe score, and ASES score as well as the VAS pain after aPLR. Additionally, we sought to determine preoperative factors predictive of reaching, as well as failing to reach, clinical significance. Study Design: Case-control study; Level of evidence, 3. Methods: This study was a retrospective analysis of patient-reported outcome scores collected from patients who underwent aPLR between January 2011 and December 2018. To determine the clinically significant threshold that corresponded to achieving a meaningful outcome, the MCID, SCB, and PASS were calculated for the SANE, Rowe score, ASES score, and VAS pain utilizing either an anchor- or distribution-based method. Additionally, univariate and multivariate logistic regression analyses were performed to determine the factors associated with achieving, or not achieving, the MCID, SCB, and PASS. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months were available for final analysis. MCID, SCB, and PASS values for the VAS pain were 1.10, 6, and 3, respectively; for the ASES score were 7.8, 34, and 80, respectively; for the SANE were 10.15, 33, and 85, respectively; and for the Rowe score were 11.3, 60, and 90, respectively. To meet the MCID, male sex (odds ratio [OR], 1.1639; P = .0293) was found to be a positive predictor for the VAS pain, and a lower preoperative SANE score (OR, 0.9939; P = .0003) was found to be a negative predictor for the SANE. Dominant arm involvement was associated with lower odds of achieving the PASS for the ASES score (OR, 0.7834; P = .0259) and VAS pain (OR, 0.7887; P = .0436). Patients who reported a history of shoulder trauma were more likely to reach the PASS for the SANE (OR, 1.3501; P = .0089), Rowe score (OR, 1.3938; P = .0052), and VAS pain (OR, 1.3507; P = .0104) as well as the SCB for the ASES score (OR, 1.2642; P = .0469) and SANE (OR, 1.2554; P = .0444). A higher preoperative VAS pain score was associated with higher odds of achieving the SCB for both the VAS pain (OR, 1.1653; P = .0110) and Rowe score (OR, 1.1282; P = .0175). Lastly, concomitant biceps tenodesis was associated with greater odds of achieving the SCB for the ASES score (OR, 1.3490; P = .0130) and reaching the PASS for the SANE (OR, 1.3825; P = .0038) and Rowe score (OR, 1.4040; P = .0035). Conclusion: To our knowledge, this study is the first to define the MCID, SCB, and PASS for the ASES score, Rowe score, SANE, and VAS pain in patients undergoing aPLR. Furthermore, we found that patients who reported a history of shoulder trauma and those who underwent concomitant biceps tenodesis demonstrated a greater likelihood of achieving clinical significance. Dominant arm involvement was associated with lower odds of achieving clinical significance.

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Poor Psychological Readiness Inhibits Return to Play Following Operative Management of Superior-Labrum Anterior-Posterior Tears

Colasanti¹,

Akpinar²,

Rynecki³

et al. 2023

Arthroscopy, Sports Medicine, and Rehabilitation

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Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Cited by 5 publications

References 39 publications

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Posterior Labral Repair for Posterior Glenohumeral Instability

Poor Psychological Readiness Inhibits Return to Play Following Operative Management of Superior-Labrum Anterior-Posterior Tears

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