{"id":1992,"date":"2014-05-05T04:44:13","date_gmt":"2014-05-05T11:44:13","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=1992"},"modified":"2014-05-05T04:44:13","modified_gmt":"2014-05-05T11:44:13","slug":"biceps-tenodesis-effective-treatment-for-failed-slap-repairs","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=1992","title":{"rendered":"Biceps Tenodesis: Effective Treatment for Failed SLAP Repairs"},"content":{"rendered":"

SLAP tears are a common problem for overhead athletes among others today. There is no consensus per se in how to treat them and results following primary repair are mixed. Common complaints following a repair are persistent pain and stiffness. In the past, I have writtne about SLAP tears<\/a> as well as outcomes for elite pitchers<\/a>.<\/p>\n

\"type2slap\"<\/p>\n

In addition, I have discussed outcomes for type 2 SLAP tear revision surgery<\/a> on this blog. \u00a0What always concerns me (and more importantly patients who undergo surgery is how to achieve predictable pain relief and recover shoulder function. \u00a0In the April 2014 edition of the American Journal of Sports Medicine, there is a level 4 prospective study by McCormick et al. looking at the efficacy of subpectoral biceps tenodesis as a viable solution for failed primary SLAP repairs. \u00a0The study took place from 2006-2010 and all procedures were performed by 2 fellowship trained surgeons at a tertiary military facility.<\/p>\n

Subjects<\/span>: Active-duty men and women b\/w 18 and 50 years old who had arthroscopically confirmed type 2 SLAP lesions and who then underwent arthroscopic repair and were subsequently unable to return to duty(follow-up period was 2-6 yeaers with mean follow-up of 3.5 years). \u00a0They also had to consent to a biceps tenodesis to address the failed repair. \u00a0All told, 42 of 46 patients completed the study. \u00a0The mean age was 39.2, while 85% of the subjects were male.<\/p>\n

Criteria to be included in the study<\/span>: inability to return to active duty within a minimum 6 months of surgery, ASES score less than 75 at 1 year follow-up from the primary procedure, or patient electing to undergo revision surgery due to dissatisfaction with the primary results.<\/p>\n

Procedure<\/span>: Biceps tendon was released and the remaining stump was debrided so the superior labrum was confluent with the remaining labral tissue. \u00a0All sutures and loose anchors were removed. \u00a0If the rotator cuff interval was inflamed, debridement with a 4.o mm shaver was used and\/or radiofrequency wand was used. \u00a0Next, a 2 cm incision was made in the axillary skin crease at the inferior border of the pec major. \u00a0The biceps tendon was anchored 1 cm proximal to the musculotendinous junction using a nonabsorbable suture and 8 x 12 interference anchor fixation.<\/p>\n

Rehab protocol<\/span>: Patients were in a sling for 4 weeks with no active biceps use for 6 weeks. \u00a0They all underwent graded supervised physical therapy consisting of an initial 6-week phase of passive ROM exercise in addition to scapular and core strengthening. This was followed by progressive strengthening at 6 weeks and return to-duty-evaluation at 3 months post-op.<\/p>\n

Results<\/span><\/p>\n