A Treatment-Based Algorithm for the Management of Type-II SLAP Tears

Treatment of type II SLAP tears, Incorporating Discussion of Relevant RCTs and Meta-analyses


Superior labral anterior-posterior (SLAP) tears are injuries to the labrum and biceps anchor. Type II lesions where the biceps anchor detaches are most common. Optimal surgical management remains debated.


A literature review was performed to develop an evidence-based treatment algorithm for type II SLAP tears based on patient factors.

Surgical Options

Options include debridement, SLAP repair, biceps tenotomy, and biceps tenodesis. SLAP repair aims to restore anatomy but has risks of failure and stiffness. Tenotomy and tenodesis decompress the biceps.

Treatment Algorithm

Nonoperative treatment is first-line. If it fails, treatment is guided by age and activity level.

For patients <40 years, especially overhead athletes, isolated SLAP repair is recommended. RCTs suggest tenodesis may have higher failure rates in young athletes.

For patients ≥40 years or with biceps tendinopathy, tenodesis is preferred over repair, which has shown good outcomes. Meta-analysis by Hurley et al. found tenodesis had higher satisfaction versus repair.

In low-demand elderly patients, tenotomy is an option, but may risk cramping or Popeye deformity.

Postoperative Rehab

For SLAP repairs, early motion, especially external rotation, is critical to prevent stiffness. Strengthening begins at 12 weeks.

After tenodesis/tenotomy, immediate motion is allowed. Elbow flexion against resistance is restricted for 4 weeks.


Outcomes are optimized when surgery is tailored to patient factors. Further studies are needed to clarify optimal management.


Nonoperative treatment should be exhausted before surgery for type II SLAP tears. When indicated, SLAP repair, biceps tenodesis or tenotomy can provide good outcomes if careful patient selection and personalized rehabilitation protocols are followed.

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© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow