Repair versus biceps tenodesis for SLAP tears, incorporating discussion of relevant RCTs and meta-analyses
Superior labral anterior-posterior (SLAP) tears are common injuries, especially in overhead athletes. Optimal treatment remains debated between arthroscopic labral repair and biceps tenodesis.
This systematic review aimed to compare outcomes of SLAP repair versus biceps tenodesis, including patient satisfaction, functional scores, return to sport, complications, and reoperation rates.
A comprehensive literature search was conducted using PRISMA guidelines. Six studies (1 RCT, 5 retrospective cohort studies) with minimum 1 year follow-up were included, evaluating 287 patients (160 SLAP repairs, 127 biceps tenodeses).
Patient satisfaction was higher with tenodesis in most studies, though not statistically significant. Various functional scores showed no significant differences between techniques.
Return to preinjury sport level was higher with tenodesis in 5/6 studies. Meta-analysis by Frantz et al found 70% RTP rate for tenodesis versus 63% for repair in overhead athletes.
Reoperation rate was lower for tenodesis (6% vs 12% for repair). RCT by Schroder et al found no difference in outcomes between SLAP repair, biceps tenodesis, and even sham surgery.
Results suggest biceps tenodesis may allow higher rates of return to sport and greater patient satisfaction compared to labral repair, with similar functional outcomes.
However, level I evidence remains limited. Chalmers et al’s RCT found no differences in overall RTP between tenodesis and repair groups. Outcomes are likely influenced by factors like age, activity level, and sport-specific demands.
Future large prospective RCTs controlling for these variables are warranted to better guide treatment algorithms for management of SLAP tears, especially in overhead throwing athletes.
Current evidence shows biceps tenodesis may have some advantages over labral repair for treatment of SLAP tears, but high-quality RCTs are still needed to clarify optimal management. Treatment decisions should be individualized based on patient characteristics.