Failure Rates of SLAP Repair Compared With Subpectoral Biceps Tenodesis for Young Military Patients With Type 2 SLAP at 10-Year Follow-up

Abstract

Background:

Recent evidence has demonstrated short-term superiority of biceps tenodesis compared to superior labrum anterior-posterior (SLAP) repair for the management of symptomatic type 2 SLAP tears. Long-term comparative patient-reported outcomes and revision rates remain poorly described.

Purpose:

To compare minimum 10-year outcomes of arthroscopic SLAP repair with those of mini-open subpectoral biceps tenodesis for type 2 SLAP tears in active-duty military patients younger than 35 years of age.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Consecutive active-duty military servicemembers younger than 35 years of age at the time of surgery who underwent arthroscopic SLAP repair or mini-open subpectoral biceps tenodesis for type 2 SLAP tears between January 2010 and December 2015 with at least 10 years of follow-up were included. SLAP repair was performed if preoperative biceps testing did not elicit pain and, intraoperatively, the tendon appeared clinically normal. All other patients underwent biceps tenodesis. Patient characteristics, patient-reported outcome measures, range of motion, complications, and return to military duty were assessed.

Results:

In total, 25 patients who underwent arthroscopic SLAP repair and 23 who underwent biceps tenodesis were included (mean follow-up, 146.5 ± 18.7 months). Ten patients (40%) for whom SLAP repair failed were analyzed separately from those who did not experience failure. Pain visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons scores improved significantly in the successful SLAP repair, failed SLAP repair, and tenodesis subgroups (P < .0188), with greater improvements in the successful SLAP repair and tenodesis groups. When compared to successful SLAP repair, patients undergoing tenodesis were significantly more likely to achieve substantial clinical benefit (SCB) for VAS scores (100.0% vs 33.3%; P < .0001) and Patient Acceptable Symptom State (PASS) and SCB for SANE scores (95.7% vs 53.3% [P = .0032] and 100.0% vs 13.3% [P < .0001], respectively). All patients for whom SLAP repair failed were revised to tenodesis at a mean of 68.7 ± 48.9 months, while none of the patients initially treated with tenodesis required revision (P = .0007).

Conclusion:

At the minimum 10-year follow-up, 40% of the military cohort younger than 35 years of age treated with SLAP repair experienced treatment failure and underwent subsequent revision to biceps tenodesis, compared with no revisions in patients who underwent biceps tenodesis as the index procedure. Furthermore, even with successful SLAP repair, patient-reported outcomes were inferior to those after biceps tenodesis. Overall, this study suggests that biceps tenodesis is superior to SLAP repair for the treatment of type 2 SLAP tears in active-duty military patients younger than 35 years of age.