Subpectoral Biceps Tenodesis for Treatment of Isolated Type II SLAP Lesions in a Young and Active Population

SLAP tears occur at the superior glenoid labrum-biceps anchor complex, and generally are attributed to either acute trauma or chronic overuse. SLAP tears were first described by Andrews and later classified into 4 distinct subtypes by Snyder. Type II SLAP tears involve complete detachment of the biceps anchor from the superior glenoid, with the anterior and posterior labrum remaining intact. Although SLAP lesions are often associated with concomitant shoulder pathology (e.g., Bankart lesions, rotator cuff tears, acromioclavicular joint arthritis, glenohumeral chondral injuries), they can occur as an isolated lesion that can cause pain, mechanical symptoms, instability, and loss of range of motion causing patients to not be able to perform at the preinjury athletic level.

Several factors have been shown to potentially influence the management and outcomes of type II SLAP lesions including patient age, activity level, quality of labral tissue, and concomitant pathology. Initial management consists of activity modification, nonsteroidal anti-inflammatory drugs, physical therapy, or injections. Surgical treatment options involve either primary repair or biceps tenodesis (BT). Despite previous research, patient selection for repair versus BT is yet to be clearly delineated. Primary arthroscopic repair of type II SLAP lesions has traditionally been considered the gold standard in young patients with several studies reporting good to excellent results after repair. Conversely, BT has been favored in older patients because of lower failure rates, reduced pain, and higher rates of satisfaction and return to sport in comparison to repair. Recent work has shown that BT can be a reasonable option in younger patients who failed SLAP repair presenting the question whether younger patients should be managed with BT primarily.

The purpose of this study was to evaluate outcomes following open subpectoral BT for the treatment of isolated type II SLAP lesions in patients 45 years of age or younger and evaluate the rate of return to sport. We hypothesized that open subpectoral BT in the young population would be an effective treatment with a low revision rate and significant improvement in post-operative outcomes scores with a high rate of return to sport near preinjury level.

Full Article: Subpectoral Biceps Tenodesis for Treatment of Isolated Type II SLAP Lesions in a Young and Active Population

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Subpectoral Biceps Tenodesis for Treatment of Isolated Type II SLAP Lesions in a Young and Active Population

About the Author: Peter Millett, MD