Role of the superior labrum after biceps tenodesis in glenohumeral stability
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SLAP (superior labrum anterior-posterior) tears are associated with pain, shoulder instability, and significant glenohumeral dysfunction, especially in a throwing athlete. First described by Andrews et al1 and later classified by Snyder SLAP tears have been noted to result from trauma or overuse. Whereas SLAP lesions commonly occur in association with injuries to the rotator cuff, internal impingement, and glenohumeral instability, they may occur in isolation, acting as a primary source of shoulder pain and disability for the overhead athlete.
At present, arthroscopic repair of unstable superior labral tears involving the long head of the biceps (LHB) anchor (type II SLAP lesions) has become the standard of operative care, resulting in good to excellent outcomes in the majority of published reports. However, results of arthroscopic fixation in overhead throwing athletes have been less consistent, with clinical studies demonstrating a return to preinjury level of sports participation ranging from 22% to 84%. Of 19 baseball players treated with arthroscopic suture anchor fixation of type II SLAP tears, Ide reported that only 12 players (63%) had a complete return to play without pain or functional limitation at a mean follow-up of 3.5 years. It is believed that persistent pain after SLAP repair results in a loss of motion from rigidity and is the reason behind these low rates of return to overhead athletics. A potential hypothesis for the high incidence of post-slap repair shoulder pain accounts for the rigidity of the suture anchor fixation with a consequent loss of physiologic motion at the labral-LHB anchor junction. Others theorize that the highly innervated proximal LHB tendon acts as the primary pain generator after injury or surgery. The low rates of return to play and the potential for continued symptoms postoperatively have led surgeons to look for alternative treatment methods for management of type II SLAP lesions.
Currently, little is known about the role that a torn superior labrum plays in glenohumeral stability after biceps tenodesis. The present biomechanical study evaluates the effects of a type II SLAP lesion on glenohumeral translation in the presence of a biceps tenodesis. We hypothesized that subsequent to biceps tenodesis, the presence of a torn superior labrum does not affect glenohumeral stability and therefore does not require anatomic repair in a throwing athlete with a type II SLAP lesion.