An Age and Activity Algorithm for Treatment of Type II SLAP Tears

Abstract

Background: Type II SLAP tears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can also occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral-biceps complex repair, and labral debridement with biceps tenodesis or tenotomy.

Objective: To review the existing literature on the management of Type II SLAP tears and provide clinical recommendations based on patient age and activity level.

Methods: A review of the existing literature through October 2017 investigating the management of Type II SLAP tears was performed. Emphasis was placed on distinguishing the outcomes based on age and activity level to provide an appropriate treatment algorithm.

Results: Patients with Type II SLAP tears should first be trialed with non-operative management and many patients will have a successful result with ability to return to their respective sports or activities. Surgical management should be considered if non-operative management does not provide symptomatic relief. Young, athletic, or high-demand patients should be treated with a SLAP repair while biceps tenodesis should be considered for older or worker's compensation patients. Patients undergoing revision surgery for a failed SLAP repair should be managed with biceps tenodesis.

Conclusion: Type II SLAP tears remain a difficult pathology to manage clinically, but the treatment indications are narrowing. The age and activity algorithm described in this review provides an effective method of managing this complex clinical condition.

Keywords: Biceps tenodesis; Non-operative treatment; Overhead athlete; SLAP repair; Superior labrum-biceps complex; Type II SLAP tear.

Fig. (1)

Algorithm for Management of SLAP Tears. Red represents overarching observed pathology. Green represents treatment options. Blue represents patient factors involved in decision making. Orange represents types of SLAP tears. SLAP tears = superior labrum anterior to posterior tears.

Fig. (2)

Repair of a Type II SLAP Tear. Intraoperative arthroscopic images of a right shoulder depicting A) a Type II SLAP tear with an intact long head of the biceps, B) elevation of the labrum from the superior glenoid using a Bankart elevator, and C) SLAP repair.

Fig. (3)

Open All Suture Subpectoral Biceps Tenodesis for a Type II SLAP Tear. Intraoperative images of a right shoulder depicting A) a Type II SLAP tear extending into the long head of the biceps, B) 3cm incision over the junction of the inferior border of the pectoralis major and anterior deltoid with the extracted long head of the biceps, C) placement of a suture anchor into the anterior humerus, D) placement of Krackow type sutures into the long head of the biceps, E) fixation of the long head of the biceps to the anterior humerus, and F) excision of the excess biceps tendon.