Objective
When surgically managing SLAP tears, there is no consensus on whether SLAP repair or biceps tenodesis yields superior long-term outcomes. No previous studies have specifically examined outcomes of these procedures in female patients, despite their vastly different postoperative activity tolerances and evidence of sex-based differences in recovery following orthopedic surgery. The purpose of this study was to retrospectively compare outcomes after SLAP repair vs. biceps tenodesis in females. Our hypothesis was that outcomes between patients who undergo SLAP repair and biceps tenodesis will not significantly differ.
Methods
Female patients who underwent arthroscopic SLAP repair or biceps tenodesis for treatment of SLAP lesions between 1/1/2014 and 9/1/2019 at a single institution were retrospectively reviewed. Exclusion-criteria included: age less than 18-years-old at the time of surgery, revision surgery, concomitant rotator cuff repair, clavicle excision, non-SLAP labral repair, capsular reconstruction, or if the patient had adhesive capsulitis or significant degenerative joint disease at the time of surgery. Patients were contacted at a minimum of two-years post-surgery to complete the standardized American Shoulder and Elbow Surgeons (ASES), single assessment numerical evaluation (SANE), and visual analog scale (VAS) for pain surveys. Patients were also given custom surveys assessing return to activity and level of activity. Differences in post-operative function were assessed using T-tests or Mann-Whitney U tests for continuous data and Fisher’s Exact testing for categorical-data.
Results
The study included 65 patients, including 38 (58.4%) who underwent arthroscopic SLAP repair and 27 (41.5%) undergoing open- or arthroscopic-biceps tenodesis. Between SLAP repair and biceps tenodesis groups, mean age was 36.7±8.44 years versus 44.4±10.4 years (p=0.003), mean BMI was 27.4 versus 28.9 (p=0.424), and the rates of right shoulder repairs was 57.9% versus 74.1% (p=0.280). Concomitant-pathologies rates were recorded in 28.9% versus 66.7% (p=0.006) and concomitant-procedures rates were 5.26% versus 0.0% (p=0.507).
There was no difference in two-year ASES scores (78.3 in SLAP repair vs 80.0 in biceps tenodesis, p=0.591), SANE scores (77.0 in SLAP repair vs 80.1 in biceps tenodesis, p=0.722) or VAS scores (26.4 in SLAP repair vs 24.4 in biceps tenodesis, p=0.530). Furthermore, rates of participation in sports prior to surgery was similar (58.8% in SLAP repair vs 37.0% in biceps tenodesis, p=0.152); of those who reported prior participation, return to participation rate following surgery was (75.0% in SLAP repair vs 80.0% in biceps tenodesis, p=1.000).
Conclusion
Female patients who underwent surgical treatment of SLAP lesions with SLAP repair or biceps tenodesis show comparable two-year results with respect to level of function, self-reported pain, and ability to return to sports after these procedures. Therefore, neither procedure was found to be superior to the other. The incidence of concomitant-pathologies and concomitant-procedures at the time of SLAP repair and biceps tenodesis differed between cohorts, possibly related to group age-disparity. Further research is necessary to define precise treatment indications for this pathology in this specific patient population.