REVIEW ARTICLE


A Treatment-Based Algorithm for the Management of Type-II SLAP Tears



Adam M. Johannsen, John G. Costouros*
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA


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Creative Commons License
© 2018 Johannsen and Costouros.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC:6342, Redwood City, CA 94063 USA; Tel: 650-721-7122; Fax: 650-721-3470; E-mail: jgcost@stanford.edu


Abstract

Background:

The management of Type-II superior labral tears (SLAP) of the shoulder remains a controversial topic. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. An optimal treatment algorithm has yet to reach universal acceptance.

Objective:

The goal of this paper was to provide a treatment algorithm for the management of Type-II SLAP tears based on current literature and expert opinion.

Method:

Current literature was reviewed and expert opinion was reported to develop a comprehensive treatment protocol for patients based on age, activity level, and pathology.

Results:

Operative management of type-II SLAP tears yields good to excellent outcomes when proper indications are followed. Biceps tenodesis may produce more reliable pain relief and functional improvement when compared to primary SLAP repair in patients over the age of 40.

Conclusion:

When non-operative management of Type-II SLAP tears fails, operative management yields good to excellent outcomes in most patients. Primary SLAP repair should be performed in patients under the age of 40 with no evidence of proximal biceps pathology, while biceps tenodesis can provide consistent pain relief and return to activity in patients over the age of 40 or with significant proximal biceps pathology. Tenotomy should be reserved for elderly or low demand individuals.

Keywords: Biceps, Labrum, Shoulder, Tenodesis, Tenotomy, SLAP tear.