There are no related studies evaluating the rate of return to play into pre-injury levels. Therefore, I want to know the experience by clinicians in sports medicine.
At all times repair (mainly arthroscopic) is the first line but inn case of failure or in active muscular patients (for example body builders) a tenodesis would be the solution.
Routine biceps tenodesis is not a recommended procedure for SLAP tears. It is only advisable to do it after a failed or difficult SLAP repair
Recent studies may suggest otherwise. Provencher et al., Buoleau et al. and my own paper are worth reading (cited both of those papers in mine if you need further reference). Patient age, sport, and type of SLAP should be considered prior to deciding to fix a SLAP tear. Certainly for a failed SLAP tear, Tenodesis is certainly the best option. For primary SLAP tears it is debatable, but more surgeons are not fixing these and going to straight tenodesis. The overhead young athlete remains the most controversial as well as a professional overhead athlete. Hope this helps.
I keep to Dr. Vaishya's protocol. Tenodesis is better than nothing, and in my experience the functional result is very good after a proper and systematic rehabilitation with physical therapy.
I've got any EBM data, but in my personal experience of treating either athletes or have workers, the tenodesis is the best way in most of the patients, because you definitively solve the problem of painful shoulder without waiting for final results of your repair after long lasting rehab and at the same time with no loss of strength and function what is proven
I totally agree that biceps tenodesis is the second line operation an most reliable operation in the case of SLAP lesion.
Contrary to popular belief, a SLAP lesion as a cause of disability is an overused diagnosis. It is referred to as the biceps anchor for a reason - the biceps itself is the issue. Boileau and Weber have shown that biceps tenosesis is is the superior treatment as a firstline operation. The failure rate for repair of the so-called SLAP is unacceptable ly high.
The repair of a SLAP lesion depends on numerous factors: type of SLAP, age, sport activity...As a secondary procedure, biceps tenodesis is a good solution, but you should also consider wich type of tenodesis is indicated in each particular case (intra articular, supra or sub pectoral, what kind of material you use to the procedure...). Therefore, there is no straight answer to this question, and many surgeons are showing a tendency to use the tenodesis as a first option, particulary in older atheletes.
Logically, biceps tenodesis should be reserved for a failed SLAP repair and cannot be justified as a primary procedure.
There is nothing logical about reserving biceps tenodesis for failed SLAP repairs. If you read the literature on unbiased reports about SLAP repairs, the failure rate is 50% or more (see Boileau or Weber), thus you would be subjecting your patients to two operations when one (tenodesis) would provide a good result in one operation.
As for the type of tenodesis, all of the types, except for interarticular (which can restrict motion) have good outcomes, so essentially you do whichever one you feel comfortable with.
According to Romeo et al. "Recently, biceps tenodesis has been suggested as a potential option for the treatment of SLAP lesions in overhead athletes. This option is controversial, and data on return to play in overhead athletes are scant".: Am J Orthop (Belle Mead NJ). 2017 Jan/Feb;46(1):E71-E78.
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