Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes

Calcei, Jacob G.; Boddapati, Venkat; Altchek, David W.; Camp, Christopher L.; Dines, Joshua S.

doi:10.1007/s12178-018-9460-9

Cited by 16 publications

(3 citation statements)

References 70 publications

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“…However, broader sutures such as labral tape may have the benefit of increased strength while restoring labral height and allowing for a broader surface of compression, thus limiting "cut-through" on the labrum. 31 Furthermore, the technique or type of suture passage could be important and not often reported upon (Figs 3 and 4 A and B).…”

Section: Discussionmentioning

confidence: 99%

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes

Weick

Bush

McCollum

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To systematically review the available literature to further describe and report the available data on SLAP repair techniques and the association with outcomes. Methods: A systematic review of literature was performed on manuscripts describing type II SLAP repairs in athletes. Selection criteria included studies reporting exclusively type II SLAP tears without concomitant pathology, minimum 2-year postoperative follow-up, use of anchor fixation, and return to previous level of play data available. We extracted patient outcome as well as surgical construct details from each article. Average outcomes and return to play rates were calculated and substratified further by athlete type. Return to play rates were compared by repair constructs with the Student t test. Results: Initial search resulted in 107 articles. After exclusion criteria were applied, 17 articles were included in the final analysis. Overall, 84% of patients had good-to-excellent results. Of all athletes, 66% returned to previous level of play. There was significant variation in reported technique in terms of anchor number, location, material, suture type, and knotless versus knotted constructs. No significant difference was reported in outcomes in comparison of suture type (P-value .96) or knotted versus knotless constructs (P-value .91). Given the significant variability in reporting, no statistical analysis was felt able to be performed on anchor location and number. Conclusions: Repair of type II SLAP tears in athletes is a difficult problem to treat with overall low return to play despite a high rate of "good" outcomes when assessed by outcome measures. Significant variability exists in surgical technique, as well as reporting of surgical technique, potentially limiting the ability to define the best or most effective technique for SLAP repair. Level of Evidence: IV, systematic review of level III and level IV studies.

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Section: Discussionmentioning

confidence: 99%

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes

Weick

Bush

McCollum

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The rate of successful repair of SLAP lesions has been reported to be as low as 74% 66 . The decrease in primary SLAP repair has come with a concurrent increase in biceps tenotomy and tenodesis procedures 41,66,67 . The literature has demonstrated that both procedures result in similar postoperative functional outcomes, including pain, stiffness, mobility, and strength 41,68,69 .…”

Section: Decision-making For Bicipital-labral Complex Injuriesmentioning

confidence: 99%

Current Controversies and Decision-Making in the Management of Biceps Pathologies

et al. 2021

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Biceps tendon pathologies include a spectrum of injuries that range from mild tendinosis to complete tendon rupture.Tendinosis, the most common pathology, occurs more frequently with age and is likely related to chronic degeneration. On the other side of the spectrum of severity lies a rupture of the long head of the biceps tendon (LHBT), which may be accompanied by injury to the glenoid labrum.Superior labral anterior-posterior (SLAP) tears are frequently associated with biceps pathology. Surgical management for injuries of the bicipital-labral complex includes biceps tenodesis or tenotomy and SLAP repair. A consensus as to which of these procedures is the optimal choice has not been reached, and management may ultimately depend on patient-specific characteristics.Due to the relatively low incidence of distal biceps tendon rupture, agreement on the optimal management strategy has not been reached. Surgical repair, or reconstruction in the case of a chronic rupture, is often chosen. However, nonoperative management has also been utilized in older, less-active patients.

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“…Shoulder pain related to biceps-labrum complex (BLC) disease, which includes superior labral anterior and posterior (SLAP) tears, long head of the biceps tendon (LHBT) instability, and proximal LHBT tearing, is a frequent clinical dilemma. 2 Tenodesis of the LHBT is a common procedure to address refractory BLC symptoms, including LHBT instability, biceps tendinopathy or tearing, and SLAP tears in some patients, with over 44,000 procedures performed annually and an increasing number of tenodeses performed each year. 11 , 14 Recently, indications for this procedure have expanded to include the treatment of SLAP tears and extra-articular bicipital tunnel disease.…”

mentioning

confidence: 99%

Physiologic Long Head Biceps Tendon Excursion Throughout Shoulder Range of Motion: A Cadaveric Study

Lamplot

Ward

O’Brien

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Restoration of the long head of the biceps tendon (LHBT) length-tension relationship is critical in preserving muscle strength and efficiency when performing biceps tenodesis. While static anatomic landmarks such as the inferior border of the pectoralis major may be used intraoperatively to achieve this, shoulder position may affect the excursion of the biceps tendon and represents another variable to consider. Purpose/Hypothesis: The purpose of this study was to quantitatively evaluate the normal excursion of LHBT that occurs through a glenohumeral range of motion. We also sought to determine whether elbow position affects LHBT excursion. We hypothesized that LHBT excursion will be affected by glenohumeral flexion and extension, and elbow extension will result in increased excursion at each glenohumeral position compared with a neutral position. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen specimens underwent a standard approach for subpectoral biceps tenodesis. The LHBT was identified and tagged with a radiopaque marker within zone 3 of the bicipital tunnel. A total of 3 K-wires were then drilled into the osseous floor: one at the level of the marker in the LHBT, one at 1 cm proximal, and a third 1 cm distal. All 3 K-wires were then cut flush with the anterior humeral cortex. The specimens were next placed into 8 different positions, and the excursion of the LHBT was measured by referencing the K-wires using static fluoroscopic imaging. The results were analyzed using 1-way analysis of variance testing followed by Tukey honestly significant difference testing for pairwise comparison between each individual position and the reference position. Results: The average total LHBT excursion was 24.4 ± 5.2 mm between the neutral shoulder position and the other shoulder positions tested. The position of the LHBT was significantly different in the reference position compared with each of the other 7 shoulder positions ( P < .001). Additionally, the 2 positions of shoulder extension had different LHBT excursions when compared with each position of shoulder flexion ( P < .0001). For each shoulder position tested, the position of the LHBT was not significantly different in elbow flexion compared with extension. Conclusion: There is approximately 24 mm of LHBT excursion throughout the glenohumeral range of motion, with significantly different amounts of excursion in glenohumeral flexion and extension. Elbow position does not significantly affect LHBT excursion. Positioning the shoulder in extension during biceps tenodesis may overtension the biceps, while positioning the shoulder in flexion may undertension the biceps relative to the neutral position. Further research is needed to identify the optimal shoulder position for biceps tenodesis. Clinical Relevance: Shoulder positioning is an important consideration in establishing a normal length-tension relationship during biceps tenodesis. When compared with flexed shoulder positions, LHBT excursion significantly differs in positions of extension and in a neutral position.

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Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes

Cited by 16 publications

References 70 publications

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes

Current Controversies and Decision-Making in the Management of Biceps Pathologies

Physiologic Long Head Biceps Tendon Excursion Throughout Shoulder Range of Motion: A Cadaveric Study

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