SLAP tears and return to sport and work: current concepts

LeVasseur, Matthew R.; Mancini, Michael R.; Hawthorne, Benjamin C.; Romeo, Anthony A.; Calvo, Emílio; Mazzocca, Augustus D.

doi:10.1136/jisakos-2020-000537

Cited by 14 publications

(13 citation statements)

References 57 publications

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“… 11 , 12 Biceps tenodesis is commonly advocated as the treatment of choice for older patients and non-overhead athletes, and the incidence of biceps tenodesis for SLAP tears notably surpassed the incidence of SLAP repair starting in 2017. 6 , 13 , 14 , 15 …”

mentioning

confidence: 99%

Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Sandler¹,

Baird²,

Dunn³

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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mentioning

confidence: 99%

Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Sandler¹,

Baird²,

Dunn³

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…With regard to return to sports, there is continued controversy about the role of SLAP repair versus biceps tenodesis in young patients that is even more uncertain with athlete status, especially overhead athletes and baseball pitchers whose sports affiliations confer notably lower rates of return to play. 16 Our index systematic review demonstrated a higher rate of return to sport in patients with biceps tenodesis (72.6%) compared to SLAP repair (59.2%), with a marginally significant increase in the likelihood of return to sport after biceps tenodesis (OR, 1.85 [95% CI, 0.91-3.85]; P = .09). 25 Rates of return to play among baseball pitchers are extremely variable and cited to range from 22% to 64% after SLAP repair, with notably detrimental changes in pitching biomechanics and nonpitching performance statistics.…”

Section: Discussionmentioning

confidence: 74%

“…25 Rates of return to play among baseball pitchers are extremely variable and cited to range from 22% to 64% after SLAP repair, with notably detrimental changes in pitching biomechanics and nonpitching performance statistics. 11,15,16 Biceps tenodesis yields similarly disappointing outcomes, with a return to sport rate of 35% in baseball players and 17% in pitchers 4 ; however, an investigation of return to pitching after SLAP repair versus biceps tenodesis demonstrated equivalent pitching kinematics and physiological neuromuscular control with both procedures, with more closely maintained prior pitching kinematics, specifically thoracic rotation, after biceps tenodesis. 5 Our comparison of cost-effectiveness focuses on patients younger than 40 years and is subsequently more broadly applicable than a study unique to baseball players or athletes; however, the high rates of athletic activity among patients with SLAP tears magnify the weight of indirect costs when comparing SLAP repair to biceps tenodesis.…”

Section: Discussionmentioning

confidence: 99%

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Sandler

Childs

Dunn

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. Hypothesis: In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Results: Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. Conclusion: In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.

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“…Verletzungen des Ankers der LBS werden als SLAP-Läsionen (SLAP: superior labrum anterior-to-posterior) bezeichnet [5]. Vor allem Überkopfsportler [2,6], jedoch auch körperlich arbeitende Männer mittleren Alters sind davon betroffen [6]. Eine SLAP-Läsion kann durch einen Sturz auf den gestreckten Arm mit abduzierter und leicht flektierter Schulter bedingt sein.…”

Section: Slap-läsionenunclassified

“…Eine SLAP-Läsion kann durch einen Sturz auf den gestreckten Arm mit abduzierter und leicht flektierter Schulter bedingt sein. Zudem kann sie durch forcierte Traktion [6] oder durch chronische Überlastung bei mechanischem Stress im Rahmen von Wurfbewegungen entstehen [7].…”

Section: Slap-läsionenunclassified

Verletzungen der proximalen und distalen Bizepssehne

Otto¹,

Fritsch²,

Kadantsev³

et al. 2023

OP-Journal

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ZusammenfassungDer M. biceps brachii besitzt 2 proximale Ursprünge und einen distalen Ansatz. Dabei kann die lange Bizepssehne (LBS) häufig als Ursache für den vorderen Schulterschmerz identifiziert werden. Zahlreiche Pathologien wie eine Tendinitis, (Partial-)Risse oder Subluxation der LBS sind dafür grundlegend. Rupturen der Rotatorenmanschette stellen dabei auch ursächliche Veränderungen für Beschwerden der LBS dar. Scheitert die konservative Therapie, kann entsprechend dem körperlichen Anspruch eine Tenotomie resp. Tenodese der LBS erfolgen. Sowohl supra- als auch subpektorale LBS-Tenodesen führen dabei zu guten funktionellen Ergebnissen. Die LBS-Tenotomie kann bei Patienten mit geringeren funktionellen Anforderungen angewandt werden, jedoch mit einem höheren Risiko für eine postoperative Distalisierung des Muskelbauchs des Biceps brachii.Die distale Bizepssehne (DBS) ist der wichtigste Supinator des Unterarms und fungiert als sekundärer Flexor des Ellenbogens. Rupturen der DBS treten am häufigsten bei Männern mittleren Alters im Rahmen eines traumatischen Ereignisses auf. Bei körperlichem Anspruch mit relevantem Defizit von Supinationskraft und -ausdauer ist die chirurgische Versorgung indiziert. Verschiedene Operationstechniken sind zur Refixation der DBS beschrieben. In unserer Praxis hat sich die unikortikale Onlay-Refixation sowohl mit dem Kortikalis-Button als auch mit All-Suture-Ankern bewährt. Bei chronischen Rupturen der DBS kann eine Augmentation durch ein Transplantat durchgeführt werden.Dieser Artikel bietet einen umfassenden Überblick über Therapie von proximalen und distalen Sehnenrupturen des Biceps brachii.

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SLAP tears and return to sport and work: current concepts

Cited by 14 publications

References 57 publications

Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis

Verletzungen der proximalen und distalen Bizepssehne

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