Clinical Question

For overhead athletes with SLAP tears,

how would total repair of the labrum
Biceps Tenotomy with a biceps tenotomy compared to a
repair with a biceps tenodesis affect
Through six studies, there was very little the athletes' return to play and
evidence of athletes that returned to performance?
play. In two of the studies, 39% resulted
in “Popeye” deformity. Patients usually
complain of frequent cramping when
returning to activity. More commonly
used in older patients and with rotator
cuff pathologies. One positive is patient
is in a sling for only a week and
rehabiliation time is around 1 to 2
months.
Clinical Bottom Line:

Overall, a biceps tenodesis is the best option for an

overhead athlete that plans to return to play. It has
shown to have better results when isolated or after a
SLAP repair. A biceps tenotomy is common to see in
patients that are near the end of their career and do
not plan to return to play. If done in isolation, the
Biceps Tenodesis patient will have a shorter recovery time but will have
more complications.
There is only a 25% RTP rate for a
major league baseball player that has
a SLAP repair with a tenodesis. Out of
the 17 MLB players, only six returned
to play at least ten games. In a study
with 22 overhead athletes after a
tenodesis alone, 48% returned to prior
level of play. There is also an 81%
RTP out of 42 patients after failed
SLAP repair and then tenodesis
performed. Although, it takes eight
weeks in a sling to start full ROM and
costs are similar to SLAP repair.
Sources: 1.2017 OTO. Baseball players see low return to play after biceps tenodesis for SLAP tears. Healio. 2. Calcei JG, Boddapati V, Altchek
DW, Camp CL, Dines JS. Diag-nosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes. Current
Reviews in Musculoskeletal Medicine. 2018 3. Chalmers PN, Monson B, Frank RM, et al. Combined SLAP repair and biceps tenodesis for
superior labral anterior–posterior tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 4. Duralde XA, McClelland WB. Face-Off:
Tenotomy Versus Tenodesis. Unsustainable Physician Reimbursement Rates. 5. Friedman JL, Fitzpatrick JL, Rylander LS, Bennett C, Vidal AF,
Mccarty EC. Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years. Orthopaedic Journal of Sports Medicine. 2015
6. Gothelf T. IS IT NECESSARY TO REPAIR A LARGE SLAP LESION IN A STABLE SHOULDER? Orthosports. September 2010.
7. SLAP Type II Repair/Biceps Tenodesis/tenotomy Protocol. NMC.

Cameron Pease, ATS

Beth Funkhouser, Med, LAT, ATC, CSCS
Committee: Breanna Bebber, MBA, LAT, ATC
Matt Harris, PT, ATC