SLAP TEAR SURGERY AND RECOVERY TIME
Most studies report good to excellent results after SLAP repairs in 84-97% of patients.5-7 However, some patients may not do as well with a SLAP repair, particularly those with biceps tendinitis or partial tearing of the biceps tendon.8 In these cases, treatment of a SLAP tear may necessitate detachment of the biceps tendon from the torn superior labrum. This can be done in several ways. The biceps tendon can be cut and allowed to retract out of the shoulder (i.e. tenotomy) or it can be cut and attached to the humerus bone (i.e. tenodesis). A tenodesis can be performed arthroscopically or with a small incision in the patient’s axilla and may include the use of permanent suture, a small suture anchor, or other implant device.
The main advantages to the patient with performing a tenotomy include a lower risk of persistent pain over the front of the shoulder after surgery and the avoidance of additional rehabilitation precautions. The risks, however, include up to a 70% chance of the biceps tendon slipping down the arm resulting in a cosmetic deformity (i.e. the so-called “Popeye deformity”), a 40% risk of having fatigue and soreness when flexing the elbow, and 10-25% losses in strength with elbow flexion and supination.9 The risks associated with tenodesis include a higher chance of having pain over the front of the shoulder after surgery and the additional rehabilitation precautions, including avoidance of active elbow flexion for six weeks and resisted elbow flexion for up to three months.
Following surgery, if the SLAP lesion was debrided with or without a biceps tenotomy, the recovery is often dictated by the treatment of any other shoulder problems (e.g. rotator cuff repair, etc). If no other treatments are performed, then recovery may take 6 weeks to 3 months, based on one’s desired activities. If a SLAP repair and/or a biceps tenodesis are performed, then recovery may last 3-6 months, with athletes returning to high-level play after at least 5 months.
5. Neri BR, Vollmer EA, Kvitne RS. Isolated type II superior labral anterior posterior lesions: age-related outcome of arthroscopic fixation. Am J Sports Med. 2009 May;37(5):937-42.
6. Brockmeier SF, Voos JE, Williams RJ, Altchek DW, Cordasco FA, Allen AA., Hospital for Special Surgery Sports Medicine and Shoulder Service. Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am. 2009 Jul;91(7):1595-603.
7. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998 Sep;14(6):553-65.
8. Taylor SA, Degen RM, White AE, McCarthy MM, Gulotta LV, O’Brien SJ, Werner BC. Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective. Am J Sports Med. 2017 Jun;45(7):1640-1644.
9. Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005 Feb;33(2):208-13.
If you are experiencing shoulder pain or would like to learn more don’t hesitate to reach out.
Nels Sampatacos, MD
Orthopedic Surgeon and Sports Medicine Specialist
