Arthroscopic repair of concomitant type II SLAP lesions in large to massive rotator cuff tears: comparison with biceps tenotomy

Abstract

BACKGROUND: There are no studies examining superior labrum anterior and posterior (SLAP) repair combined with repair of large to massive rotator cuff tears, and it is unclear whether a combined SLAP repair would lead to better outcomes than biceps tenotomy.

HYPOTHESIS: Tenotomy and rotator cuff repair would lead to better outcomes compared with those of combined SLAP and rotator cuff repair.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: Our study population consisted of 36 patients who had undergone either combined SLAP and rotator cuff repair (when the biceps was too healthy to cut; group R = 16 patients) or tenotomy and rotator cuff repair (when any fraying or partial tear existed in the biceps tendon; group T = 20 patients) for concomitant type II SLAP lesions and large to massive rotator cuff tears. The cuff repair was performed in a single row for both groups. Outcomes were assessed by comparing range of motion as well as Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores between the 2 groups.

RESULTS: At the 2-year follow-up, both groups demonstrated significant improvements in functional shoulder scores and range of motion. However, group T had better SST scores (group T, 9.3 ± 1.6; group R, 7.8 ± 1.9; P = .012), ASES scores (group T, 88.6 ± 8.9; group R, 80.4 ±8.9; P = .009), UCLA scores (group T, 29.6 ± 3.0; group R, 26.0 ± 4.2; P = .007), and forward flexion (group T, 145.9° ± 13.0°; group R, 132.5° ± 15.3°; P = .008). The mean tear size and the degree of preoperative muscle atrophy and fatty infiltration on magnetic resonance imaging were similar between the groups.

CONCLUSION: For patients with concomitant type II SLAP lesions and large to massive rotator cuff tears, the outcomes of simultaneous arthroscopic SLAP and rotator cuff repair were inferior to those of arthroscopic biceps tenotomy and cuff repair in terms of functional shoulder scores and range of motion. Biceps tenotomy and rotator cuff repair may be a more reliable method to address concomitant type II SLAP lesions and large to massive rotator cuff tears in patients, although a randomized controlled trial is needed to confirm the results.