Role of the superior labrum after bicep tenodesis in glenohumeral stability
Strauss EJ, Salata MJ, Sershon RA, Garbis N, Provencher MT, Wang VM, McGill KG, Bush-Joseph CA, Nicholson GP, Cole BP, Romeo AR, Verma NH. Journal Shoulder Elbow Surgery. (2013); 1-7.
Take Home Message: A bicep tenodesis has minimal influence on passive shoulder instability.
Superior labrum anterior-posterior (SLAP) lesions are often associated with pain, shoulder instability, and significant shoulder dysfunction. During arthroscopic surgery for a SLAP lesion a bicep tenodesis is often performed instead of a SLAP repair. However, it is unclear how glenohumeral stability is influenced by a SLAP tear and a biceps tenodesis. Therefore, the purpose of this cadaveric study was to examine the effect of a type II SLAP lesion and biceps tenodesis on glenohumeral translation. Using 20 cadaveric shoulders, the authors measured anterior and posterior translation with the shoulder in neutral and anterior translation with the shoulder in 90 degrees of abduction and max external rotation. The authors translated the humerus in all directions on a fixed scapula using a standardize force at four time points. At baseline, they measured the glenohumeral translation in the uninjured shoulders. Next, the authors created anterior (10 shoulders) and posterior (10 shoulders) type II SLAP lesions by separating the superior labrum from the glenoid and reevaluated the glenohumeral translations. The third testing occurred following a bicep tenodesis. Finally, the authors reattached the labrum to the glenoid rim and tested the glenohumeral translation. The presence of anterior or posterior lesions led to glenohumeral instability in all directions. Performing a bicep tenodesis, in the presence of a SLAP lesion, did not increase glenohumeral translation compared with when the shoulders only had a SLAP lesion. Following the reattachment of the labrum, glenohumeral translation was restored to baseline levels with the exception of the amount of anterior translation occurring in the specimens with an anterior SLAP lesion.
It was previously believed that a biceps tenodesis resulted in increased glenohumeral translations. However, this study demonstrated that a tenodesis may not influence passive glenohumeral stability but a labral lesion may. Clinicians should be aware that although stability was not hindered by a tenodesis in this study, it is unknown how a biceps tenodesis affects strength or osteokinematics. For an overhead athlete, stability is crucial, but it is only one aspect of overall function. Although this study had interesting findings, a major limitation was the use of cadaveric models that did not include muscular force which may enhance stability during functional motions. Overall, the inclusion of biceps tenodesis to treat a symptomatic SLAP lesion shows promise, but further research should be conducted.
Questions for Discussion: Have any of your athletes ever been treated with a bicep tenodesis for a type II SLAP lesion? Was their full function restored after having the procedure done or did they experience limitations?
Written by: Callie Jedrzejek
Reviewed by: Lisa Chinn and Stephen Thomas
Strauss EJ, Salata MJ, Sershon RA, Garbis N, Provencher MT, Wang VM, McGill KC, Bush-Joseph CA, Nicholson GP, Cole BJ, Romeo AA, & Verma NN (2013). Role of the superior labrum after biceps tenodesis in glenohumeral stability. Journal of Shoulder and Elbow Surgery PMID: 24090980