Role
of the superior labrum after bicep tenodesis in glenohumeral stability
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.
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.
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.
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.
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?
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
by: Callie Jedrzejek
Reviewed
by: Lisa Chinn and Stephen Thomas
by: Lisa Chinn and Stephen Thomas
Related Posts:
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
I have not had an athlete with a SLAP lesion that was treated with a tenodesis. These findings however are interesting. It is difficult to translate findings from a cadaver to a live athlete. There are a number of different things that need to be taken into account, including those that were addressed above. With the limited research that has been done, it would be difficult to convince an athlete to have this procedure done. It will be difficult to get much more evidence since it would be hard to convince anyone to agree to have a surgical procedure that has not been shown to be as good as the other option. Even if it is due to the lack of evidence. It would be interesting to see the difference in recovery time between having a tenodesis and not having it done. If amount of translation is the same after both procedures, but the recovery time is significantly different, then that reason alone would give the athlete incentive to have a tenodesis done. I always am intrigued by new surgical procedures to try and return an athlete back to baseline quicker and easier than the current procedure.
Nic Philpot,
I have also never dealt with an athlete who has been treated with a tenodesis for a SLAP lesion. The findings were very interesting and I agree it is difficult to translate cadaver studies to a live athlete. I agree with what you have to say on it is difficult to get further research on this study since no athlete will willingly volunteer for this procedure. I also agree with your comment about if this does provide a faster recovery for an athlete I do think more athletes would want to have this procedure done, but unfortunately there is no research proving this. I am also very interested in new surgical techniques even though they are hard to read at times.
Personally, I have never treated an athlete who has had a tenodesis. To me, this is an interesting procedure and seems a little extreme from an athletics perspective. I agree that new surgical procedures that may return an athlete back sooner would be beneficial, however, a biceps tenodesis, in theory, may not allow that to happen. I think by fixing the tendon to the humerus and by changing the biceps moment arm may in some cases be harder to rehabilitate strengthening wise. Not to mention, bone healing as well. I agree with Nic in saying that cadaver studies, although informative, aren't the best comparison to alive, healthy, and physically active human beings. I will be interested to see where biceps tenodesis treatments end up in the future based on more research.