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.

Home Message: A bicep tenodesis has minimal influence on passive shoulder

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.  

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?

by: Callie Jedrzejek
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