Superior labral tears: repair versus biceps tenodesis.

Tears of the superior labrum were first described by Andrews et al in 1985 as injuries caused by traction due to throwing. In 1990 Snyder and Karzel published their comprehensive description of the labral/biceps attachment pathology, coining the name ‘‘SLAP (superior labrum anterior-to-posterior)’’ lesion. Since that time, understanding the nuances associated with etiology, diagnosis, and treatment of SLAP lesions has proven to be a difficult task. Several published studies have attempted to describe outcomes associated with surgical intervention, but there have been no level I or II publications related to the treatment of SLAP tears to date. Almost all evidence to date consists of level IV studies, making it impossible to draw definitive conclusions from any of the published results. Level III, IV, and V evidence can certainly be of value to the practicing orthopedist, but controversies arise when the published data are not definitive or describe variable, differing, or unpredictable results. Such has been the case with the investigation into the treatment of SLAP tears. The earliest reports described treatment of SLAP lesions with arthroscopic debridement only. Later, the focus turned to labral repair and repair of the biceps anchor, and now more recently, the role of biceps tenodesis is being more closely investigated. This article will discuss SLAP tear surgical treatment, focusing on the current controversy of repair vs biceps tenodesis. The pertinent anatomy, biomechanics, classification, diagnostic imaging, and the literature will also be reviewed, because properly diagnosing symptomatic SLAP