Superior Labrum Anterior to Posterior (SLAP) Repair is Associated with Increased Rate of Subsequent Rotator Cuff Diagnoses and Revision Surgery: A Propensity-Matched Comparison

Background Surgical management of superior labrum anterior to posterior (SLAP) tears remains controversial. Current management utilizes 2 well-established procedures: biceps tenodesis and SLAP repair. This study evaluates the complications associated with arthroscopic SLAP repair versus an open or arthroscopic biceps tenodesis to further elucidate optimal surgical management. Methods In this retrospective cohort study, the TriNetX database was utilized to evaluate patients who underwent repair of SLAP lesions (ICD10:S43.43) from May 15, 2003 to May 15, 2023. Three patient cohorts were evaluated: those who underwent arthroscopic SLAP repair (CPT:29807), those who underwent arthroscopic biceps tenodesis (CPT:29828), and those who underwent open tenodesis of the biceps (CPT:23430). Cohorts were propensity matched for type 2 diabetes, nicotine dependence, alcohol-related disorders, body mass index, and demographic factors such as age at event, ethnicity, race, and sex. The outcomes evaluated were disruption of surgical wound, deep vein thrombosis, mononeuropathy of upper limb, shoulder contusion, humeral fracture, sepsis, deceased, acute postoperative pain, revision, shoulder stiffness, and rotator cuff strain. All outcomes were evaluated within 1-year post-procedure. Results A total of 11,081 arthroscopic SLAP repairs, 9,960 arthroscopic biceps tenodesis, and 9,420 open biceps tenodesis were matched. Compared to arthroscopic biceps tenodesis, patients that underwent arthroscopic SLAP repair were 1.8 times more likely to undergo revision (2.9% vs 1.6%, P < 0.0001). Compared to open biceps tenodesis, patients that underwent SLAP repair were 1.4 times more likely to undergo revision (3.1% vs 2.3%, P = 0.013) and 1.6 times more likely to have a subsequent rotator cuff strain diagnosis (5.1% vs 3.2%, P = 0.0002). Compared to SLAP repair, patients that underwent arthroscopic biceps tenodesis exhibited 1.3 times more instances of acute postoperative pain (5.2% vs 4.0%, P = 0.011). Similarly, open biceps tenodesis exhibited 1.8 times more instances of acute postoperative pain (6.9% vs 3.8%, P < 0.0001) and 1.3 times more shoulder stiffness (11.8% vs 9.0%, P < 0.0001). Conclusion In the last 20 years, patients that underwent SLAP repair were associated with higher risk of revision surgery and subsequent rotator cuff strain diagnosis. Conversely, patients that underwent biceps tenodesis were associated with higher rates of acute postoperative pain and shoulder stiffness.