This Level 1 RCT asks whether repairing a type II SLAP lesion adds value when it accompanies a rotator cuff tear in patients over 50. 63 patients were randomized to either dual repair (cuff + SLAP) or cuff repair plus biceps tenotomy. Outcomes were tracked with UCLA scores and range of motion at a mean 5.2 years.
When you find a type II SLAP lesion alongside a rotator cuff tear in a patient over 50, the reflex to fix everything is wrong. This trial shows that adding a formal SLAP repair does not improve outcomes and actually leaves patients stiffer and with worse function.
The mental model: in older shoulders, type II SLAP lesions behave like type I lesions, so the diseased biceps-labral complex is better addressed by tenotomy than by fixation. Tenotomy is faster, avoids over-constraining the biceps anchor, and sidesteps the postoperative stiffness that plagues this age group.
The trade-off is a Popeye deformity, which occurred in 19 patients here and bothered none of them. One caveat for critical appraisal: there was no formal power analysis and no third arm leaving the SLAP untreated, so whether doing nothing to the labrum would work equally well remains open.
This Level 1 RCT asks whether repairing a type II SLAP lesion adds value when it accompanies a rotator cuff tear in patients over 50. 63 patients were randomized to either dual repair (cuff + SLAP) or cuff repair plus biceps tenotomy. Outcomes were tracked with UCLA scores and range of motion at a mean 5.2 years.
When you find a type II SLAP lesion alongside a rotator cuff tear in a patient over 50, the reflex to fix everything is wrong. This trial shows that adding a formal SLAP repair does not improve outcomes and actually leaves patients stiffer and with worse function.
The mental model: in older shoulders, type II SLAP lesions behave like type I lesions, so the diseased biceps-labral complex is better addressed by tenotomy than by fixation. Tenotomy is faster, avoids over-constraining the biceps anchor, and sidesteps the postoperative stiffness that plagues this age group.
The trade-off is a Popeye deformity, which occurred in 19 patients here and bothered none of them. One caveat for critical appraisal: there was no formal power analysis and no third arm leaving the SLAP untreated, so whether doing nothing to the labrum would work equally well remains open.