This is the first double-blind, sham-controlled surgical trial in the shoulder. It asks whether labral repair or biceps tenodesis actually helps isolated type II SLAP lesions, or whether improvement comes from placebo and rehabilitation. 118 surgical candidates were randomised during arthroscopy to labral repair, biceps tenodesis, or sham surgery, then followed for 2 years.
For an isolated type II SLAP lesion in a middle-aged patient, this trial says the operation adds risk without adding benefit. The mental model to carry: a SLAP lesion seen on MRI arthrography is often an incidental finding, since these tears are common in asymptomatic middle-aged shoulders. Treating the picture rather than the patient is the trap.
The recovery in every arm, including sham, points to natural history, regression to the mean, and structured rehabilitation as the real drivers. Physiotherapy was given to all three groups. Real surgery here caused more postoperative capsulitis than sham. That matters when you counsel a patient about a long recovery and a real complication risk.
The honest caveat: this population was middle-aged (mean age 40), and the young overhead athlete was underrepresented. Whether repair helps that specific patient remains debated and unresolved by this trial.
This is the first double-blind, sham-controlled surgical trial in the shoulder. It asks whether labral repair or biceps tenodesis actually helps isolated type II SLAP lesions, or whether improvement comes from placebo and rehabilitation. 118 surgical candidates were randomised during arthroscopy to labral repair, biceps tenodesis, or sham surgery, then followed for 2 years.
For an isolated type II SLAP lesion in a middle-aged patient, this trial says the operation adds risk without adding benefit. The mental model to carry: a SLAP lesion seen on MRI arthrography is often an incidental finding, since these tears are common in asymptomatic middle-aged shoulders. Treating the picture rather than the patient is the trap.
The recovery in every arm, including sham, points to natural history, regression to the mean, and structured rehabilitation as the real drivers. Physiotherapy was given to all three groups. Real surgery here caused more postoperative capsulitis than sham. That matters when you counsel a patient about a long recovery and a real complication risk.
The honest caveat: this population was middle-aged (mean age 40), and the young overhead athlete was underrepresented. Whether repair helps that specific patient remains debated and unresolved by this trial.