This review examines why SLAP repairs fail and how to work up and manage the patient with persistent or recurrent shoulder pain after repair. It covers the Snyder classification, diagnostic pitfalls, and the surgical and nonsurgical options for salvage. It argues that biceps tenodesis is often a better choice than revision repair.
When a patient returns with pain after a SLAP repair, resist the urge to blame the labrum first. Stiffness is the most common cause of failure, so start with a careful motion exam, differential injections, and a full search for missed pathology like biceps disease, rotator cuff tears, or AC joint impingement.
Work up the diagnosis deliberately: noncontrast MRI is unreliable (38% sensitivity), so use MR arthrography, and remember physical exam can outperform imaging for SLAP pathology. When surgery is needed, counsel realistically. Revision repair returns athletes to roughly 40% of prior sport level, and salvage results are consistently inferior to primary repair.
Biceps tenodesis is the preferred rescue for most patients, especially middle-aged patients, women, and those with biceps pathology. The recurring theme, echoed by Boileau, is that many patients, particularly those over 40 with a type II tear, may be better served by biceps tenodesis than by SLAP repair in the first place.
This review examines why SLAP repairs fail and how to work up and manage the patient with persistent or recurrent shoulder pain after repair. It covers the Snyder classification, diagnostic pitfalls, and the surgical and nonsurgical options for salvage. It argues that biceps tenodesis is often a better choice than revision repair.
When a patient returns with pain after a SLAP repair, resist the urge to blame the labrum first. Stiffness is the most common cause of failure, so start with a careful motion exam, differential injections, and a full search for missed pathology like biceps disease, rotator cuff tears, or AC joint impingement.
Work up the diagnosis deliberately: noncontrast MRI is unreliable (38% sensitivity), so use MR arthrography, and remember physical exam can outperform imaging for SLAP pathology. When surgery is needed, counsel realistically. Revision repair returns athletes to roughly 40% of prior sport level, and salvage results are consistently inferior to primary repair.
Biceps tenodesis is the preferred rescue for most patients, especially middle-aged patients, women, and those with biceps pathology. The recurring theme, echoed by Boileau, is that many patients, particularly those over 40 with a type II tear, may be better served by biceps tenodesis than by SLAP repair in the first place.