Editorial Commentary: Outcomes After SLAP Repair and Biceps Tenodesis Are Unpredictable for Throwing Athletes With SLAP Lesions.

Abstract

SLAP tears have been associated with pain, poor performance, and missed playing time for decades. Treatment of SLAP tears in the throwing athlete, particularly baseball pitchers, remains a significant challenge. As few as 7% of baseball players are able to return to elite-level performance after a SLAP repair. The throwing athlete must repeatedly orchestrate a sequence of rotational, accelerating, and decelerating movements to produce a throw with sufficient velocity and control to perform at an elite level. Repetitive overhead stress leads to physiologic adaptations in shoulder motion and structure but can also generate biceps labral complex pathology. Recommendations of SLAP repair for young competitive athletes and biceps tenodesis for middle-aged recreational athletes or salvage cases may be grounded in dogma more than evidence. The line between the young and middle-aged athlete may be blurring; many world-class athletes compete into their late 30s and early 40s. Current literature shows massive variability in outcomes after each procedure. Return to sport for throwers after SLAP repair or biceps tenodesis remains completely unpredictable.