title: Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior Lesions of the Shoulder: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database.
abstract: BACKGROUND
  After failure of nonoperative treatment, repair has long been the primary treatment option for symptomatic superior labrum anterior and posterior (SLAP) lesions of the shoulder. There is growing evidence to support both biceps tenotomy and tenodesis as effective alternative treatments for SLAP lesions.
  
  
  OBJECTIVE
  For patients with isolated SLAP lesions, the frequency of SLAP repair has decreased, while treatment with biceps tenodesis and tenotomy has increased. Similar trends are expected in patients with SLAP lesions undergoing concomitant rotator cuff repair.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A query of the American Board of Orthopaedic Surgery part II database was performed from 2002 to 2011. The database was searched for patients with isolated SLAP lesions undergoing SLAP repair, open biceps tenodesis, arthroscopic biceps tenodesis, or biceps tenotomy. The database was then queried a second time for patients undergoing arthroscopic rotator cuff repair with concomitant SLAP repair, biceps tenodesis, or biceps tenotomy.
  
  
  RESULTS
  From 2002 to 2011, there were 8963 cases reported for the treatment of an isolated SLAP lesion and 1540 cases reported for the treatment of SLAP lesions with concomitant rotator cuff repair. For patients with isolated SLAP lesions, the proportion of SLAP repairs decreased from 69.3% to 44.8% (P < .0001), while biceps tenodesis increased from 1.9% to 18.8% (P < .0001), and biceps tenotomy increased from 0.4% to 1.7% (P = .018). For patients undergoing concomitant rotator cuff repair, SLAP repair decreased from 60.2% to 15.3% (P < .0001), while biceps tenodesis or tenotomy increased from 6.0% to 28.0% (P < .0001). There was a significant difference in the mean age of patients undergoing SLAP repair (37.1 years) versus biceps tenodesis (47.2 years) versus biceps tenotomy (55.7 years) (P < .0001).
  
  
  CONCLUSIONS
  Practice trends for orthopaedic board candidates indicate that the proportion of SLAP repairs has decreased over time, with an increase in biceps tenodesis and tenotomy. Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair.
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA bmackinn@unch.unc.edu.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Patterson
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: R Alexander
authors.initials: RA
authors.lastname: Creighton
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Spang
authors.affiliation: Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Roberson
authors.affiliation: Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Kamath
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000639:trends; D001182:Arthroscopy; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D051445:Fibrocartilage / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D009985:Orthopedics; D012782:Shoulder / Q000601:surgery*; D000070599:Shoulder Injuries; D053656:Tenodesis / Q000639:trends*; D058971:Tenotomy / Q000639:trends*; D016896:Treatment Outcome; D014481:United States
keywords: SLAP; biceps tenodesis; biceps tenotomy; rotator cuff tear