Superior labrum (SLAP) tear repair is an arthroscopic procedure that reattaches the torn superior labrum and biceps tendon anchor to the glenoid. The procedure addresses symptomatic SLAP tears that produce deep shoulder pain, mechanical catching, and loss of throwing performance. In selected older patients or those with biceps tendon disease, biceps tenodesis is performed instead of SLAP repair because it produces more reliable outcomes.
What Is SLAP Tear Repair?
The superior labrum is the rim of soft tissue at the top of the glenoid socket. The long head of the biceps tendon attaches into the superior labrum and anchors there as it enters the joint. A SLAP tear is a tear of the labrum at this junction, often involving the biceps anchor.
Arthroscopic SLAP repair reattaches the torn labrum to the glenoid rim using suture anchors, restoring the biceps anchor and the labral attachment. The procedure is performed entirely through small arthroscopic portals.
For older patients (typically over 35) and patients with significant biceps tendon disease, biceps tenodesis is preferred. In tenodesis, the biceps tendon is detached from the labral anchor and reattached to the humerus, removing the tension on the SLAP region and resolving symptoms more reliably than SLAP repair alone in this population.
Who Is a Candidate?
Candidates for SLAP repair typically have:
- A symptomatic SLAP tear documented on MRI arthrogram or arthroscopy
- Mechanical symptoms (catching, popping) or pain that interferes with overhead activity
- Failure of non-surgical treatment
- Younger active patients (typically under 35) with isolated Type II SLAP tears
- Throwing athletes, where SLAP repair preserves the biceps anchor for sport-specific function
Patients over 35, those with significant biceps tendon disease, and those with massive SLAP tears extending into the rotator cuff are typically better served by biceps tenodesis.
How the Procedure Is Performed
The procedure is performed through three to four arthroscopic portals. The joint is examined to confirm the tear pattern (Type I, II, III, IV, or complex variants). The torn superior labrum and biceps anchor are mobilized off the glenoid rim. The bone is prepared with a small burr to create a healing surface.
Suture anchors are placed in the superior glenoid, typically two to three for a standard SLAP repair. Sutures are passed through the labrum and biceps anchor, then tied to secure the tissue back to the bone. Associated rotator cuff or other labral pathology is addressed at the same procedure when present.
Recovery and Rehabilitation
Recovery follows a protected protocol because the biceps anchor must heal back to the glenoid:
- Sling protection for four to six weeks
- Passive motion within safe limits during the protected period
- Progressive active motion from six weeks
- Strengthening from three months, with biceps-loading activities protected for an additional period
- Return to overhead sport at five to six months
- Return to throwing sport at six to nine months with a graduated return-to-throw program
Risks and Outcomes
Risks include persistent pain (a known limitation of SLAP repair, particularly in patients over 35), stiffness, biceps tendon symptoms, and recurrent tear. Outcomes are best in younger active patients with isolated Type II tears and in throwing athletes where the biceps anchor function is sport-specific.
For patients over 35 or with biceps tendon disease, biceps tenodesis produces more reliable outcomes than SLAP repair alone.
Why Dr. Chudik for SLAP Repair
Dr. Chudik evaluates SLAP tears in the context of the full shoulder, not in isolation. His approach matches the procedure to the patient: SLAP repair for younger throwers and isolated tears, biceps tenodesis for older patients and those with biceps disease. His high case volume and arthroscopic experience produce consistent outcomes across the spectrum of SLAP pathology.