Biceps Tenodesis and SLAP Repair Show Similar Outcomes in Overhead Throwing Athletes With Baseball Pitchers Exhibiting Worse Rates of Return to Sport: A Systematic Review

Purpose: To compare clinical outcomes, return-to-play (RTP) outcomes, and incidence of postoperative complications in overhead throwing athletes with SLAP lesions undergoing SLAP repair versus biceps tenodesis (BT) with minimum 1-year follow-up. Methods: Using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted on July 9, 2024, by querying PubMed, Scopus, and EMBASE databases. Inclusion criteria consisted of Level I to IV human clinical studies reporting RTP rate, complications, and/or failure rates following SLAP repair versus BT for SLAP lesions in overhead throwing athletes with a minimum 1-year follow-up. Study quality was determined using the Methodological Index for Non-Randomized Studies criteria. Results: A total of 16 studies from 2005 to 2023, reporting on 547 patients with a mean age ranging from 17.4 to 36.0 years and a mean follow-up ranging from 2.7 to 7.2 years, met inclusion criteria. Twelve studies (n = 459 athletes) reported outcomes following SLAP repair and 5 (n = 88 athletes) following BT. A total of 15 studies reported on baseball players, 8 on softball players, and 2 on handball players. There were 220 pitchers who underwent SLAP repair compared to 34 pitchers who underwent BT. RTP rates for all throwers ranged from 37.5% to 94.7% following SLAP repair and 35.3% to 93.1% following BT. The RTP rate for pitchers and position players following SLAP repair ranged from 40% to 80% and 76.3% to 91.3%, respectively, compared to 16.7% and 80%, respectively, following BT. Complication rates ranged from 0% to 21.8% following SLAP repair compared to 0% following BT. Failure rates and revisions ranged from 7.5% to 12.5% for SLAP repair versus 0% for BT. Conclusions: In overhead throwing athletes with SLAP tears, an analysis of 547 patients from 16 studies shows variable RTP rates following SLAP repair and BT, with baseball pitchers having lower RTP rates compared to position players for both procedures. Outcomes for both SLAP repair and BT exhibit massive variability when treating SLAP tears in overhead throwers. Level of Evidence: Level IV, systematic review of Level III and IV studies.