{"paper_id":"344675eb-002c-4477-bd36-9c68e663ccc3","body_text":"Short-term clinical outcomes of biceps tenodesis and SLAP repair for Type V SLAP lesions caused by anterior shoulder instability in active-duty military patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Short-term clinical outcomes of biceps tenodesis and SLAP repair for Type V SLAP lesions caused by anterior shoulder instability in active-duty military patients Peng Zhou, Fei Han, MaoSheng Zhao, ShenSong Li, Peng Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4455016/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To compare the outcomes of arthroscopic Bankart repair combined with arthroscopic SLAP repair and arthroscopic Bankart repair combined with subpectoral biceps tenodesis in active-duty military individuals with type V SLAP lesions. Methods From June 2015 to June 2021, all patients with type V SLAP lesions who underwent Bankart repair surgery simultaneously with arthroscopic SLAP repair or combined with biceps tenodesis and who were followed up for at least 2 years were included in the study. The clinical data of 28 patients who underwent Bankart repair combined with arthroscopic SLAP repair (repair group) were compared with those of 22 patients who underwent arthroscopic Bankart repair combined with suprascapular biceps tenodesis (tenodesis group). The findings of the preoperative and postoperative clinical assessments, physical examination, injury mechanism assessment, and magnetic resonance imaging (MRI) examination were reviewed. Patient-reported disabilities of the arm, shoulder, and hand (DASH) scores, Western Ontario Shoulder Instability Index (WOSI) scores, American Shoulder and Elbow Surgeons (ASES) scores, and visual analog scale (VAS) scores for pain and satisfaction were evaluated. Results Both groups of patients met the study's inclusion criteria. There was no significant difference between the groups in terms of preoperative range of motion or outcome evaluations. The DASH, ASES, WOSI, and VAS scores of the two groups were significantly greater at the last follow-up than before surgery (P < 0.01). Compared with the repair group, the tenodesis group had significantly better postoperative WOSI and DASH scores (P < 0.01). Conclusion Both arthroscopic Bankart repair combined with suprascapular biceps tenodesis and arthroscopic Bankart repair combined with SLAP lesion repair can effectively treat type V SLAP lesions, as indicated by significant improvements in postoperative clinical outcomes and pain scores. However, we found that early clinical outcomes are better for biceps tenodesis combined with anterior labral repair than for arthroscopic type V SLAP lesion repair in active-duty military patients. Level of evidence: Level III. V-type SLAP biceps tenodesis SLAP repair labrum lesion Figures Figure 1 Figure 2 Introduction Shoulder instability is caused by the displacement of the humeral head or its failure to remain in the center of the glenoid. The main clinical manifestation is dislocation or subluxation, which refers to the complete or partial detachment of the humeral head from the glenoid joint under external force [ 1 ] . Superior labral anterior to posterior (SLAP) lesions were first described by Andrews et al. and named by Snyder et al. [ 2 , 3 ] . Maffet and Powell improved the SLAP classification [ 4 , 5 ] . Slap lesions involve the upper labrum and long head of the biceps tendon (LHBT), which are important structures for maintaining the stability of the shoulder joint, and disrupting their mechanism of action causes shoulder joint instability. Shoulder instability, in turn, can also cause tears in the superior labrum and LHBT, and there is a certain reciprocal causal relationship between the two [ 6 , 7 ] . Among all types of SLAP lesions, type V SLAP lesions have a greater impact on the stability of the shoulder joint due to their accompanying Bankart injury [ 8 ] . Provencher et al evaluated the clinical results of 179 military patients with type II SLAP lesions who underwent arthroscopic repair and reported that 37% of the patients had unsatisfactory clinical outcomes, and 28% of patients underwent revision surgery with biceps tenodesis [ 9 ] . Parnes et al. directly compared the results of young military patients with type II lesions and discovered that arthroscopic-assisted subpectoral biceps tenodesis can produce excellent functional results while reducing the failure rate [ 10 ] . However, Green et al. showed that SLAP repair and biceps tenodesis with posterior labral repair were equally effective in treating type VIII SLAP lesions [ 11 ] . Data published on the surgical treatment of type V SLAP lesions are limited in the literature. The aim of this study was to compare the short-term clinical efficacy of arthroscopic Bankart repair combined with arthroscopic SLAP repair with that of arthroscopic Bankart repair combined with subpectoral biceps tenodesis for the treatment of type V SLAP lesions in active-duty military individuals. In this study, we hypothesized that arthroscopic Bankart repair combined with subpectoral biceps tenodesis would be more effective than would arthroscopic Bankart repair combined with arthroscopic SLAP repair for the treatment of type V SLAP lesions in active-duty military individuals. Materials and methods Patient Selection A retrospective analysis of the clinical data of military individuals who underwent surgical intervention for shoulder instability from June 2015 to June 2021 was conducted. Before beginning the study, the institutional review board the institutional research ethics committee of the 940th Hospital of Logistics Support Force of PLA gave their approval, all methods were carried out in accordance with relevant guidelines and regulations. All patients obtained informed consent and signed informed consent regarding publishing their data and photographs. The inclusion criteria were as follows: (1) aged between 18 and 50 years; (2) had preoperative physical examination results from the Apprehension Test, Anterior Drawer Test, and O'Brien test results and positive magnetic resonance imaging findings for V-type SLAP lesions; and (3) underwent intraoperative arthroscopy further confirming type V SLAP lesions. The exclusion criteria were as follows: (1) had other shoulder joint injuries, such as complete rotator cuff tear and acromioclavicular joint dislocation; (2) had other shoulder joint injuries combined with compound injuries outside the Bankart lesion area, such as Off-track Hill-Sachs lesions; (3) had other types of SLAP lesions; and (4) had previous shoulder operation. We treated a total of 243 patients with shoulder instability. According to the inclusion and exclusion criteria, fifty patients met the inclusion criteria, and all patients were diagnosed with type V SLAP lesions. All patient procedures were performed by the same team of skilled surgeons. This study included 28 patients with type V SLAP lesions who underwent Bankart repair combined with arthroscopic SLAP repair from June 2015 to January 2018 (repair group). The clinical data of 22 patients with type V SLAP lesions who underwent arthroscopic Bankart repair combined with suprascapular biceps tenodesis (tenodesis group) from June 2018 to June 2021 were selected and compared with the clinical data of the repair group. All patients underwent postoperative radiological examination. Shoulder function was assessed using the O'Brien test, speed test, and Yergason test at 6 and 24 months postoperatively for follow-up evaluation. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and pain visual analog scale (VAS) scores were used to assess shoulder joint function at 6, 12 and 24 months after the operation. Surgical procedure After receiving general anesthesia, the patient was placed in the lateral decubitus position. Arthroscopy performed via the standard posterior portal identified a type V SLAP (concurrent Bankart and type II SLAP) lesion, and an anterior portal was used to probe for dissection of the tendon of the long head of the biceps brachii. For patients in the repair group, operative portals were established on the front and anterolateral sides, and 2–3 absorbable suture anchors (3.0 mm Gryphon BR, DePuy Mitek Inc., Switzerland) were implanted to repair the anterior inferior glenoid labrum according to the location and size of the SLAP tear. An absorbable suture anchor was then implanted through the anterolateral portal, and the superior labrum lesions were fixed with an SMC knot after simple suturing (a typical case is shown in Fig. 1 ). For the tenodesis group, after repairing the anterior inferior glenoid labrum, the subacromial space was evaluated from the anterolateral portal. An arthroscopic portal was created at the level of the highest point of the axillary fold on the upper border of the pectoralis major muscle, and the long head tendon of the biceps was released using an arthroscopic shaver and temperature-controlled plasma radiofrequency. Two 2.0-mm sutures (Orthocord®; DePuy Synthes, West Chester, PA, USA) were used to bypass and puncture the tendon at the long head of the biceps, and after ligating the tendon using the lasso-loop configuration, the tail ends of the four sutures were pulled out of the anterior portal. These four strands of suture were threaded into a 4.9-mm knotless suture anchor (Versalok®; DePuy Synthes), which was then implanted in the upper edge of the pectoralis major muscle after drilling a hole in the anterior humeral cortex and adjusting the suture tension. Finally, the proximal end of the biceps brachii was cut off within the glenohumeral joint. A typical patient is shown in Fig. 2 . Postoperative Rehabilitation Both groups of patients were provided with shoulder rehabilitation plans and physical therapy guidance by the same physical therapist. Postoperatively, patients wore a shoulder brace for 6 weeks and were allowed to perform passive movements such as shrugging, pendulum, and elbow flexion. The patients gradually began performing active shoulder and elbow exercises after 6 weeks. Patients could resume daily activities after three months. Over-the-top activities were avoided within 1 year after surgery. After evaluation and clearance by the doctor, patients were allowed to resume overhead activities at 1 year postoperatively. Throwing-type activities could be resumed at 18 months postoperatively based on follow-up. Statistical Analysis The SPSS software package (version 22.0; IBM, Armonk, NY, USA) was used for statistical analysis. The variations between the preoperative and postoperative results were compared using paired t tests. The threshold for significance in all analyses was set at p < 0.01. Results Table 1 shows the demographics of the study population. The repair group had a mean follow-up time of 28.59 ± 4.98 months, and the fixation group had a mean follow-up time of 27.50 ± 6.11 months. All surgeries were completed without obvious complications, and no Popeye signs were observed in the fixation group after surgery. All patients underwent follow-up evaluations. For all patients, the shortest follow-up period was 24 months. At the last follow-up, the DASH, ASES, WOSI, and VAS scores of the two groups were significantly greater than those before surgery (P < 0.01). Compared with those before surgery, the symptoms of shoulder joint anteflexion in the repair group were significantly improved. (Table 2 ) (P < 0.01). At the final follow-up, the postoperative WOSI and DASH scores in the tenodesis group were significantly greater than those in the repair group (P < 0.01). There was no significant difference in shoulder joint mobility, ASES score, or VAS score between the two groups. During this study, 23 patients in the repair group recovered to their preinjury training state. However, Five patients could not perform horizontal bar pull-up exercises or throwing exercises because of limited shoulder flexion, and four of these patients had shoulder instability due to postoperative retraumatization, which required revision surgery with suprascapular biceps tenodesis. A total of four patients in the tenodesis group experienced symptoms of biceps brachii stimulation in the early postoperative period, and the symptoms were relieved at the last follow-up. Three patients did not return to their preoperative motion status. At the last follow-up, there were no cases of failure that led to revision surgery in the tenodesis group, and the results of all the patients' O'Brien, Speed, and Yergason tests of the shoulder joints were negative. Table 1 Demographic Data Patients SLAP Repair (N = 28) Biceps Fixation (N = 22) Follow-up, months, mean ± SD 28.59 ± 4.98 27.50 ± 6.11 Age, years, mean ± SD 25.50 ± 7.47 31.36 ± 6.06 Sex, male/female, n (%) 26(92.9%)/2 (7.1%) 22(100%)/0 (0%) Body mass index 23.87 ± 1.05 23.58 ± 0.93 Smoking/no smoking 16 (57.1%)/12 (42.9%) 13 (59.1%)/9 (40.9%) Secondary injury (acute/chronic) 1 (25.0%)/3 (75.0%) 0(0%) Time from the first surgery to the second, months, mean ± SD 16.00 ± 3.07 0 Biceps brachii irritation symptoms 0 (0%) 4(18%) Operative time(minutes) 70.11 ± 14.18 67.64 ± 12.37 The data are presented as the mean ± standard deviation (SD) unless otherwise indicated. Table 2 Preoperative and Postoperative Outcomes Between Groups Repair Group (n = 28) Tenodesis Group(n = 22) T Value P Value Forward flexion ROM(°) Preoperative 143.57 ± 11.54 145.00 ± 11.55 0.43 0.67 Last follow-up 150.18 ± 7.00 150.91 ± 6.48 0.38 0.71 T Value 2.82 2.29 P Value <0.01 0.03 External rotation ROM(°) Preoperative 39.25 ± 2.91 39.77 ± 2.47 0.67 0.50 Last follow-up 39.39 ± 2.31 39.77 ± 1.95 0.62 0.54 T Value 0.23 0.00 P Value 0.82 1.00 Internal rotation ROM(°) Preoperative 63.82 ± 5.85 64.45 ± 4.54 0.42 0.68 Last follow-up 63.36 ± 5.70 64.91 ± 3.60 1.11 0.27 T Value 0.68 0.71 P Value 0.50 0.49 DASH score Preoperative 60.93 ± 5.46 61.32 ± 6.07 0.24 0.81 Last follow-up 22.96 ± 15.26 13.27 ± 2.75 3.29 <0.01 T Value 12.12 41.11 P Value <0.01 <0.01 ASES score Preoperative 55.07 ± 11.29 54.95 ± 12.30 0.49 0.04 Last follow-up 83.46 ± 11.61 84.41 ± 12.03 0.39 0.28 T Value 9.28 8.03 P Value <0.01 <0.01 VAS pain score Preoperative 4.89 ± 0.79 4.55 ± 1.18 1.19 0.24 Last follow-up 2.14 ± 0.89 1.95 ± 0.58 0.86 0.39 T Value 20.77 10.66 P Value <0.01 <0.01 WOSI score Preoperative 1505.54 ± 112.67 1492.05 ± 128.99 0.69 0.50 Last follow-up 718.57 ± 353.48 514.09 ± 91.98 2.94 <0.01 T Value 11.68 34.95 P Value <0.01 <0.01 The data are presented as the mean ± standard deviation (SD) unless otherwise indicated. DASH Disabilities of the Arm, Shoulder, and Hand Questionnaire, ASES American Shoulder and Elbow Surgeons, VAS visual analog scale, WOSI the western Ontario shoulder instability index. Discussion Multiple studies have shown that most shoulder joint SLAP lesions gradually develop on the basis of recurrent instability of the shoulder joint. The severity and scope of SLAP lesions increase with time and the number of dislocations [ 12 – 15 ] . Superior labrum lesions are most likely secondary to primary anterior shoulder instability, and the extension of superior labrum lesions leading to more severe total labrum lesions is also associated with shoulder instability [ 16 ] . Tokish et al reported that most of the studies on primary shoulder anterior instability have shown that the biceps tendon-labrum complex has a dynamic stabilizing effect on the shoulder joint, and SLAP lesions destroy this stabilizing effect and subsequently cause shoulder instability [ 17 ] . Moreover, SLAP lesions not only damage the upper labrum and destroy the shoulder joint's static stability mechanism but also affect the insertion point of the LHBT, weaken its stabilizing effect on the shoulder joint, and cause symptoms of shoulder joint instability. SLAP lesions disrupt the static stabilization of the glenoid labrum, impairing the ability of the shoulder joint to resist external forces. Notably, acute or chronic shoulder instability, whether caused by dislocation or subluxation, can in turn exacerbate SLAP lesions. In particular, complex type V-X SLAP injuries are considered closely related to shoulder instability [ 18 ] . According to Koss et al. [ 19 ] and Habermeyer et al. [ 20 ] , type V SLAP injury is not uncommon in patients with chronic recurrent shoulder instability. As the number of dislocations increased and the time from the first dislocation increased, the SLAP lesions tended to gradually exacerbate the labrum injury and increase the tear range. It has been suggested that recurrent and prolonged preoperative shoulder dislocation are the main reasons for the worsening of SLAP lesions [ 21 ] ; however, Kim et al. reported that the incidence of type V SLAP lesions in patients with initial shoulder dislocation was approximately 42.8%, whereas the incidence in patients with recurrent dislocations was low, at approximately 32.0% [ 22 ] . In addition, they found that 68.7% of patients with extensive glenoid labrum tears had fewer than 5 joint dislocations, and they concluded that the increase in the number of dislocations and the time from injury to surgery may not necessarily lead to worsening of the labrum tear or widening of the tear range. Severe SLAP lesion formation was correlated with the magnitude of trauma at the time of the patient's injury. Sarikaya et al. [ 23 ] also found no significant difference in the preoperative symptom duration or the trauma mechanism between patients with and without isolated Bankart lesions, and they found that exacerbation of glenoid labral injury may be more strongly correlated with the severity of the initial trauma. We believe that SLAP lesions caused by shoulder instability can be caused not only by chronic recurrent dislocations but also by high-energy trauma during initial dislocations. Our research results indicated that biceps tenodesis combined with Bankart repair was an effective alternative to arthroscopic type V SLAP repair for active-duty military individuals. The tenodesis group had better postoperative outcomes and scores and lower revision rates in the early follow-up period. During our grassroots rounds, we found that physically demanding shoulder movements during military training led to an increased risk of glenohumeral injuries in soldiers. Waterman et al. [ 24 ] retrospectively analyzed the rate of SLAP lesions in the US military and reported that the incidence of SLAP lesions has increased annually, especially with age. Although there are no current studies reporting the incidence of type V SLAP lesions in military individuals, military personnel perform more training exercises than civilians, so the incidences of shoulder instability and SLAP injuries are greater. In addition, Beyzadeoglu et al. [ 25 ] noted that 37.1% of elite athletes with SLAP injuries have Bankart lesions. In the past, such lesions were usually treated as two independent injuries in the arthroscopic examination of patients with clinically unstable shoulder joints. According to the study described by Maffet et al. [ 26 ] , type II SLAP lesions combined with Bankart lesions should be classified as type V SLAP lesions. Although SLAP lesions are frequently diagnosed in military patients, surgical treatment remains challenging. In active-duty military individuals, biceps tenodesis combined with arthroscopic posterior labral repair has been shown to produce good results [ 11 ] . Hurley et al. [ 27 ] conducted a meta-analysis and reported that bicipital tenodesis improved patient satisfaction and shortened the return to sport time and that patients treated with either bicipital tenodesis or SLAP repair had comparable functional outcome scores. In their later study, they found that biceps tenodesis was an effective and safe alternative to SLAP repair in patients under 30 years of age with isolated type II-IV SLAP lesions [ 28 ] . In our study, we found that all patients were able to return to active service at the last follow-up, and the return-to-sport rate in the SLAP repair group (71.4%) was lower than that in the biceps tenodesis group (81.8%). Since 2015, we have performed SLAP repair combined with Bankart repair on patients with type V SLAP injuries. Although patients were advised to avoid throwing activities for 18 months, 4 patients (14%) in the repair group ultimately experienced shoulder instability due to overhead movement, which affected training. Ultimately, all patients underwent biceps tenodesis, and no symptoms of instability reappeared at the last follow-up. A biomechanical study by Itoigawa et al. revealed that repairing Bankart lesions alone did not compromise shoulder stability in a type V SLAP lesion model, indicating that the remaining type II SLAP injury after Bankart repair would not cause shoulder instability [ 29 ] . Hantes et al. found through a cohort study that patients with type V SLAP injuries who underwent surgical repair had a greater level of satisfaction, better functional outcomes, and less residual pain than those in the conservative control group [ 12 ] . However, Hogan et al. discovered that after arthroscopic repair, patients who underwent Type V SLAP repair had significantly lower rates of return-to-sport at the same or higher level than patients in the isolated Bankart repair group [ 30 ] . The reason for the failure of SLAP repair in this study was that we restricted the patients’ throwing activities until 18 months after surgery, but all patients with recurrent instability were injured again 1 year after surgery due to overhead movements such as horizontal bar pull-up exercises and obstacle running that caused the affected limb to support their body weight. In our study, MRI and arthroscopic examinations of all the patients whose SLAP repairs failed revealed tears or incomplete healing of the superior glenoid labrum, satisfactory repair of the inferior glenoid labrum, and that the prominent characteristic of this injury was related to the type of training exercises the subjects performed during their postoperative recovery training. During the follow-up of the patients in the repair group, we performed bicipital tenodesis revision surgery for patients whose SLAP repairs failed. Since 2018, patients with type V SLAP injuries have been treated with biceps tenodesis combined with Bankart repair, and the results of late clinical follow-up have been satisfactory. McCormick et al. prospectively evaluated the results of biceps tenodesis revision surgery in patients whose arthroscopic repair of type II SLAP lesions failed and discovered that 81% of patients returned to active duty and sports at a mean of 3.5 years postoperatively [ 31 ] . Therefore, they concluded that biceps tenodesis can be used as the initial or revision surgery for the treatment of type II SLAP lesions, but for high-level athletes, biceps tenodesis should be performed cautiously when it is the initial surgery or revision surgery after SLAP repair failure. However, the findings of this study showed that while the shoulder joint can retain normal biomechanics after SLAP repair, the results after returning to sports were not entirely satisfactory. Biceps tenodesis for the treatment of a specific patient population of active-duty military personnel has shown good postoperative clinical follow-up results, including a high level of patient satisfaction, when performed as either the initial or revision procedure. Therefore, we believe that after adequate clinical evaluation of the indications for SLAP suture repair and biceps tenodesis, patients should be provided with relevant literature and data that describe the benefits and risks of both procedures to choose the best treatment plan based on their needs and desire for future return to sports. Limitations Due to its retrospective design, this research has several limitations. First, the sample size was small, and most of the patients were male. Second, this study included patients between the ages of 18 and 50 years, whereas previous studies on these lesions limited the age of patients to younger than 35 years. Third, all our research subjects were active-duty military personnel, so the findings did not apply to the general population. Finally, this study had a short follow-up period, and additional prospective studies with longer follow-up periods are needed to evaluate the results of biceps tenodesis combined with Bankart repair procedures. Conclusion Both arthroscopic Bankart repair combined with suprascapular biceps tenodesis and arthroscopic Bankart repair combined with SLAP repair can effectively treat type V SLAP lesions in military individuals, as noted by significant improvements in postoperative clinical outcomes and pain scores. Our research results indicate that bicipital tenodesis combined with anterior labral repair has better early clinical outcomes than arthroscopic type V SLAP repair in active-duty military patients with type V lesions. Abbreviations SLAP Superior labral anterior to posterior MRI Magnetic resonance imaging DASH Patient-reported disabilities of the arm, shoulder, and hand WOSI Western Ontario Shoulder Instability Index ASES American Shoulder and Elbow Surgeons VAS Visual analog scale Declarations Funding No funding was provided for the completion of this study. Ethics Approval This study was approved by the ethics committee of (NO 2023KYLL289). Competing interests The authors have declared that there are no competing interests. Data availability The data that support the findings of this study are available from the corresponding author, [Peng Zhang], upon reasonable request. Acknowledgements We would like to thank AJE Author Services for helping us to improve our manuscript language in English writing. References Pappas AM, Goss TP, Kleinman PK (1983) Symptomatic shoulder instability due to lesions of the glenoid labrum. Am J Sports Med 11:279-288. https://doi.org/10.1177/036354658301100501. 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Knee Surg Sports Traumatol Arthrosc 21(2):430-437. https://doi.org/10.1007/s00167-012-2045-z. Sarikaya B, Bozkurt C, Gül O, Bekin Sarıkaya PZ, Sipahioğlu S, Altay MA (2020) Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair. Jt Dis Relat Surg 31:223-229. https://doi.org/ 10.5606/ehc.2020.74750. Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD (2015) Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc 23:1453-1459. https://doi.org/ 10.1007/s00167-013-2798-z. Beyzadeoglu T, Circi E (2015) Superior Labrum Anterior Posterior Lesions and Associated Injuries: Return to Play in Elite Athletes. Orthop J Sports Med 3:2325967115577359. https://doi.org/10.1177/2325967115577359. Maffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93-98. https://doi.org/10.1177/036354659502300116. Hurley ET, Fat DL, Duigenan CM, Miller JC, Mullett H, Moran CJ (2018) Biceps tenodesis versus labral repair for superior labrum anterior-to-posterior tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 27:1913-1919. https://doi.org/10.1016/j.jse.2018.04.011. Hurley ET, Colasanti CA, Lorentz NA, Campbell KA, Alaia MJ, Strauss EJ, Matache BA, Jazrawi LM (2022) Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30. Arthroscopy 38:307-312. https://doi.org/10.1016/j.arthro.2021.07.028. Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN (2020) Bankart repair alone in combined Bankart and superior labral anterior-posterior lesions preserves range of motion without compromising joint stability. JSES Int 4:63-67. https://doi.org/10.1016/j.jseint.2019.11.001. Hantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN (2009) Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med 37:1093-1098. https://doi.org/ 10.1177/0363546508331139. McCormick F, Nwachukwu BU, Solomon D, Dewing C, Golijanin P, Gross DJ, Provencher MT (2014) The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs. Am J Sports Med 42:820-825. https://doi.org/10.1177/0363546513520122. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4455016\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":311335206,\"identity\":\"72f4f00b-c3f2-4f31-82cd-d3db4df2f69f\",\"order_by\":0,\"name\":\"Peng Zhou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Peng\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"},{\"id\":311335207,\"identity\":\"4f255fb5-a6d3-466f-b015-758c44903f38\",\"order_by\":1,\"name\":\"Fei Han\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Nantong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Fei\",\"middleName\":\"\",\"lastName\":\"Han\",\"suffix\":\"\"},{\"id\":311335208,\"identity\":\"c80ef808-aebf-4cf2-8369-3a0ad8d83d12\",\"order_by\":2,\"name\":\"MaoSheng Zhao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"MaoSheng\",\"middleName\":\"\",\"lastName\":\"Zhao\",\"suffix\":\"\"},{\"id\":311335209,\"identity\":\"405eb1a4-3f3c-4f34-ab22-8c64df83f8c8\",\"order_by\":3,\"name\":\"ShenSong Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"ShenSong\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":311335210,\"identity\":\"79c84d12-72b8-4133-9d9a-268853cdaa81\",\"order_by\":4,\"name\":\"Peng Zhang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBAC+xkINuODhIoawloYkbQwGzw4c4w0LWySD1uYCWthlm5+9vDrDps8+YjstIrEBjYG/vbuBLxa2GSOmRvLnkkrNryRu+1G4g4ZBokzZzfg1cIjkWAmLdl2OHHjDJCWM2wMBhK5+LVISKR/A2r5D9ZSkNjGTFiLgUSOmeTHtgOJ8yVytzEQq6VMmvFMcuIGnrebJRLOHOMh6Bf7GenbJH/usEuc35678eOPiho5/vZe/FpAgJm3AWjdhQQwh4egchBg/AnUIt9/gCjFo2AUjIJRMAIBANHTTgbnMFhMAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Fudan University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Peng\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-05-21 13:01:22\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4455016/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4455016/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":58171762,\"identity\":\"f0611404-63d7-4e55-b07a-ae7532f2ba60\",\"added_by\":\"auto\",\"created_at\":\"2024-06-12 03:49:21\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1317709,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTypical case. A 26-year-old male patient suffered from right shoulder joint instability caused by trauma for more than 9 months. Fig a\\u0026amp;b show tears in the right shoulder upper and anterior lower glenoid lips within the glenoid humeral joint, indicating a V-shaped SLAP lesion. Fig c\\u0026amp;d showthat the superior and anteroinferior labra in the glenohumeral joint were in good internal fixation positionsafter repair.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4455016/v1/b166ef69f43419264efa09a0.png\"},{\"id\":58171761,\"identity\":\"58c8bdbe-a5bc-4df4-ad72-0c319e918ead\",\"added_by\":\"auto\",\"created_at\":\"2024-06-12 03:49:21\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1567358,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTypical case. A 35-year-old male patient suffered from left shoulder joint instability caused by trauma for 2 years. Fig a shows tears in the upper and anterior lower glenoid lips of the left shoulder within the glenoid humeral joint, indicating a V-shaped SLAP lesion. Fig b showsthe separation of the long head tendon of the biceps brachii muscle from the intertubercular sulcus in the subacromial space. c Lasso loop ligation of the biceps brachii muscle in the subacromial space. d Fixation of the biceps brachii muscle to the upper edge of the pectoralis major muscle using an external anchor screw in the subacromial space.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4455016/v1/de9d72b50c9a06249b58ec43.png\"},{\"id\":75002599,\"identity\":\"47093e77-7299-42c8-ae63-dfb74945f7b6\",\"added_by\":\"auto\",\"created_at\":\"2025-01-29 10:02:06\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":3481015,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4455016/v1/989fc442-18ae-4a2a-8b69-4b31512b364b.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Short-term clinical outcomes of biceps tenodesis and SLAP repair for Type V SLAP lesions caused by anterior shoulder instability in active-duty military patients\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eShoulder instability is caused by the displacement of the humeral head or its failure to remain in the center of the glenoid. The main clinical manifestation is dislocation or subluxation, which refers to the complete or partial detachment of the humeral head from the glenoid joint under external force \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. Superior labral anterior to posterior (SLAP) lesions were first described by Andrews et al. and named by Snyder et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. Maffet and Powell improved the SLAP classification \\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. Slap lesions involve the upper labrum and long head of the biceps tendon (LHBT), which are important structures for maintaining the stability of the shoulder joint, and disrupting their mechanism of action causes shoulder joint instability. Shoulder instability, in turn, can also cause tears in the superior labrum and LHBT, and there is a certain reciprocal causal relationship between the two \\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. Among all types of SLAP lesions, type V SLAP lesions have a greater impact on the stability of the shoulder joint due to their accompanying Bankart injury \\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eProvencher et al evaluated the clinical results of 179 military patients with type II SLAP lesions who underwent arthroscopic repair and reported that 37% of the patients had unsatisfactory clinical outcomes, and 28% of patients underwent revision surgery with biceps tenodesis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. Parnes et al. directly compared the results of young military patients with type II lesions and discovered that arthroscopic-assisted subpectoral biceps tenodesis can produce excellent functional results while reducing the failure rate \\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. However, Green et al. showed that SLAP repair and biceps tenodesis with posterior labral repair were equally effective in treating type VIII SLAP lesions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. Data published on the surgical treatment of type V SLAP lesions are limited in the literature.\\u003c/p\\u003e \\u003cp\\u003eThe aim of this study was to compare the short-term clinical efficacy of arthroscopic Bankart repair combined with arthroscopic SLAP repair with that of arthroscopic Bankart repair combined with subpectoral biceps tenodesis for the treatment of type V SLAP lesions in active-duty military individuals. In this study, we hypothesized that arthroscopic Bankart repair combined with subpectoral biceps tenodesis would be more effective than would arthroscopic Bankart repair combined with arthroscopic SLAP repair for the treatment of type V SLAP lesions in active-duty military individuals.\\u003c/p\\u003e\"},{\"header\":\"Materials and methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient Selection\\u003c/h2\\u003e \\u003cp\\u003eA retrospective analysis of the clinical data of military individuals who underwent surgical intervention for shoulder instability from June 2015 to June 2021 was conducted. Before beginning the study, the institutional review board the institutional research ethics committee of the 940th Hospital of Logistics Support Force of PLA gave their approval, all methods were carried out in accordance with relevant guidelines and regulations. All patients obtained informed consent and signed informed consent regarding publishing their data and photographs. The inclusion criteria were as follows: (1) aged between 18 and 50 years; (2) had preoperative physical examination results from the Apprehension Test, Anterior Drawer Test, and O'Brien test results and positive magnetic resonance imaging findings for V-type SLAP lesions; and (3) underwent intraoperative arthroscopy further confirming type V SLAP lesions. The exclusion criteria were as follows: (1) had other shoulder joint injuries, such as complete rotator cuff tear and acromioclavicular joint dislocation; (2) had other shoulder joint injuries combined with compound injuries outside the Bankart lesion area, such as Off-track Hill-Sachs lesions; (3) had other types of SLAP lesions; and (4) had previous shoulder operation. We treated a total of 243 patients with shoulder instability. According to the inclusion and exclusion criteria, fifty patients met the inclusion criteria, and all patients were diagnosed with type V SLAP lesions. All patient procedures were performed by the same team of skilled surgeons. This study included 28 patients with type V SLAP lesions who underwent Bankart repair combined with arthroscopic SLAP repair from June 2015 to January 2018 (repair group). The clinical data of 22 patients with type V SLAP lesions who underwent arthroscopic Bankart repair combined with suprascapular biceps tenodesis (tenodesis group) from June 2018 to June 2021 were selected and compared with the clinical data of the repair group. All patients underwent postoperative radiological examination. Shoulder function was assessed using the O'Brien test, speed test, and Yergason test at 6 and 24 months postoperatively for follow-up evaluation. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and pain visual analog scale (VAS) scores were used to assess shoulder joint function at 6, 12 and 24 months after the operation.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSurgical procedure\\u003c/h2\\u003e \\u003cp\\u003eAfter receiving general anesthesia, the patient was placed in the lateral decubitus position. Arthroscopy performed via the standard posterior portal identified a type V SLAP (concurrent Bankart and type II SLAP) lesion, and an anterior portal was used to probe for dissection of the tendon of the long head of the biceps brachii. For patients in the repair group, operative portals were established on the front and anterolateral sides, and 2\\u0026ndash;3 absorbable suture anchors (3.0 mm Gryphon BR, DePuy Mitek Inc., Switzerland) were implanted to repair the anterior inferior glenoid labrum according to the location and size of the SLAP tear. An absorbable suture anchor was then implanted through the anterolateral portal, and the superior labrum lesions were fixed with an SMC knot after simple suturing (a typical case is shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). For the tenodesis group, after repairing the anterior inferior glenoid labrum, the subacromial space was evaluated from the anterolateral portal. An arthroscopic portal was created at the level of the highest point of the axillary fold on the upper border of the pectoralis major muscle, and the long head tendon of the biceps was released using an arthroscopic shaver and temperature-controlled plasma radiofrequency. Two 2.0-mm sutures (Orthocord\\u0026reg;; DePuy Synthes, West Chester, PA, USA) were used to bypass and puncture the tendon at the long head of the biceps, and after ligating the tendon using the lasso-loop configuration, the tail ends of the four sutures were pulled out of the anterior portal. These four strands of suture were threaded into a 4.9-mm knotless suture anchor (Versalok\\u0026reg;; DePuy Synthes), which was then implanted in the upper edge of the pectoralis major muscle after drilling a hole in the anterior humeral cortex and adjusting the suture tension. Finally, the proximal end of the biceps brachii was cut off within the glenohumeral joint. A typical patient is shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePostoperative Rehabilitation\\u003c/h2\\u003e \\u003cp\\u003eBoth groups of patients were provided with shoulder rehabilitation plans and physical therapy guidance by the same physical therapist. Postoperatively, patients wore a shoulder brace for 6 weeks and were allowed to perform passive movements such as shrugging, pendulum, and elbow flexion. The patients gradually began performing active shoulder and elbow exercises after 6 weeks. Patients could resume daily activities after three months. Over-the-top activities were avoided within 1 year after surgery. After evaluation and clearance by the doctor, patients were allowed to resume overhead activities at 1 year postoperatively. Throwing-type activities could be resumed at 18 months postoperatively based on follow-up.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eThe SPSS software package (version 22.0; IBM, Armonk, NY, USA) was used for statistical analysis. The variations between the preoperative and postoperative results were compared using paired t tests. The threshold for significance in all analyses was set at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows the demographics of the study population. The repair group had a mean follow-up time of 28.59\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.98 months, and the fixation group had a mean follow-up time of 27.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.11 months. All surgeries were completed without obvious complications, and no Popeye signs were observed in the fixation group after surgery. All patients underwent follow-up evaluations. For all patients, the shortest follow-up period was 24 months. At the last follow-up, the DASH, ASES, WOSI, and VAS scores of the two groups were significantly greater than those before surgery (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). Compared with those before surgery, the symptoms of shoulder joint anteflexion in the repair group were significantly improved. (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). At the final follow-up, the postoperative WOSI and DASH scores in the tenodesis group were significantly greater than those in the repair group (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). There was no significant difference in shoulder joint mobility, ASES score, or VAS score between the two groups. During this study, 23 patients in the repair group recovered to their preinjury training state. However, Five patients could not perform horizontal bar pull-up exercises or throwing exercises because of limited shoulder flexion, and four of these patients had shoulder instability due to postoperative retraumatization, which required revision surgery with suprascapular biceps tenodesis. A total of four patients in the tenodesis group experienced symptoms of biceps brachii stimulation in the early postoperative period, and the symptoms were relieved at the last follow-up. Three patients did not return to their preoperative motion status. At the last follow-up, there were no cases of failure that led to revision surgery in the tenodesis group, and the results of all the patients' O'Brien, Speed, and Yergason tests of the shoulder joints were negative.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDemographic Data\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePatients\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eSLAP Repair (N\\u0026thinsp;=\\u0026thinsp;28)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eBiceps Fixation (N\\u0026thinsp;=\\u0026thinsp;22)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eFollow-up, months, mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28.59\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge, years, mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e31.36\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSex, male/female, \\u003cem\\u003en\\u003c/em\\u003e (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26(92.9%)/2 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22(100%)/0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBody mass index\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.93\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSmoking/no smoking\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16 (57.1%)/12 (42.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13 (59.1%)/9 (40.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSecondary injury (acute/chronic)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (25.0%)/3 (75.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eTime from the first surgery to the second, months, mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBiceps brachii irritation symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(18%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eOperative time(minutes)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e70.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e67.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.37\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe data are presented as the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD) unless otherwise indicated.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePreoperative and Postoperative Outcomes Between Groups\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRepair Group (n\\u0026thinsp;=\\u0026thinsp;28)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTenodesis Group(n\\u0026thinsp;=\\u0026thinsp;22)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e Value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eForward flexion ROM(\\u0026deg;)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e143.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e145.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e150.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e150.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eExternal rotation ROM(\\u0026deg;)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e39.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e39.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInternal rotation ROM(\\u0026deg;)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e63.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.85\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64.45\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e63.36\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDASH score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e60.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e61.32\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.81\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22.96\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eASES score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e55.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.95\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e83.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84.41\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVAS pain score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.89\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.14\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.89\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.95\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.66\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWOSI score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePreoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1505.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;112.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1492.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;128.99\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLast follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e718.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;353.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e514.09\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;91.98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eT Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eP Value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe data are presented as the mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD) unless otherwise indicated. DASH Disabilities of the Arm, Shoulder, and Hand Questionnaire, ASES American Shoulder and Elbow Surgeons, VAS visual analog scale, WOSI the western Ontario shoulder instability index.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eMultiple studies have shown that most shoulder joint SLAP lesions gradually develop on the basis of recurrent instability of the shoulder joint. The severity and scope of SLAP lesions increase with time and the number of dislocations \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR13 CR14\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e. Superior labrum lesions are most likely secondary to primary anterior shoulder instability, and the extension of superior labrum lesions leading to more severe total labrum lesions is also associated with shoulder instability \\u003csup\\u003e[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e. Tokish et al reported that most of the studies on primary shoulder anterior instability have shown that the biceps tendon-labrum complex has a dynamic stabilizing effect on the shoulder joint, and SLAP lesions destroy this stabilizing effect and subsequently cause shoulder instability \\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. Moreover, SLAP lesions not only damage the upper labrum and destroy the shoulder joint's static stability mechanism but also affect the insertion point of the LHBT, weaken its stabilizing effect on the shoulder joint, and cause symptoms of shoulder joint instability. SLAP lesions disrupt the static stabilization of the glenoid labrum, impairing the ability of the shoulder joint to resist external forces. Notably, acute or chronic shoulder instability, whether caused by dislocation or subluxation, can in turn exacerbate SLAP lesions. In particular, complex type V-X SLAP injuries are considered closely related to shoulder instability \\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. According to Koss et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e and Habermeyer et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e, type V SLAP injury is not uncommon in patients with chronic recurrent shoulder instability. As the number of dislocations increased and the time from the first dislocation increased, the SLAP lesions tended to gradually exacerbate the labrum injury and increase the tear range. It has been suggested that recurrent and prolonged preoperative shoulder dislocation are the main reasons for the worsening of SLAP lesions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e; however, Kim et al. reported that the incidence of type V SLAP lesions in patients with initial shoulder dislocation was approximately 42.8%, whereas the incidence in patients with recurrent dislocations was low, at approximately 32.0% \\u003csup\\u003e[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e. In addition, they found that 68.7% of patients with extensive glenoid labrum tears had fewer than 5 joint dislocations, and they concluded that the increase in the number of dislocations and the time from injury to surgery may not necessarily lead to worsening of the labrum tear or widening of the tear range. Severe SLAP lesion formation was correlated with the magnitude of trauma at the time of the patient's injury. Sarikaya et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e also found no significant difference in the preoperative symptom duration or the trauma mechanism between patients with and without isolated Bankart lesions, and they found that exacerbation of glenoid labral injury may be more strongly correlated with the severity of the initial trauma. We believe that SLAP lesions caused by shoulder instability can be caused not only by chronic recurrent dislocations but also by high-energy trauma during initial dislocations.\\u003c/p\\u003e \\u003cp\\u003eOur research results indicated that biceps tenodesis combined with Bankart repair was an effective alternative to arthroscopic type V SLAP repair for active-duty military individuals. The tenodesis group had better postoperative outcomes and scores and lower revision rates in the early follow-up period. During our grassroots rounds, we found that physically demanding shoulder movements during military training led to an increased risk of glenohumeral injuries in soldiers. Waterman et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e retrospectively analyzed the rate of SLAP lesions in the US military and reported that the incidence of SLAP lesions has increased annually, especially with age. Although there are no current studies reporting the incidence of type V SLAP lesions in military individuals, military personnel perform more training exercises than civilians, so the incidences of shoulder instability and SLAP injuries are greater. In addition, Beyzadeoglu et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e noted that 37.1% of elite athletes with SLAP injuries have Bankart lesions. In the past, such lesions were usually treated as two independent injuries in the arthroscopic examination of patients with clinically unstable shoulder joints. According to the study described by Maffet et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e, type II SLAP lesions combined with Bankart lesions should be classified as type V SLAP lesions. Although SLAP lesions are frequently diagnosed in military patients, surgical treatment remains challenging. In active-duty military individuals, biceps tenodesis combined with arthroscopic posterior labral repair has been shown to produce good results \\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. Hurley et al. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e conducted a meta-analysis and reported that bicipital tenodesis improved patient satisfaction and shortened the return to sport time and that patients treated with either bicipital tenodesis or SLAP repair had comparable functional outcome scores. In their later study, they found that biceps tenodesis was an effective and safe alternative to SLAP repair in patients under 30 years of age with isolated type II-IV SLAP lesions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eIn our study, we found that all patients were able to return to active service at the last follow-up, and the return-to-sport rate in the SLAP repair group (71.4%) was lower than that in the biceps tenodesis group (81.8%). Since 2015, we have performed SLAP repair combined with Bankart repair on patients with type V SLAP injuries. Although patients were advised to avoid throwing activities for 18 months, 4 patients (14%) in the repair group ultimately experienced shoulder instability due to overhead movement, which affected training. Ultimately, all patients underwent biceps tenodesis, and no symptoms of instability reappeared at the last follow-up. A biomechanical study by Itoigawa et al. revealed that repairing Bankart lesions alone did not compromise shoulder stability in a type V SLAP lesion model, indicating that the remaining type II SLAP injury after Bankart repair would not cause shoulder instability \\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e. Hantes et al. found through a cohort study that patients with type V SLAP injuries who underwent surgical repair had a greater level of satisfaction, better functional outcomes, and less residual pain than those in the conservative control group \\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e. However, Hogan et al. discovered that after arthroscopic repair, patients who underwent Type V SLAP repair had significantly lower rates of return-to-sport at the same or higher level than patients in the isolated Bankart repair group \\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e. The reason for the failure of SLAP repair in this study was that we restricted the patients\\u0026rsquo; throwing activities until 18 months after surgery, but all patients with recurrent instability were injured again 1 year after surgery due to overhead movements such as horizontal bar pull-up exercises and obstacle running that caused the affected limb to support their body weight. In our study, MRI and arthroscopic examinations of all the patients whose SLAP repairs failed revealed tears or incomplete healing of the superior glenoid labrum, satisfactory repair of the inferior glenoid labrum, and that the prominent characteristic of this injury was related to the type of training exercises the subjects performed during their postoperative recovery training. During the follow-up of the patients in the repair group, we performed bicipital tenodesis revision surgery for patients whose SLAP repairs failed. Since 2018, patients with type V SLAP injuries have been treated with biceps tenodesis combined with Bankart repair, and the results of late clinical follow-up have been satisfactory.\\u003c/p\\u003e \\u003cp\\u003eMcCormick et al. prospectively evaluated the results of biceps tenodesis revision surgery in patients whose arthroscopic repair of type II SLAP lesions failed and discovered that 81% of patients returned to active duty and sports at a mean of 3.5 years postoperatively \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, they concluded that biceps tenodesis can be used as the initial or revision surgery for the treatment of type II SLAP lesions, but for high-level athletes, biceps tenodesis should be performed cautiously when it is the initial surgery or revision surgery after SLAP repair failure. However, the findings of this study showed that while the shoulder joint can retain normal biomechanics after SLAP repair, the results after returning to sports were not entirely satisfactory. Biceps tenodesis for the treatment of a specific patient population of active-duty military personnel has shown good postoperative clinical follow-up results, including a high level of patient satisfaction, when performed as either the initial or revision procedure. Therefore, we believe that after adequate clinical evaluation of the indications for SLAP suture repair and biceps tenodesis, patients should be provided with relevant literature and data that describe the benefits and risks of both procedures to choose the best treatment plan based on their needs and desire for future return to sports.\\u003c/p\\u003e\"},{\"header\":\"Limitations\",\"content\":\"\\u003cp\\u003eDue to its retrospective design, this research has several limitations. First, the sample size was small, and most of the patients were male. Second, this study included patients between the ages of 18 and 50 years, whereas previous studies on these lesions limited the age of patients to younger than 35 years. Third, all our research subjects were active-duty military personnel, so the findings did not apply to the general population. Finally, this study had a short follow-up period, and additional prospective studies with longer follow-up periods are needed to evaluate the results of biceps tenodesis combined with Bankart repair procedures.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eBoth arthroscopic Bankart repair combined with suprascapular biceps tenodesis and arthroscopic Bankart repair combined with SLAP repair can effectively treat type V SLAP lesions in military individuals, as noted by significant improvements in postoperative clinical outcomes and pain scores. Our research results indicate that bicipital tenodesis combined with anterior labral repair has better early clinical outcomes than arthroscopic type V SLAP repair in active-duty military patients with type V lesions.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eSLAP \\u0026nbsp; \\u0026nbsp;Superior labral anterior to posterior\\u003c/p\\u003e\\n\\u003cp\\u003eMRI \\u0026nbsp; \\u0026nbsp; Magnetic resonance imaging\\u003c/p\\u003e\\n\\u003cp\\u003eDASH \\u0026nbsp;\\u0026nbsp;Patient-reported disabilities of the arm, shoulder, and hand\\u003c/p\\u003e\\n\\u003cp\\u003eWOSI \\u0026nbsp; \\u0026nbsp;Western Ontario Shoulder Instability Index\\u003c/p\\u003e\\n\\u003cp\\u003eASES \\u0026nbsp; \\u0026nbsp;American Shoulder and Elbow Surgeons\\u003c/p\\u003e\\n\\u003cp\\u003eVAS \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Visual analog scale\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo funding was provided for the completion of this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eEthics Approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the ethics committee of (NO 2023KYLL289).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eCompeting interests\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have declared that there are no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eData availability\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available from the corresponding author, [Peng Zhang], upon reasonable request.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe would like to thank AJE Author Services for helping us to improve our manuscript language in English writing.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003ePappas AM, Goss TP, Kleinman PK (1983) Symptomatic shoulder instability due to lesions of the glenoid labrum. Am J Sports Med 11:279-288. https://doi.org/10.1177/036354658301100501.\\u003c/li\\u003e\\n\\u003cli\\u003eAndrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13:337-341. https://doi.org/10.1177/036354658501300508.\\u003c/li\\u003e\\n\\u003cli\\u003eSnyder SJ, Banas MP, Karzel RP(1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4:243-248. https://doi.org/10.1016/s1058-2746(05)80015-1\\u003c/li\\u003e\\n\\u003cli\\u003eMaffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93-98. https://doi.org/10.1177/036354659502300116.\\u003c/li\\u003e\\n\\u003cli\\u003ePowell SE, Nord KD, Ryu RKN (2012) The diagnosis, classification, and treatment of SLAP lesions. Oper Tech Sports Med 20: 46-56 https://doi.org/10.1053/j.otsm.2012.03.006\\u003c/li\\u003e\\n\\u003cli\\u003ePak T, Kim AM (2023) Anterior Glenohumeral Joint Dislocation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.\\u003c/li\\u003e\\n\\u003cli\\u003eVaracallo M, Tapscott DC, Mair SD (2023) Superior Labrum Anterior Posterior Lesions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.\\u003c/li\\u003e\\n\\u003cli\\u003eKandeel AA (2020) Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability. J Shoulder Elbow Surg 29:95-103. https://doi.org/10.1016/j.jse.2019.05.038.\\u003c/li\\u003e\\n\\u003cli\\u003eProvencher MT, McCormick F, Dewing C, McIntire S, Solomon D (2013) A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med 41:880-886. https://doi.org/10.1177/0363546513477363.\\u003c/li\\u003e\\n\\u003cli\\u003eParnes N, Dunn JC, Czajkowski H, DeFranco MJ, Green CK, Scanaliato JP (2013) Biceps Tenodesis as an Attractive Alternative to Superior Labral Anterior-Posterior (SLAP) Repair for Type II SLAP Lesions in Active-Duty Military Patients Younger Than 35 Years. Am J Sports Med 49:3945-3951. https://doi.org/10.1177/03635465211049373.\\u003c/li\\u003e\\n\\u003cli\\u003eGreen CK, Scanaliato JP, Duvall O, Eckhoff MD, Dunn JC, Parnes N (2013) Biceps Tenodesis Combined With Arthroscopic Posterior Labral Repair for Type VIII SLAP Lesions in Active-Duty Military Patients Yields Excellent Return to Military Duty. Arthroscopy 38:2620-2627. https://doi.org/10.1016/j.arthro.2022.03.021.\\u003c/li\\u003e\\n\\u003cli\\u003eHantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN (2009) Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med 37:1093-1098. https://doi.org/\\u003c/li\\u003e\\n\\u003cli\\u003eCho HL, Lee CK, Hwang TH, Suh KT, Park JW (2010) Arthroscopic repair of combined Bankart and SLAP lesions: operative techniques and clinical results. Clin Orthop Surg 2:39-46. https://doi.org/ 10.4055/cios.2010.2.1.39.\\u003c/li\\u003e\\n\\u003cli\\u003eMilano G, Grasso A, Russo A, Magarelli N, Santagada DA, Deriu L, Baudi P, Bonomo L, Fabbriciani C (2011) Analysis of risk factors for glenoid bone defect in anterior shoulder instability. Am J Sports Med 39:1870-1876. https://doi.org/ 10.1177/0363546511411699.\\u003c/li\\u003e\\n\\u003cli\\u003eBurkhart SS, Morgan CD (1998) The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy14:637-640. https://doi.org/10.1016/s0749-8063(98)70065-9.\\u003c/li\\u003e\\n\\u003cli\\u003eLo IK, Burkhart SS (2005) Triple labral lesions: pathology and surgical repair technique-report of seven cases. Arthroscopy 21:186-193. https://doi.org/ 10.1016/j.arthro.2004.09.022.\\u003c/li\\u003e\\n\\u003cli\\u003eTokish JM, McBratney CM, Solomon DJ, Leclere L, Dewing CB, Provencher MT (2009) Arthroscopic repair of circumferential lesions of the glenoid labrum. J Bone Joint Surg Am 91:2795-2802. https://doi.org/10.2106 /JBJS .H.01241.\\u003c/li\\u003e\\n\\u003cli\\u003eRokito SE, Myers KR, Ryu RK (2014) SLAP lesions in the overhead athlete. Sports Med Arthrosc Rev 22:110-116. https://doi.org/10.1097/JSA.0000000000000018.\\u003c/li\\u003e\\n\\u003cli\\u003eKoss S, Richmond JC, Woodward JS Jr (1997) Two- to five-year follow up of arthroscopic Bankart reconstruction using a suture anchor technique. Am J Sports Med 25:809-12. https://doi.org/ 10.1177/036354659702500613.\\u003c/li\\u003e\\n\\u003cli\\u003eHabermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8:66-74. https://doi.org/10.1016/s1058-2746(99)90058-7.\\u003c/li\\u003e\\n\\u003cli\\u003eGutierrez V, Monckeberg JE, Pinedo M, Radice F (2012) Arthroscopically determined degree of injury after shoulder dislocation relates to recurrence rate. Clin Orthop Relat Res 470(4):961-964. https://doi.org/ 10.1007/s11999-011-2229-8.\\u003c/li\\u003e\\n\\u003cli\\u003eKim DS, Yi CH, Kwon KY, Oh JR (2013) Relationship between the extent of labral lesions and the frequency of glenohumeral dislocation in shoulder instability. Knee Surg Sports Traumatol Arthrosc 21(2):430-437. https://doi.org/10.1007/s00167-012-2045-z.\\u003c/li\\u003e\\n\\u003cli\\u003eSarikaya B, Bozkurt C, G\\u0026uuml;l O, Bekin Sarıkaya PZ, Sipahioğlu S, Altay MA (2020) Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair. Jt Dis Relat Surg 31:223-229. https://doi.org/ 10.5606/ehc.2020.74750.\\u003c/li\\u003e\\n\\u003cli\\u003eWaterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD (2015) Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc 23:1453-1459. https://doi.org/ 10.1007/s00167-013-2798-z.\\u003c/li\\u003e\\n\\u003cli\\u003eBeyzadeoglu T, Circi E (2015) Superior Labrum Anterior Posterior Lesions and Associated Injuries: Return to Play in Elite Athletes. Orthop J Sports Med 3:2325967115577359. https://doi.org/10.1177/2325967115577359.\\u003c/li\\u003e\\n\\u003cli\\u003eMaffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93-98. https://doi.org/10.1177/036354659502300116.\\u003c/li\\u003e\\n\\u003cli\\u003eHurley ET, Fat DL, Duigenan CM, Miller JC, Mullett H, Moran CJ (2018) Biceps tenodesis versus labral repair for superior labrum anterior-to-posterior tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 27:1913-1919. https://doi.org/10.1016/j.jse.2018.04.011.\\u003c/li\\u003e\\n\\u003cli\\u003eHurley ET, Colasanti CA, Lorentz NA, Campbell KA, Alaia MJ, Strauss EJ, Matache BA, Jazrawi LM (2022) Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30. Arthroscopy 38:307-312. https://doi.org/10.1016/j.arthro.2021.07.028.\\u003c/li\\u003e\\n\\u003cli\\u003eItoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN (2020) Bankart repair alone in combined Bankart and superior labral anterior-posterior lesions preserves range of motion without compromising joint stability. JSES Int 4:63-67. https://doi.org/10.1016/j.jseint.2019.11.001.\\u003c/li\\u003e\\n\\u003cli\\u003eHantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN (2009) Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med 37:1093-1098. https://doi.org/ 10.1177/0363546508331139.\\u003c/li\\u003e\\n\\u003cli\\u003eMcCormick F, Nwachukwu BU, Solomon D, Dewing C, Golijanin P, Gross DJ, Provencher MT (2014) The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs. Am J Sports Med 42:820-825. https://doi.org/10.1177/0363546513520122.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"V-type SLAP, biceps tenodesis, SLAP repair, labrum lesion\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4455016/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4455016/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e \\u003cp\\u003eTo compare the outcomes of arthroscopic Bankart repair combined with arthroscopic SLAP repair and arthroscopic Bankart repair combined with subpectoral biceps tenodesis in active-duty military individuals with type V SLAP lesions.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eFrom June 2015 to June 2021, all patients with type V SLAP lesions who underwent Bankart repair surgery simultaneously with arthroscopic SLAP repair or combined with biceps tenodesis and who were followed up for at least 2 years were included in the study. The clinical data of 28 patients who underwent Bankart repair combined with arthroscopic SLAP repair (repair group) were compared with those of 22 patients who underwent arthroscopic Bankart repair combined with suprascapular biceps tenodesis (tenodesis group). The findings of the preoperative and postoperative clinical assessments, physical examination, injury mechanism assessment, and magnetic resonance imaging (MRI) examination were reviewed. Patient-reported disabilities of the arm, shoulder, and hand (DASH) scores, Western Ontario Shoulder Instability Index (WOSI) scores, American Shoulder and Elbow Surgeons (ASES) scores, and visual analog scale (VAS) scores for pain and satisfaction were evaluated.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eBoth groups of patients met the study's inclusion criteria. There was no significant difference between the groups in terms of preoperative range of motion or outcome evaluations. The DASH, ASES, WOSI, and VAS scores of the two groups were significantly greater at the last follow-up than before surgery (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). Compared with the repair group, the tenodesis group had significantly better postoperative WOSI and DASH scores (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eBoth arthroscopic Bankart repair combined with suprascapular biceps tenodesis and arthroscopic Bankart repair combined with SLAP lesion repair can effectively treat type V SLAP lesions, as indicated by significant improvements in postoperative clinical outcomes and pain scores. However, we found that early clinical outcomes are better for biceps tenodesis combined with anterior labral repair than for arthroscopic type V SLAP lesion repair in active-duty military patients.\\u003c/p\\u003e\\u003ch2\\u003eLevel of evidence:\\u003c/h2\\u003e \\u003cp\\u003eLevel III.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Short-term clinical outcomes of biceps tenodesis and SLAP repair for Type V SLAP lesions caused by anterior shoulder instability in active-duty military patients\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-06-12 03:49:17\",\"doi\":\"10.21203/rs.3.rs-4455016/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"e8ef0f9b-2d66-45f1-97e5-21d9ae57a815\",\"owner\":[],\"postedDate\":\"June 12th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-01-29T09:53:53+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-06-12 03:49:17\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4455016\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4455016\",\"identity\":\"rs-4455016\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}