Effects of Type II SLAP Lesion Repair Techniques on the Vascular Supply of the Long Head of the Biceps Tendon: A cadaveric injection study.

Abstract Background One option for treatment of Type 2 Superior Labral Anterior to Posterior (SLAP) lesions is arthroscopic repair. However, the fact that the vascular supply of the proximal long head of the biceps tendon (LHBT) arises from the soft tissue near the SLAP repair site must also be considered. The aims of this study were to evaluate the vascular channel of the proximal long head biceps tendon and to compare potential damage to the vascular supply with alternative SLAP techniques. Methods Forty-five fresh cadaveric shoulders were divided into three groups: nine shoulders each for the normal group and the created SLAP group, and 27 shoulders for the repaired SLAP group. SLAP group shoulders were repaired using one of three techniques: two-anchors with simple sutures, one-anchor with double sutures, or one-anchor with horizontal mattress suture. India ink was then injected into the acromial branch of the thoracoacromial artery. The proximal LHBT was resected for histological cross-sectional study. Intratendinous vascular distance was measured and compared among the groups. Results The vascular supply of the proximal LHBT arises from soft tissue lying anterior and dorsal to the tendon origin. In the normal shoulders, the average intratendinous vascular distance was 16.92 ± 1.49 mm. (95%CI: 15.78-18.06). Comparing non-repaired SLAPs to each of the repair techniques found that using two-anchors with simple sutures showed no significant difference in vascular distance (P=0.716), while the other techniques showed a significant disruption of the blood supply. The differences in vascular distance among the three repair techniques were statistically significant (P=0.0001). Conclusions The main vascular supply of the proximal LHBT comes from the anterior – dorsal direction. Some SLAP repair techniques can disrupt vascularization; however, the technique using two-anchors with simple sutures, one anchor 3-mm anterior to the anterior border and one at the posterior border of the tendon, can preserve the vascularization of the LHBT. Level of evidence Anatomy Study; Cadaver Dissection