Arthroscopic Circumferential Labral Repair and Biceps Tenodesis in Elite Throwing Athletes: Technical Considerations

SLAP lesions are a common cause of shoulder pain in overhead athletes and are often seen together with circumferential labral tearing, partial-thickness rotator cuff tearing, and biceps pathology. Isolated repair of the superior labrum has produced inconsistent outcomes, with low return-to-play rates in professional throwers. In patients with these complex cases, instability and anterior shoulder pain often coexist, and isolated labral repair or tenodesis may not be adequate treatment. Conversely, tenodesis without superior labral repair may increase glenohumeral translation. The senior author believes long head of the biceps tendon release reduces traction on the SLAP repair and may support healing. We describe an arthroscopic technique for circumferential labral repair, with knotless all-suture anchors performed in the beach-chair position, combined with open subpectoral biceps tenodesis and adjunct subacromial decompression. This technique restores stability, removes the biceps as a pain generator, eliminates traction on the repaired labrum, and preserves motion.