The superior labrum anterior and posterior (SLAP) lesion is a common reason for shoulder pain and snapping or popping and severely affects exercise performance. According to the pathological structure, SLAP injury is classified into four sub-types, and type II is the most common injury. The treatment of SLAP lesion is based on the type of SLAP injury, the patient's age, and the need for shoulder movement, etc. However, the surgical method for SLAP-II injury remains controversial, and there is a lack of high-level evidence-based support. Though with a sound effect for SLAP repair, it is reported that the patient satisfaction and return rates are not high among elderly or overhead athletes, and there is a possibility of prolonged recovery time and surgery failure. Tenotomy or tenodesis has gradually become the alternative option for primary SLAP injury.

To explore the decisive factors influencing the clinical decision for the surgery of SLAP injuries.

A total of 163 patients with SLAP injuries who had undergone surgery in our hospital from January 2018 to January 2021 was retrospectively analyzed, and the correlation between the surgical methods and the critical factors, including age, history of shoulder trauma, history of conservative treatment, duration, combined injuries and classification, etc. were investigated. The Logistics regression equation was used to construct the regression model.

Among the 163 patients, 4 cases were type I, 132 cases were type II, 13 cases were type III, and 14 cases were type IV. There was no correlation between the surgery method and the SLAP classification (P>0.05) . In type II SLAP injury, there were no significant correlative factors related to SLAP repair (P>0.05) . The average age of patients who underwent SLAP repair was 18.84 years younger than those who did not. The average age of patients who underwent tenotomy were 13.01 years younger than those who did not (P<0.01) . Compared to tenotomy, there is a negative correlation between simple tenodesis or insertion downward tenodesis with LHBT tear (OR=0.169, 95% CI: 0.039-0.736; OR=0.275, 95% CI: 0.086-0.878) . However, compared to tenotomy or insertion downward tenodesis, there is a positive correlation between tenodesis with the history of conservative treatment (OR=26.979, 95% CI: 2.622-277.635; OR=8.827, 95% CI: 1.007-77.358) .

SLAP repair is widely used for all types of SLAP lesions. For type II SLAP injuries, SLAP repair is preferred for young patients, while elderly patients and those with LHBT tear were more likely to undergo tenotomy. In addition, the simple tenodesis is preferred for patients with a history of conservative treatment.