Shoulder surgery · UK
SLAP tear repair, or the modern tenodesis alternative.
A day-case arthroscopic operation for a torn superior labrum at the biceps anchor. Modern evidence favours biceps tenodesis over SLAP repair in most patients over 30 to 35. We tell you honestly which fits you before you book.
Why patients choose us
- 01
A specialist shoulder surgeon, high labral volume
Not a general orthopaedic list. A named shoulder and elbow surgeon with a high arthroscopic labral and biceps case load.
- 02
The right operation for the tear, not just the scan
Modern evidence favours biceps tenodesis over SLAP repair in most patients over 30 to 35. We tell you honestly which fits.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private SLAP tear surgery costs in London.
Indicative ranges across our partner units. Send the MRI or MRA and we quote firm figures across two or three options.
In short
Arthroscopic day-case in our network: £6,500 to £18,000, home the same day.
| Procedure | Indicative range | Typical duration | Setting |
|---|---|---|---|
| Consultant shoulder assessment with ultrasound | £300–£450 | 30–45 min | Same visit |
| Biceps tenodesis (arthroscopic or subpectoral) | £8,500–£13,500 | 45–75 min | Day case |
| SLAP repair (type II, suture anchor) | £9,500–£14,500 | 60–90 min | Day case |
| Combined SLAP or tenodesis with rotator cuff repair | £12,500–£18,000 | 90–120 min | Day case |
| Biceps tenotomy alone | £6,500–£9,500 | 30–45 min | Day case |
| Second-opinion review of MRI or MRA | £250–£450 | 30 min | 48 hours |
Prices vary by hospital, by surgeon, by whether a rotator cuff repair is added, and by implant selection. We come back with a firm quote within one working day.
The journey
From MRI to return to sport, what happens, in order.
One team from first message to your last physiotherapy milestone.
- 01
Before
You send us the MRI or MRA
A short, confidential form. The mechanism, sport or occupation, any prior injections and the radiology report if you have it.
- 02
Before
We come back with a recommendation
Within one working day: whether a SLAP repair, biceps tenodesis or tenotomy is the better call, with an indicative price and an honest read either way.
- 03
Before
We arrange the operation
Usually within one to three weeks. Anaesthetic review, regional block plan, and pre-operative physiotherapy contact.
- 04
On the day
Arrival at the hospital
Admission, consent and a chat with the surgeon and anaesthetist. Interscalene block plus general anaesthetic in beach-chair or lateral position.
- 05
On the day
The arthroscopy itself
45 to 90 minutes. Diagnostic look, decision confirmed under the scope, then tenodesis with interference screw or PEEK button, or a suture anchor SLAP repair.
- 06
On the day
Home the same day
A short recovery, sling fitted, and home within a few hours. Someone should collect you and stay overnight after the block wears off.
- 07
After
Rehabilitation and return
Sling 4 weeks after tenodesis, 6 weeks after SLAP repair. Structured physio for 3 to 6 months. Return to overhead sport at 4 to 6 months.
When surgery helps
Who benefits from SLAP surgery, and who does not.
Aetiology, clinical signs and the imaging picture that make a labral or biceps operation the right call.
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Overhead throwing athlete with deep pain
Baseball pitchers, cricket bowlers, tennis servers and volleyball players with posterior-superior pain in the late-cocking phase.
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Fall on an outstretched hand (FOOSH)
A sudden traction or compression injury to the biceps anchor at the 12 o'clock position on the superior labrum.
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Traction injury lifting a heavy load
A sudden downward pull on the arm, or catching a falling weight, can avulse the biceps anchor cleanly off the glenoid rim.
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Paralabral cyst compressing the nerve
A superior labral tear can fill with fluid and form a spinoglenoid cyst that compresses the suprascapular nerve, weakening infraspinatus.
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Clicking, catching or a dead-arm feeling
Mechanical symptoms in the shoulder, or a sudden loss of throwing velocity, are classic for a type II SLAP tear.
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Positive O'Brien, Speed's and biceps load II
Clinical tests in combination raise suspicion. No single test is definitive and MRA remains the gold standard for confirmation.
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Painful bicipital groove tenderness
Tenderness over the intertubercular groove with a positive Yergason test points to biceps pathology and often coexists with a SLAP tear.
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Red flag: sudden true weakness or numbness
True neurological weakness, night pain unrelated to position, or a fever after injection needs urgent assessment rather than a private wait.
Procedure options
SLAP surgery is a family of operations, not a single fix.
What each option involves and which fits which patient. The modern trend, well supported by Boileau and Denard, is to prefer tenodesis over repair in most patients over 30 to 35.
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Biceps tenodesis (preferred over 30 to 35)
Boileau and Denard evidence: less pain, better function and lower stiffness than SLAP repair in most non-elite patients. Suprapectoral or subpectoral, fixed with interference screw or PEEK button.
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SLAP repair (young elite throwers)
Suture anchor placed at the 12 o'clock position or slightly posterior, avoiding anteriorising the labrum. Sutures passed through the labrum and tied, or knotless. Reserved for preserving biceps anatomy in an elite thrower.
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Biceps tenotomy alone
Simple release of the long head of biceps at its origin. Quick, reliable pain relief. Around 30 per cent get a Popeye deformity, purely cosmetic. A sensible option in older, sedentary patients.
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Combined with rotator cuff repair
Around half of SLAP tears in older patients coexist with a rotator cuff tear. The two are usually addressed at the same sitting through the same portals.
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Paralabral cyst decompression
Where a spinoglenoid cyst compresses the suprascapular nerve, arthroscopic decompression through the labral tear allows the cyst to drain and the nerve to recover.
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Snyder classification, in brief
Type I: fraying, debridement only. Type II: detached biceps anchor, the most common repairable lesion. Type III: bucket-handle with intact anchor. Type IV: bucket-handle extending into biceps.
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Revision SLAP surgery
A failed primary SLAP repair with persistent pain or stiffness is almost always converted to a biceps tenodesis rather than a repeat repair.
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Second-opinion review
A specialist review of your MRI or MRA, images and clinical notes. Sometimes the answer is targeted physiotherapy and an ultrasound-guided injection, not an operation.
Our vetted London network
A small panel of shoulder surgeons, we picked them.
Consultant shoulder surgeons with high arthroscopic labral and biceps volumes at Fortius, London Shoulder Partnership, HCA Wellington, Cromwell BUPA, RNOH Private and ISEH UCLH. Introductions are private, once we understand your case.
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Consultant shoulder and elbow surgeons with high arthroscopic labral and biceps volumes
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CQC-registered private hospitals with modern arthroscopy suites and regional block services
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Structured shoulder physiotherapy pathways with tenodesis and SLAP-specific protocols
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MDT input from radiology and pain medicine when the diagnosis is unclear
Safety and recovery
What to expect afterwards, honestly.
SLAP surgery is a well-established arthroscopic day-case. The things worth planning are your regional block, sling time, physiotherapy schedule and realistic return to sport.
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Regional block plus general anaesthetic
Interscalene block delivers excellent pain relief for the first 18 to 24 hours. General anaesthetic on top allows beach-chair or lateral positioning without discomfort.
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Sling and early passive range
Sling for 4 weeks after tenodesis, 6 weeks after SLAP repair. Gentle pendulum and passive elevation from day 1 to prevent stiffness.
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Stiffness is the main risk after SLAP
Around 10 to 15 per cent of SLAP repairs develop clinically significant stiffness. This risk is a key reason tenodesis is preferred in most patients over 30 to 35.
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Popeye deformity after tenotomy
A visible bulge in the mid-upper arm in around 30 per cent of tenotomies. Purely cosmetic, no functional loss. Uncommon after tenodesis where the tendon is anchored below.
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Return to work and driving
Desk work at 1 to 2 weeks out of sling. Driving at 4 to 6 weeks depending on procedure and side. Manual work at 3 to 4 months.
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Return to overhead sport
Return to overhead sport at 4 to 6 months. Return to competitive throwing at 6 to 9 months, with realistic counselling on velocity and endurance.
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Outcomes: biceps tenodesis
85 to 95 per cent good or excellent function, low reoperation rate. High patient satisfaction across published series.
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Outcomes: SLAP repair in throwers
60 to 75 per cent return to prior competitive level. Honest counselling on this figure matters more than any single technical decision.
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Red flags after discharge
Fever, spreading redness, calf swelling, chest pain, sudden loss of active elevation or new pins and needles down the arm: call the unit or go to A and E the same day.
Reading your operation note
Your surgery note in four parts. Read the last one first.
- 01 Header
Snyder type and biceps anchor status
Which Snyder type (I, II, III, IV), whether the biceps anchor is detached, and any extension into the biceps tendon itself.
- 02 Technique
What was done and where
SLAP repair with number and position of suture anchors, or tenodesis method (suprapectoral vs subpectoral, screw vs button), and any cyst decompression.
- 03 Findings
Associated pathology
Rotator cuff, capsule, bicipital groove and cartilage findings. Around half of tears in older patients have coexisting rotator cuff or cuff-sided pathology.
- 04 Impression
Rehabilitation protocol and milestones
Read this first: sling duration, passive range milestones, active range at 6 weeks, strengthening at 12 weeks, sport at 4 to 6 months.
Recognised by major UK insurers
Cover for SLAP surgery varies by insurer and by indication, usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about SLAP surgery.
Quick answers on tenodesis vs repair, diagnosis, cost and return to sport.
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Should I have a SLAP repair or a biceps tenodesis?
The modern evidence, led by Boileau, Denard and others, favours biceps tenodesis over SLAP repair in patients over 30 to 35 and in non-elite throwers. Tenodesis gives less pain, better function and a lower rate of postoperative stiffness. SLAP repair is reserved for younger elite throwers where preserving the native biceps anatomy is a genuine priority.
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What is a SLAP tear?
A tear of the superior labrum from anterior to posterior at the 12 o'clock position on the glenoid, where the long head of biceps anchors. Snyder classified them into four types; type II, with a detached biceps anchor, is by far the most common repairable lesion.
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How is a SLAP tear diagnosed?
Clinical tests such as O'Brien's active compression test, Speed's test, Yergason's test and the biceps load II raise suspicion but no single test is definitive. Magnetic resonance arthrography (MRA) is the gold standard imaging investigation and confirms the tear pattern before surgery.
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How much does SLAP tear surgery cost privately in London?
Roughly £8,500 to £13,500 for a biceps tenodesis, £9,500 to £14,500 for a SLAP repair and £12,500 to £18,000 when combined with a rotator cuff repair. Biceps tenotomy alone is £6,500 to £9,500. We confirm a firm figure within one working day.
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Which London centres do you work with?
Our shoulder network includes surgeons at Fortius Shoulder Unit, London Shoulder Partnership, HCA Wellington, Cromwell BUPA, RNOH Private Care and ISEH at UCLH. Introductions are private and depend on the case.
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When can I return to throwing sport?
Overhead sport at 4 to 6 months, competitive throwing at 6 to 9 months. In elite throwers, published return to prior competitive level after SLAP repair sits between 60 and 75 per cent. We think honest counselling about that figure is more important than the surgical technique itself.
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Ready when you are
Send the MRI. We come back with the honest answer.
Whether the right operation is a SLAP repair, a biceps tenodesis or a tenotomy, we tell you which fits before you commit, with a firm price across two or three London options.