To use an expected-value decision analysis to determine the optimal treatment decision between repair or a biceps tenodesis (BT) for an isolated type II Superior Labral Anterior Posterior (SLAP) injury. An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. To determine outcome probabilities, a decision tree was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome utilities, we evaluated 70 patients with a chief complaint of shoulder pain with regard to age, sex, Shoulder Activity Level (SAL) and visual analog scale regarding potential outcome preferences. Statistical fold back analysis calculated optimal treatment. One-way sensitivity analysis determined the effect of changing the reinjury rate on the expected value of a biceps tenodesis. The overall expected value for biceps tenodesis was 8.66 versus 7.19 for SLAP repair. One-way sensitivity demonstrated that biceps tenodesis was the superior choice if reinjury rates are expected to be less than 28%. Meta-analysis of 23 studies and 908 patients revealed the probability of a well outcome was significantly greater for BT (87.8%; 95% CI 74.9-94.6%, I2=0.0%) than SLAP repair (62.9%; 95% CI 55.9-69.3%, I2=65.9%; p=0.0023). Reinjury with BT was 1.5% (95% CI 0.05% to 33.8%, I2=0.0%) and repair 6.4% (95% CI 4.2%-9.6%, I2=24%) which was not statistically significantly different (p=0.411). 50 participants mean age=25.4 (SD 8.9), male = 76%; overhead athletes = 50% met inclusion criteria. Forty-six percent of participants had a SAL score of ‘high’. Decision analysis demonstrated that biceps tenodesis is preferred over repair for an isolated type II SLAP tear based on greater expected value of BT versus repair. Meta-analysis demonstrated more frequent favorable outcomes with BT. Surgeons can use this information to tailor discussion with patients..