Results of Arthroscopic Repair of Type II Superior Labral Anterior Posterior Lesions in Overhead Athletes: Assessment of Return to Preinjury Playing Level and Satisfaction.
Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB. Am J Sports Med. 2011 Jul 7. [Epub ahead of print]
If you’ve ever had to rehabilitate an overhead athlete after arthroscopic repair of a type II SLAP tear, you know that reaching and sustaining pre-injury performance level can be challenging. While studies have indicated arthroscopic repair is the technique of choice (Morgan CD et al 1998), there seems to be a lack of studies available that tracks the long-term (>1 year) success of these patients. As sports medicine professionals, it’s vital that we have the information at hand to answer the inevitable question of “When will I be back to normal?”. Recovery doesn’t stop at the end of year one. In this study, a retrospective chart review was conducted and 76 subjects were identified as overhead athletes that underwent arthroscopic repair of symptomatic, isolated type II SLAP tears as well as a standardized rehabilitation protocol. Upon contact, each subject was asked to complete two surveys: 1) the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form and 2) the Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow score. The ASES Form is used to determine the day-to-day functionality of the shoulder, while the KJOC is used to evaluate the performance of overhead athletes, specifically. The maximum score for both tests is 100. Of the 76 patients identified, only 30 of those identified were able to be contacted and included into this study. The study population included 22 males and 8 females with a mean age of 24 years. The mean follow-up time was 3.5 years. The participants included 3 professional athletes, 1 Olympic athlete, 16 collegiate athletes and 10 recreational athletes participating in the following sports; baseball, softball, javelin throwing and tennis. All patients were identified as having had this procedure done within a 5-year span from January 2002-December 2007. In this study the average ASES score was 87.9 with a 93.3% of participants stating that they were either “satisfied” or “very satisfied” with the outcome of their surgery at the time of follow-up. On the other hand, the average KJOC score of 73.6 indicated a lower return to pre-injury function. Only 79.5% of the baseball/softball players reported reaching pre-injury levels of performance while the “other” overhead athletes returned to the same level 93.3% of the time, as indicated by the KJOC. Interestingly enough, when examined further, and the baseball/softball players were categorized by position, the position players stated lower return to pre-injury levels (72.1%) than those of pitchers (83.8%)
This study is important for the sports medicine community at large because it does a very good job of delineating the success of arthroscopic repair of type II SLAP for returning to activities of daily-living vs. the return to higher-end athletic function. While the return to activities of daily-living is very good, it’s apparent that there is still progress to be made in returning to pre-injury levels of overhead athletic function. It’s also important for us because we now have information stating that overhead athletes’ will return to pre-injury levels 80% of the time within an average timeframe of 3.5 years. This study is also relevant to the sports medicine professional because it identifies that certain positions/sports respond better to arthroscopic type II SLAP repair. By virtue of this, the rehabilitation expert can know which players may need to remain in therapy, via maintenance programs, for a longer period of time. What are your experiences with SLAP repairs in overhead athletes? Do you have similar success?
Written by: Mark A. Rice
Reviewed by: Stephen Thomas