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Clinical Orthopaedics and Related Research®

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01-06-2012 | Symposium: Injuries in Overhead Athletes

Return to Play After Type II Superior Labral Anterior-Posterior Lesion Repairs in Athletes: A Systematic Review

Authors: William M. Sayde, MD, Steven B. Cohen, MD, Michael G. Ciccotti, MD, Christopher C. Dodson, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2012

Abstract

Background

Superior labral anterior-posterior (SLAP) lesions are a common cause of pain and disability in athletes. Individual studies have suggested low patient satisfaction with SLAP repairs in throwing athletes in particular and it is unclear how frequently athletes return to their previous level of competetion.

Questions/purposes

We systematically reviewed the literature to determine (1) patient satisfaction and (2) return to play at previous level of competition among throwing athletes compared to all athletes who underwent repair of Type II SLAP tears using various types of fixation.

Methods

We searched databases for English-language articles in peer-reviewed journals from 1950 to 2010 reporting Type II SLAP repairs with 2-year followup for our systematic review. A total of 506 patients with Type II SLAP tears were reviewed from 14 studies; of these, 327 had SLAP lesions repaired by anchor, 169 by tacks, and 10 by staples. Of the 506 patients, 198 were overhead athletes with a pooled subset of 81 identified baseball players.

Results

For the entire patient population, 83% had “good-to-excellent” patient satisfaction and 73% returned to their previous level of play whereas only 63% of overhead athletes returned to their previous level of play. Anchor repair in overhead athletes resulted in a higher percentage of “good-to-excellent” patient satisfaction (88% versus 74%) and a slightly higher return to play rate (63% versus 57%) compared with tack repair.

Conclusions

Repair of Type II SLAP tears leads to a return to previous level of play in most patients. Overhead athletes appear to have a lower rate of return to level of previous of play. Anchor fixation appears to be the most favorable fixation in both subjective scores and return to previous level of play.

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Abbot AE, Li X, Busconi BD. Arthroscopic treatment of concomitant superior labral anterior posterior (SLAP) lesions and rotator cuff tears in patients over the age of 45 years. Am J Sports Med. 2009;37:1358–1362.PubMedCrossRef

Alberta FG, El Attrache NS, Bissell S, Mohr K, Browdy J, Yocum L, Jobe F. The development and validation of a functional assessment tool for the upper extremity in the overhead athlete. Am J Sports Med. 2010;38:903–911.PubMedCrossRef

Altchek DW, Warren RF, Wickiewicz TL, Ortiz G. Arthroscopic labral debridement: a three-year follow-up study. Am J Sports Med. 1992;20:702–706.PubMedCrossRef

Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13:337–341.PubMedCrossRef

Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated Type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med. 2009;37:929–936.PubMedCrossRef

Brockmeier SF, Voos JE, Williams RJ 3rd, Altchek DW, Cordasco FA, Allen AA. Outcomes after arthroscopic repair of Type-II SLAP lesions. J Bone Joint Surg Am. 2009;91:1595–1603.PubMedCrossRef

Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien SJ, Altchek DW, Warren RF. Outcomes of isolated Type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy. 2006;22;2:136–142.PubMedCrossRef

Coleman SH, Cohen DB, Drakos MC, Allen AA, Williams RJ, O’Brien SJ, Altchek DW, Warren RF. Arthroscopic repair of Type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med. 2007;35:749–753.PubMedCrossRef

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMed

10.

Ellman H. Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy. 1987;3:173–181.PubMedCrossRef

11.

Enad JG, Gaines RJ, White SM, Kurtz CA. Arthroscopic superior labrum anterior-posterior repair in military patients. J Shoulder Elbow Surg. 2007;16:300–305.PubMedCrossRef

12.

Enad JG, Kurtz CA. Isolated and combined Type II SLAP repairs in a military population. Knee Surg Sports Traumatol Arthrosc. 2007;15:1382–1389.PubMedCrossRef

13.

Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. No advantages in repairing a Type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50. Am J Sports Med. 2008;36:247–253.PubMedCrossRef

14.

Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. 2005;87;824–831.PubMedCrossRef

15.

Ide J, Maeda S, Takagi K. Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med. 2005;33:507–514.PubMedCrossRef

16.

Keener JD, Brophy RH. Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment. J Am Acad Orthop Surg. 2009;17:627–637.PubMed

17.

Kim SH, Ha KI, Kim SH, Choi HJ. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am. 2002;84:981–985.PubMedCrossRef

18.

Lee SB, Kim KJ, O’Driscoll SW, Morrey BF, An KN. Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion: a study in cadavera. J Bone Joint Surg Am. 2000;82:849–857.PubMed

19.

L’Insalata JC, Warren RF, Cohen SB, Altchek DW, Peterson MG. A self-administered questionnaire for the assessment of symptoms and function of the shoulder. J Bone Joint Surg Am. 1997;79:738–748.PubMedCrossRef

20.

Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14;6:553–565.PubMedCrossRef

21.

Neri BR, El Attrache NS, Owsley KC, Mohr K, Yocum LA. Outcome of Type II superior labral anterior posterior repairs in elite overhead athletes. Am J Sports Med. 2011;39:114–120.PubMedCrossRef

22.

Neuman B, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB. Results of arthroscopic repair of Type II SLAP lesions in overhead athletes: assessment of return to pre-injury playing level and satisfaction. Am J Sports Med. 2011;39:1883–1888.PubMedCrossRef

23.

O’Brien SJ, Allen AA, Coleman SH, Drakos MC. The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy. 2002;18:372–377.PubMedCrossRef

24.

Oxford Centre for Evidence-Based Medicine Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Available at: http://www.cebm.net/index.aspx?o=5653. Accessed January 31, 2012.

25.

Pagnani MJ, Speer KP, Altchek DW, Warren RF, Dines DM. Arthroscopic fixation of superior labral lesions using a biodegradable implant: a preliminary report. Arthroscopy. 1995;11:194–198.PubMedCrossRef

26.

Placzek JD, Lukens SC, Badalanmenti S, Roubal PJ, Freeman DC, Walleman KM, Parrot A, Wiater JM. Shoulder outcome measures: a comparison of 6 functional tests. Am J Sports Med. 2004;32:1270–1277.PubMedCrossRef

27.

Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG. A self-administered questionnaire for the assessment of symptoms and function of the shoulder. J Shoulder Elbow Surg. 1994;3:347–351.CrossRef

28.

Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am. 1978;60:1–16.PubMed

29.

Samani JE, Marston SB, Buss DD. Arthroscopic stabilization of Type II SLAP lesions using an absorbable tack. Arthroscopy. 2001;17:19–24.PubMedCrossRef

30.

Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4:243–248.PubMedCrossRef

31.

Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–279.PubMedCrossRef

32.

Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed

33.

Tibone JE, Jobe FW, Kerlan RK, Carter VS, Shields CL, Lombardo SJ, Yocum LA. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop Relat Res. 1985;198:134–140.PubMed

34.

Voos JE, Pearle AD, Mattern CJ, Cordasco FA, Allen AA, Warren RF. Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med. 2007;35:1174–1179.PubMedCrossRef

35.

Yoneda M, Hirooka A, Saito S, Yamamoto T, Ochi T, Shino K. Arthroscopic stapling for detached superior glenoid labrum. J Bone Joint Surg Br. 1991;73:746–750.PubMed

36.

Yung PS, Fong DT, Kong MF, Lo CK, Fung KY, Ho EP, Chan DK, Chan KM. Arthroscopic repair of isolated Type II superior labrum anterior-posterior lesion. Knee Surg Sports Traumatol Arthrosc. 2008;16:1151–1157.PubMedCrossRef

Title: Return to Play After Type II Superior Labral Anterior-Posterior Lesion Repairs in Athletes: A Systematic Review
Authors: William M. Sayde, MD
Steven B. Cohen, MD
Michael G. Ciccotti, MD
Christopher C. Dodson, MD
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2295-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Return to Play After Type II Superior Labral Anterior-Posterior Lesion Repairs in Athletes: A Systematic Review

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

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