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A Novel Surgical Management for SLAP Lesions in Throwers

OBJECTIVES: Superior labrum anterior-posterior (SLAP) labrum detachment is frequently seen in throwing athletes and becomes a main cause of internal impingement. Although physical therapy correcting scapular dyskinesis is the first choice of treatment, some requires surgical intervention due to thei...

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Autores principales: Kazutomo, Onishi, Sugaya, Hiroyuki, Takahashi, Norimasa, Matsuki, Keisuki, Tokai, Morihito, Ueda, Yusuke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564936/
http://dx.doi.org/10.1177/2325967117S00377
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author Kazutomo, Onishi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuki
Tokai, Morihito
Ueda, Yusuke
author_facet Kazutomo, Onishi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuki
Tokai, Morihito
Ueda, Yusuke
author_sort Kazutomo, Onishi
collection PubMed
description OBJECTIVES: Superior labrum anterior-posterior (SLAP) labrum detachment is frequently seen in throwing athletes and becomes a main cause of internal impingement. Although physical therapy correcting scapular dyskinesis is the first choice of treatment, some requires surgical intervention due to their refractory symptoms. According to recent studies, return rate to pre-injury level in professional baseball players reported 15 to 32%. Currently, most surgeons perform a rigid anterior and postero-superior labrum repair using suture anchors for SLAP detachment. However, we assume that the rigid postero-superior labrum repair cannot have favorable effect on removing pain associated with internal impingement and that this might be the reason for inferior return rate in high-level throwers. Therefore, we do not repair the postero-superior portion, but instead, provide space by debridement in order to eliminate internal impingement. The purpose of this study was to evaluate the outcomes of our surgical management for SLAP lesions in throwers. METHODS: Between January 2006 and May 2014, 77 throwing athletes underwent arthroscopic labrum surgeries for their dominant arm. Among them, patients who underwent cuff repair for concomitant PASTA lesions were excluded leaving 65 patients as a candidate for this retrospective study. The aim of surgery is to remove internal impingement by obtaining clearance between the postero-superior glenoid and the rotator cuff. Therefore, we performed debridement for detached postero-superior labrum and repair of antero-superior labrum using 1 or 2 suture anchors, if the detachment was extended to anterior. We analyzed 50 shoulders (77 %), including 11 shoulders only with questionnaire survey, with an average age of 22 (range, 16-44 years). The subjects consisted of 12 professional, 14 collegiate, 15 high school and 9 recreational baseball players with the mean follow-up was 28 months (range, 12-99). Required time for return to pre-injury level and return rate were analyzed. To assess differences between the groups, positions, or athletic levels, student’s t-test and one-way analysis of variance were used. RESULTS: All patients demonstrated type II SLAP lesion, and concomitant PASTA lesion was observed in 24 shoulders. Twenty-one shoulders demonstrated stable lesions only with postero-superior labrum detachment; therefore, only arthroscopic debridement was performed for these shoulders (group D). The remaining 29 shoulders demonstrated extensive detachment that involved both anterior and posterior portions; therefore, both debridement for the postero-superior labrum and repair of the antero-superior labrum were performed for these shoulders (group R). Debridement was solely performed for concomitant PASTA lesions. Although 1 patient failed to return to play baseball due to persistent shoulder pain, 49 patients returned to games. Mean times to return to pre-injury level were 9 months (range, 4-20), respectively. Return rate to pre-injury level was 72% overall and 67% in professional baseball players. Mean time and return rate were not significantly different between the groups D and R, positions and athletic levels. CONCLUSION: Our surgical management for SLAP lesion can provide higher return rate within relatively short time period especially in elite baseball players.
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spelling pubmed-55649362017-08-24 A Novel Surgical Management for SLAP Lesions in Throwers Kazutomo, Onishi Sugaya, Hiroyuki Takahashi, Norimasa Matsuki, Keisuki Tokai, Morihito Ueda, Yusuke Orthop J Sports Med Article OBJECTIVES: Superior labrum anterior-posterior (SLAP) labrum detachment is frequently seen in throwing athletes and becomes a main cause of internal impingement. Although physical therapy correcting scapular dyskinesis is the first choice of treatment, some requires surgical intervention due to their refractory symptoms. According to recent studies, return rate to pre-injury level in professional baseball players reported 15 to 32%. Currently, most surgeons perform a rigid anterior and postero-superior labrum repair using suture anchors for SLAP detachment. However, we assume that the rigid postero-superior labrum repair cannot have favorable effect on removing pain associated with internal impingement and that this might be the reason for inferior return rate in high-level throwers. Therefore, we do not repair the postero-superior portion, but instead, provide space by debridement in order to eliminate internal impingement. The purpose of this study was to evaluate the outcomes of our surgical management for SLAP lesions in throwers. METHODS: Between January 2006 and May 2014, 77 throwing athletes underwent arthroscopic labrum surgeries for their dominant arm. Among them, patients who underwent cuff repair for concomitant PASTA lesions were excluded leaving 65 patients as a candidate for this retrospective study. The aim of surgery is to remove internal impingement by obtaining clearance between the postero-superior glenoid and the rotator cuff. Therefore, we performed debridement for detached postero-superior labrum and repair of antero-superior labrum using 1 or 2 suture anchors, if the detachment was extended to anterior. We analyzed 50 shoulders (77 %), including 11 shoulders only with questionnaire survey, with an average age of 22 (range, 16-44 years). The subjects consisted of 12 professional, 14 collegiate, 15 high school and 9 recreational baseball players with the mean follow-up was 28 months (range, 12-99). Required time for return to pre-injury level and return rate were analyzed. To assess differences between the groups, positions, or athletic levels, student’s t-test and one-way analysis of variance were used. RESULTS: All patients demonstrated type II SLAP lesion, and concomitant PASTA lesion was observed in 24 shoulders. Twenty-one shoulders demonstrated stable lesions only with postero-superior labrum detachment; therefore, only arthroscopic debridement was performed for these shoulders (group D). The remaining 29 shoulders demonstrated extensive detachment that involved both anterior and posterior portions; therefore, both debridement for the postero-superior labrum and repair of the antero-superior labrum were performed for these shoulders (group R). Debridement was solely performed for concomitant PASTA lesions. Although 1 patient failed to return to play baseball due to persistent shoulder pain, 49 patients returned to games. Mean times to return to pre-injury level were 9 months (range, 4-20), respectively. Return rate to pre-injury level was 72% overall and 67% in professional baseball players. Mean time and return rate were not significantly different between the groups D and R, positions and athletic levels. CONCLUSION: Our surgical management for SLAP lesion can provide higher return rate within relatively short time period especially in elite baseball players. SAGE Publications 2017-07-31 /pmc/articles/PMC5564936/ http://dx.doi.org/10.1177/2325967117S00377 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle Article
Kazutomo, Onishi
Sugaya, Hiroyuki
Takahashi, Norimasa
Matsuki, Keisuki
Tokai, Morihito
Ueda, Yusuke
A Novel Surgical Management for SLAP Lesions in Throwers
title A Novel Surgical Management for SLAP Lesions in Throwers
title_full A Novel Surgical Management for SLAP Lesions in Throwers
title_fullStr A Novel Surgical Management for SLAP Lesions in Throwers
title_full_unstemmed A Novel Surgical Management for SLAP Lesions in Throwers
title_short A Novel Surgical Management for SLAP Lesions in Throwers
title_sort novel surgical management for slap lesions in throwers
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564936/
http://dx.doi.org/10.1177/2325967117S00377
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