SLAP Repairs in Athletes
Abstract & Commentary
Synopsis: Although motion was preserved and outcomes were generally good following arthroscopic SLAP repair, it was difficult for throwers to return to pre-injury levels of activity.
Source: Kim SH, et al. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg. 2002;84-A(6): 981-985.
The results of arthroscopic treatment of isolated SLAP repairs have not been fully reviewed in overhead athletes. The purpose of this study was to evaluate the short-term results of arthroscopic repair with a suture anchor of isolated superior labral lesions of the shoulder in young patients. Thirty-four patients (average age, 26 years) were evaluated at a mean of 33 months following arthroscopic repair of an isolated superior labral lesion of the shoulder. The diagnosis for the SLAP lesion was made by a combination of a positive physical exam and positive MRI, and all were confirmed at arthroscopy. Eighteen athletes competed in overhead sports and 12 in contact sports, including 12 collegiate and 11 professional. The surgical outcomes were evaluated with the UCLA shoulder score, a visual analogue scale, and on the basis of the patient’s ability to return to prior activities.
Arthroscopic repair of the SLAP lesion resulted in a satisfactory shoulder score in 94% of the patients. Pre-injury shoulder function was obtained in 91% of patients overall. Athletes participating in overhead sports had significantly lower shoulder scores and a lower percentage of return to their preinjury level of shoulder function compared with patients who did not participate in overhead activity. Kim and colleagues conclude that arthroscopic repair of an isolated SLAP lesion is successful in young athletic patients but further state that poor results were noted in athletes participating in overhead sports.
Comment by James R. Slauterbeck, MD
This is a nice study of repair of SLAP lesions in young patients, many of whom were athletic and competing in overhead sports. History, physical exam, MRI, and arthroscopy documentation of all lesions highlighted the inclusion criteria and those patients with additional pathology were excluded. A single surgical procedure was performed that used the mini-Revo screw-type suture anchor. However, no control group was used for comparison of results.
This study identifies that arthroscopic repair of SLAP lesions is a successful procedure in the young, athletic population. However, as expected, lower shoulder scores and functional scores were identified in the overhead-throwing athletes. This does not come as a surprise because of the significant loads placed upon the shoulder during throwing. Full, uncompromised activity level was achieved by 63% of the non-throwing and just 22% of the throwing athletes. This diminished throwing ability was not due to stiffness, as this type of SLAP repair did not compromise shoulder ROM. This is a major success because significant loss of external rotation to the throwing athlete can end a career.
Shoulder surgeons who treat overhead throwing athletes need to be facile with a technique of repairing the superior labrum that does not limit motion and restores function. It is important to tell throwing athletes that SLAP repairs may not return them to the same function they had prior to injury. We must continue to search for better techniques to treat SLAP lesions in the throwing athlete. Until then, SLAP lesions remain difficult to treat in the challenging population of overhead throwers.
Dr. Slaughterbeck, Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, is Associate Editor of Sports Medicine Reports.
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