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miércoles, 21 de julio de 2010

SLAP repair may not return all overhead athletes to preinjury level of play

Brian Neuman
Brian Neuman
PROVIDENCE, R.I. — Superior labral anterior posterior (SLAP) repair leads to improved shoulder function for routine daily activities, but may be problematic in terms of a consistent return to preinjury level of play for elite throwing athletes, according to an investigation presented here.
Also, the investigators found that current scoring methods used for assessing these elite athletes may not be truly representing the return-to-play outcomes of these procedures.
“Injuries to the biceps labral complex have been well documented in baseball players, especially in pitchers due to the fact that pitching a baseball requires tremendous forces across the shoulder joint,” Brian Neuman, MD, of Philadelphia, said at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. “Type II SLAP tears are the most common labral pathologies seen, where the labrum and biceps anchor are detached from their insertion to the inferior glenoid.”

ASES vs. KJOC scores

To further investigate the outcomes of type II SLAP repairs on elite overhead athletes, Neuman and colleagues retrospectively reviewed 35 overhead athletes who underwent arthroscopic repair. “Patients were operated on by two surgeons using arthroscopic methods with bioresorbable suture anchors at the same institution and following the same rehabilitation protocol,” he said.
The study population consisted mostly of men, with a mean age of 28.8 years and an average length of follow-up of 3.6 years; 70% of the participants were baseball of softball players, Neuman reported.
Neuman said that multiple studies have shown good to excellent results after SLAP repairs and high functional outcomes validated with high scores in the American Shoulder and Elbow Society (ASES) scoring system. However, he noted that these scores can be misleading for overhead athletes in terms of reporting a return to a preinjury level of play.
Neuman and colleagues found that the Kerlan Jobe Orthopaedic Clinic (KJOC) scoring system, a 10-answer questionnaire, better describes the demands of training and competition and presents more relevant information in terms of outcomes.

Return to play

“In all overhead athletes, the average ASES score was 87.1 and the average KJOC score was 71.6. The average time to return to competition was 12.5 months, with the current perception of 84.1% return to the preinjury level,” he said.
However, the study found the actual return to the same or higher level following a SLAP repair is approximately 32% for professional baseball players.
“Even with this low return to preinjury level and a low KJOC score, there was still a high satisfaction rate of 94.3% with the surgery,” Neuman said.
The KJOC scores were significantly lower compared to the ASES scores for all other athletes as well as the baseball and softball players, he said, which correlated to the lower-percent return to the preinjury level.
“This study shows the shortcomings of the ASES which focuses on the activities of daily living which may give a falsely elevated success rate in terms of athletes’ ability to return to preinjury levels of play,” Neuman said. “The KJOC score better examines the specific demands of the elite overhead athletes and should continue to be used to assess outcomes in overhead athletes.”
Reference:
  • Reiter B, Neuman B, Cohen SB, Ciccotti MG. Results of arthroscopic repair of type II SLAP repairs in overhead athletes: Assessment of return to pre-injury throwing level and satisfaction. Presented at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 15-18, 2010. Providence, R.I.
Perspective
I think it is important that we are cautious with this type of injury. The recent data is so optimistic with high 80% to 90% success rates, which would lead us to not want to do anything but operate on them. What prompted this study was that we looked at our professional baseball players who had SLAP tears over a 3-year period. These were performed by the best SLAP surgeons in the country and we found that our ability to get them back was about 30%. … What we found was that the systems we were using to evaluate them, the ASES, were really not as precise as we should be for the sports. The KJOC or other [scoring systems] that may be sport-specific or overhead athlete-specific may give us a truer perspective.
We may not be as good as we think we are and nonoperative treatment perhaps should be the first line of treatment.
– Michael G. Ciccotti, MD
Rothman Institute
Philadelphia, Penn.
Study co-author
 ORTHOSuperSite

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