Posterior Labral Repairs of the Shoulder Among Baseball Players: Results and Outcomes With Minimum 2-Year Follow-up

Abstract

Background: There is a paucity of information regarding the treatment of posterior labral tears of the shoulder for baseball players. Reports regarding treatment and postoperative outcomes are more limited than its anterior and superior counterparts. Purpose: To evaluate the clinical presentation, surgical findings, postoperative outcomes, and rate of return to sport after arthroscopic repair of posterior labral injuries of the shoulder among baseball players. Study Design: Case series; Level of evidence, 4. Methods: Retrospective review was performed of baseball players who underwent arthroscopic posterior labral repair between 2009 and 2015 by a single surgeon, with a minimum 2-year follow-up. The group was composed of 32 male patients involved in recreational (6.3%), high school (43.8%), college (31.3%), and professional (18.8%) baseball, with a mean age of 20.5 years. Patients were categorized by chief complaint, clinical findings, surgical findings, and concomitant procedures performed. Pre- and postoperative measures included pain scale, range of motion, American Shoulder and Elbow Surgeons shoulder score, return to play, and patient satisfaction. Results: A variety of tear patterns were identified; 32% involved 90° of the posterior superior labrum; 35% involved the posterior 180°; and 32% involved 90° of the posterior inferior labrum. The dominant mechanism of injury was throwing (34.4%). The most common chief complaint was pain (n = 25, 78%), followed by pain and instability symptoms (n = 6, 18.8%), with only 3% citing isolated sensation of instability. Magnetic resonance imaging clearly identified tear patterns in 75% of cases. American Shoulder and Elbow Surgeons scores significantly improved ( P < .0001), increasing on average 30.9 points from the preoperative mean of 65.4 to a postoperative mean of 96.3. No significant range of motion deficits were noted. Tear size and number of anchors utilized did not influence outcomes. Ninety-four percent of athletes returned to play, 61% at previous levels, and 6% did not return. Pitchers had a lower return to previous level of play than position players (41% vs 86%, P = .0113). Conclusion: Arthroscopic treatment of posterior labral tears of baseball players was effective in improving pain and function, resulting in 94% patient satisfaction and 94% return to sport, with 61% returning to previous level of play. Patient presentation is variable, with a majority of patients citing pain rather than instability.

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

“…Pennington et al 23 found an overall RTS rate of 93% for those who underwent revision and 82% for those who did not, without any limitations in all athletes. Kercher et al 15 found a RTS rate of 94% at any level and 61% at the same level. However, pitchers had a RTS rate at the same level of 41%, which was lower than that of nonpitchers.…”

“…In the present study of throwing athletes only, the rate of revision was 8.6%. The demands of the throwing motion produce a tremendous amount of force on the shoulder, 14,15,17 and the stress from repeated throwing motions may lead to tensile failure of the posterior capsulolabral complex, which may account for the revision rate. Furthermore, as for superior labrum anterior-posterior (SLAP) repairs, RTS after surgery of the labrum for throwers is very challenging.…”

“…In contrast, many throwing athletes report a sense of decreased stability, ROM, ball velocity, or accuracy before posterior shoulder stabilization surgery. 15 Therefore, throwing athletes may experience improvements in pain and ability to perform daily activities, but the persistent lack of perceived stability and lack of improvement in ROM may be a more important factor in pursuing revision surgery. These factors should be considered when the surgical plan is formulated.…”

Return to Play After Arthroscopic Stabilization for Posterior Shoulder Instability—A Systematic Review

“…24 This systematic review demonstrated that RTP was achievable at a high rate after posterior shoulder stabilization. 9,18,19,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Bradley et al 28 evaluated 200 shoulders, diagnosed with unidirectional recurrent posterior shoulder instability, and noted that 90% returned to play. Both McClincy et al 38 and Radkowski et al 40 compared surgical outcomes and RTP rates in throwing and nonthrowing athletes.…”

“…However, pitchers were less likely than position players to return to preinjury levels (41% versus 86%). 35 This suggests that it may be harder to return to certain positions in baseball and potentially other major sports after PSI.…”