Return to Play in Adolescent Baseball Players after SLAP Repair (131)

Abstract

Objectives: Superior labrum from anterior to posterior (SLAP) tears are increasingly common shoulder injuries in adolescent athletes who participate in repetitive overhead throwing. The purpose of this study is to evaluate adolescent baseball athletes who undergo SLAP repair in order to determine their long-term progression of play, surgical outcomes, and overall satisfaction with surgery. Methods: Patients between the ages of 10-19 who underwent a SLAP repair over a 10-year period from 2008-2018 with minimum two year follow-up were identified by a database query in the medical records of a single institution. From this cohort, non-baseball athletes and injuries to non-throwing shoulders were excluded. After identifying the cohort, patients were contacted via phone to complete functional outcome scores including Conway Score, Western Ontario Shoulder Instability (WOSI) Index, Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score, Short Form 12 Mental (MCS)/Physical (PCS) survey and a custom return to play questionnaire. Results: During this time period, 59 baseball players met the inclusion criteria for this study and 76.3% (45/59) of patients were available to be contacted to complete final follow-up surveys at a minimum of 2 years. All patients were male with a mean age of 17.4 +/- 1.5 (14-19) years. The mean follow-up of this cohort was 5.3 +/- 2.6 (2.1-12.1) years. The overall return to play rate was 75.6% (34/45). The average time from surgery to initiation of throwing was 5.9 +/- 2.0 (2-12) months and the average time to return to full competition was 11.3 +/- 3.5 (6-22) months after the surgery. After the SLAP repair, those who returned to play continuing playing baseball competitively for 3.0 +/- 1.9 (0.5-8.0) years after surgery. At the time of final follow-up, 71.1% (32/45) of players had stopped playing baseball. Of those who had stopped playing competitive baseball, 12 (37.5%) reported it was because they were not recruited to the next level, 10 (31.3%) reported they lost the desire to play and 10 (31.3%) reported their shoulder prevented them from playing. The overall mean KOJC, WOSI, SF-12 MCS and SF-12 PCS scores were 60.0 +/- 27.4 (range, 0-100), 21.0+/-20.6% (0-73.8%), 55.2+/-3.9 (37.4-59.8) and 55.2+/-5.6 (range, 37.9-65.7) respectively. The overall satisfaction score was 83.2% with 86.7% (39/45) saying they given the opportunity they would undergo surgery again. Conclusions: The results of this study demonstrated a low return to play rate and low patient reported outcomes on baseball specific surveys among adolescent baseball players who underwent a SLAP repair. Mean functional outcome scores between pitchers and position players were not found to be significantly different. Based on these findings, orthopedic surgeons can better counsel their adolescent baseball players on expectations for future return to play and functional outcomes after SLAP repair.

Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review

“…Overall, there was a 76.3% rate of RTS at any level, and of the 1212 patients who reported the degree to which they returned, 305 (25.2%) were unable to perform at their prior level.The rate of RTS within a specific surgical procedure was reported in 16 studies # (n = 1532 patients) and was 76.3%, 67.9%, and 73.6% after arthroscopic labral repair, open labral repair, and Latarjet, respectively. Four studies 13 , 33 , 45 , 53 reported surgical characteristics with only cumulative cohort RTS rates and were subsequently excluded from this surgery-specific RTS subgroup analysis ( Table 3 ). Proportion weighed meta-analysis demonstrated an overall RTS rate of 73% and a 40.7% rate of return to prior level among the studies that assessed psychological factors associated with RTS ( Figure 2 ).…”

“…between 70% and 95%. [31][32][33][34][35][36][37][38][39][40][41][42][43] However, the estimates of the rate of return to preinjury levels of activity and competition are currently limited, potentially due to a lack of activity-level assessment standardization. 22,30,37 A recent meta-analysis identifying studies reporting RTS after surgery for shoulder instability found that, on average, 73% of people returned to any sport and 65% returned to their preinjury level of sport.…”

“…MINORS, methodological index for non-randomized studies. § ||8,10,11,13,15,17,18,20,24,26,29,31,33,42,45,46,48.…”

“… 34 , 54 Currently available data regarding rates of return to sport (RTS) vary with estimates ranging by surgical technique, injury mechanism, and patient-specific factors; however, estimates for RTS rates after shoulder surgery often range between 70% and 95%. 31 - 43 However, the estimates of the rate of return to preinjury levels of activity and competition are currently limited, potentially due to a lack of activity-level assessment standardization. 22 , 30 , 37 A recent meta-analysis identifying studies reporting RTS after surgery for shoulder instability found that, on average, 73% of people returned to any sport and 65% returned to their preinjury level of sport.…”

“… § References 2 - 4 , 8 , 10 , 11 , 13 - 15 , 17 , 18 , 20 , 24 - 26 , 29 , 31 , 33 , 42 , 45 , 46 , 48 , 53 , 55 . …”