Surgical Management of SLAP Lesions in Baseball Throwers: Posterosuperior and Posterior Labral Debridement With or Without Anterosuperior Repair Yields High Return to Play Rates

Abstract

Background:

Reported rates of return to the preinjury level of play (RTPL) after superior labrum anterior and posterior (SLAP) repair in overhead athletes are relatively low (22%-64%). Current fixation techniques that rigidly fix the posterosuperior labrum may lead to overconstraint and persistent pain.

Purpose/Hypothesis:

The purpose of this study was to retrospectively evaluate the clinical outcomes and RTPL rates of our surgical strategy in competitive baseball throwers with SLAP lesions. This strategy includes debridement of the posterosuperior labrum without fixation, with selective anterosuperior fixation when anterior extension and instability of the labral detachment are present. The authors hypothesized that posterosuperior and posterior debridement with or without anterosuperior repair would yield high return to play rates in baseball throwers with SLAP lesions.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 80 shoulders in 80 baseball players (mean age, 20 years [range, 15-38 years]) underwent arthroscopic surgery for SLAP lesions (Type II or Type VIII with posterior extension). The cohort included 16 professional, 31 collegiate, 23 high school, and 10 recreational players. Based on intraoperative findings, isolated debridement of the posterosuperior and/or posterior labrum was performed for stable lesions, defined as posterosuperior detachment without gross instability or lift-off of the superior labrum (n = 33), while anterosuperior repair, defined as suture anchor fixation of the unstable anterior labrum, was added only if the detachment extended anteriorly and demonstrated instability of the labrum in this region (n = 47). The primary outcome was the RTPL rate, defined as return to the preinjury level of play. Secondary outcomes included the time to RTPL and subgroup comparisons according to procedure, player position, and competition level.

Results:

Of the 80 players, 79 (99%) returned to competitive baseball play; 1 player failed to return secondary to persistent shoulder pain. Overall RTPL was 79% (63/80). The RTPL rate was 73% (24/33) in the debridement-alone group and 83% (39/47) in the anterosuperior repair group (P = .27). Pitchers achieved an RTPL rate of 81% (38/47), and professional players achieved an RTPL rate of 75% (12/16). The mean time to RTPL was 9 months overall. There were no significant differences in RTPL rates or time to return between procedure types, player position, or competition level.

Conclusion:

This surgical strategy involving debridement of the posterosuperior labrum yielded high RTPL rates regardless of whether anterosuperior repair was performed. Avoiding rigid fixation of the posterosuperior labrum may be a key to successful outcomes in competitive throwing athletes.