Abstract
Objectives:
Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP II injuries with posterior extension of the labral tear to the 6 o’clock aspect of the glenoid - have been shown in short-term outcome work to be a source of noted shoulder instability, pain, and reduced function/range of motion in both throwing and non-throwing athletes. Limiting our evaluation and effective treatment of these injuries in both the professional athlete and weekend warrior is our lack of mid- and long-term post-operative outcomes after surgical repair. It is hypothesized that Type VIII SLAP repairs would fare poorly, particularly in the throwing cohort, at mid- to long-term follow-up.
Methods:
With a minimum 4-year follow-up after Type VIII SLAP repair by a single surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain were compared between throwers, contact, and non-contact athletes.
Results:
With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact athletes, 10 non-contact athletes), with a mean age of 24.4 years were evaluated. Significant (p < .0001) improvements were observed between pre- and post-operative pain, range of motion, and ASES total and functional scores in throwers and non-throwers. Stability improved but was not significant (Table 1). There were no post-operative differences between throwers and non-throwers (Table 2). Pre-operative ASES functional score was significantly lower in contact athletes than in throwers and non-contact athletes (p < .01), but post-operatively improved significantly with no difference between groups (Table 3, 4). Overall, there was no difference in return to sport between groups as 73.7% of throwers and 93.3% of non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of non-throwers (p = .73) returned to the same level. Further, 89.5% of throwers and 100% of non-throwers (p = .49) said that their surgery was worthwhile.
Conclusion:
Given the paucity of literature, current surgical outcomes of athletes who have undergone Type VIII SLAP repairs is limited, particularly in mid- and long-term function and return to sport. The current findings suggest that surgical repair of Type VIII SLAP lesions contributes to significant improvements in pain, function, and shoulder range of motion that persists >4 years after repair. However, stability changes after injury appear more chronic in nature. Further, thrower and non-throwers appear to have similar outcomes, which has not previously been seen in short term studies.
Cohort Pain, Stability, and Functional Outcomes
| Pre-Op | Post-Op | P-value | |
|---|---|---|---|
| Stability | 5.7 ± 3.6 | 4.5 ± 3.7 | .23 |
| Pain | 8.0 ± 1.5 | 1.3 ± 1.7 | *** < .0001 |
| ROM | .76 ± .9 | 2.3 ± .5 | *** < .0001 |
| ASES Functional Score |
15.0 ± 4.0 | 27.6 ± 3.5 | *** < .0001 |
| ASES Total | 34.9 ± 12.1 | 90.1 ± 12.7 | *** < .0001 |
Thrower vs. Non-Thrower Post-Operative Outcomes
| Thrower | Non-Thrower | P-value | |
|---|---|---|---|
| Stability | 3.7 ± 3.6 | 5.5 ± 3.7 | .15 |
| Pain | 1.3 ± 1.8 | 1.2 ± 1.6 | .83 |
| ROM | 2.3 ± .6 | 2.3 ± .5 | .70 |
| ASES Functional Score | 27.4 ± 4.0 | 27.9 ± 2.7 | .68 |
| ASES Total | 88.9 ± 14.0 | 91.6 ± 11.2 | .54 |
| Kerlan Jobe Score | 66.0 ± 28.3 | 75.0 ± 28.7 | .19 |
Thrower vs. Contact/Non-Contact Athletes – Patient Characteristics and Pre-Operative Pain, Function, and Range of Motion
| Thrower | Contact | Non-Contact | P-value | |
|---|---|---|---|---|
| Age at OR | 22.9 ± 8.2 | 21.4 ± 5.8 | 28.9 ± 12.6 | .21 |
| Age at Follow-Up | 29.1 ± 9.3 | 27.6 ± 5.9 | 34.9 ± 11.4 | .24 |
| Post-Op Follow-Up | 6.3 ± 1.9 | 6.2 ± 1.8 | 6.0 ± 2.0 | .95 |
| # Anchors | 4.6 ± 1.3 | 5.4 ± 1.3 | 5.5 ± .9 | .22 |
| Stability | 5.7 ± 3.5 | 4 ± 4.4 | 6.3 ± 4.0 | .67 |
| Pain | 7.9 ± 1.3 | 8.7 ± 1.2 | 8.0 ± 2.0 | .74 |
| ROM | .5 ± .4 | .3 ±.6 | 1 ± .6 | .39 |
| ASES Functional Score | 14.8 ± 3.1 | 9.3 ± 5.5 | 17.7 ± 3.0 | ** < .01 |
| ASES Total | 35.0 ± 9.9 | 23.8 ± 14.0 | 39.4 ± 14.5 | .18 |
Thrower vs. Contact/Non-Contact Athletes – Post-Operative Pain, Function, and Range of Motion
| Thrower (n=17) | Contact (n=5) | Non-Contact (n=10) | P-value | |
|---|---|---|---|---|
| Stability | 3.7 ± 3.6 | 4.2 ± 4.1 | 6.3 ± 3.6 | .23 |
| Pain | 1.3 ±1.8 | .8 ± 1.8 | 1.4 ± 1.6 | .22 |
| ROM | 2.3 ± .6 | 2.6 ± .5 | 2.3 ± .5 | .47 |
| ASES Functional Score |
27.4 ± 4.0 | 27.6 ± 4.3 | 28 ± 1.8 | .90 |
| ASES Total | 88.9 ± 14.0 | 91.8 ± 16.0 | 91.5 ± 8.9 | .83 |