Abstract
Objectives:
Rotator cuff tears are rare injuries in professional contact athletes and there is limited data to help guide players and team physicians regarding outcomes after surgical management. The purpose of this study was to report on the clinical outcomes and return to play rates of professional contact athletes that underwent arthroscopic management of rotator cuff tears at our institution.
Methods:
A retrospective review was performed on 10 rotator cuff tears in 9 professional contact athletes that underwent arthroscopic management of a rotator cuff tear from 2002-2019 at our institution. 8 tears occurred in elite American football players, 7 from the NFL and 1 from the CFL. The remaining 2 rotator cuff tears were identified in professional hockey players from the NHL. The average age of the players was 28.7 ± 4.8 years. Patient information included age, sport, position played, date of injury, date of surgery and length of time from surgery to return to play. Surgical data included tear size, acuity and pattern as well as procedure performed (debridement vs repair). Both intra and post-operative complications were documented.
The primary outcome measure was the ability to return to play and the number of games played after surgery was documented. As in other similar studies, return to play was defined as the ability to participate in at least 1 full regular-season game after surgery. Return to play and career length data were collected through publicly available internet sources (NFL, CFL and NHL statistical websites) as well as from the team’s medical staff.
Results:
80% of the professional contact athletes that underwent arthroscopic management of a rotator cuff tear in this study were able to return to play at the same professional. The average age of the players that returned to play was 27.3 ± 4.2 years and the average time to return to play was 7.9 ± 1.9 months. 8 of the 10 tears occurred in professional football players and the majority of these injuries (6 of 8) occurred in defensive players. 2 of the 10 tears occurred in professional hockey players from the NHL and both were offensive players. All of these players regained sufficient range of motion, strength and function to pass a pre-participation physical performed by their team’s medical staff and all participated in at least one regular season game. For the football players, the average playing experience after surgery was 32 ± 25 games played. For the hockey players, the average playing experience after surgery was 22 ± 11games played.
9 of the 10 tears were full thickness tears that underwent arthroscopic single row repair while 1 was a partial tear that was debrided. The average tear size was 1.95 ±0.9 cm. The average number of suture anchors used was 1.35 ± 0.7. All tears involved the supraspinatus rotator cuff tendon and 4 were classified as small tears (<1cm), 3 as medium tears (1-3cm) and 2 as large tears (3-5cm). 7 of the 10 tears underwent acute surgical repair (<2 weeks from date of injury), while 3 players underwent delayed surgical intervention at the end of the season. The delay in surgical intervention did not appear to negatively impact healing rates or the ability to return to play. Other factors that did not appear to influence return to play included type of sport, position, type of procedure (debridement vs repair) or the number of suture anchors used in the repair. Post-operative imaging was available in 8 of the 10 tears and 7 of 8 (88%) demonstrated a healed repair. No intra-operative complications were noted.
2 veteran players with large (3-5cm) full thickness tears did not return to play. The average age of these players was 34.5 years and both had > 10 years of professional playing experience. One of these players was an NFL player that demonstrated a repair failure at 6 months on post-operative imaging and elected to retire rather than undergo revision surgery. The second was an NHL player that retired for reasons unrelated to his shoulder, despite a good clinical outcome and a healed repair on post-operative imaging. To our knowledge, none of the remaining players have undergone subsequent surgical intervention or revision surgery on their injured shoulder.
Conclusions:
This is one of only a few studies since 1996 to report on the clinical outcomes after operative management of rotator cuff tears in elite professional contact athletes. The majority (80%) of the professional contact athletes in this series were able to return to play at the same professional level after arthroscopic management of a symptomatic rotator cuff tear. Older players with > 10 years of professional experience and large rotator cuff tears were less likely to return to play after surgical intervention.