Abstract
Objectives:
Shoulder pain due to labral tears and biceps tendon pathology is commonly found in competitive softball players. Surgical options for treatment of these sources of shoulder pain include labral repair and biceps tenodesis. While past studies comparing these two modalities are limited by mostly heterogeneous study groups from multiple sports, this is the first study to our knowledge that assesses clinical outcomes and return to play rates specifically for softball players. The purpose of this study is to evaluate the clinical outcomes and return to play for softball players treated for a SLAP tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that performing a biceps tenodesis in softball players that have recalcitrant biceps tendonitis or a SLAP tear would have comparable outcomes with a faster return to play compared to SLAP repair.
Methods:
We performed a retrospective analysis on all patients who were active softball players at the time of injury treated surgically for either a SLAP tear, recalcitrant biceps tendonitis or a combination of both between 2001 and 2019. Inclusion criteria for this study included softball players who underwent biceps tenodesis or a SLAP repair at our institution with greater than 2-year follow-up. Exclusion criteria involved patients with less than 2-year follow-up and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a PRO-managing software, or achieved over the phone by three authors using four questionnaires: American Shoulder and Elbow Surgeons (ASES-S), Andrews/Carson KJOC, and our institution-specific VAS visual pain indication and return-to-play questionnaires.
Results:
After applying the proper inclusion and exclusion criteria, we identified 76 patients who were eligible for this study. From this group of 76 patients, 63 were successfully contacted over the phone or had self-reported outcome scores pulled from our PRO-managing software for a follow-up rate of 83%. The average age for our study group at the time of surgery was 20.6 years and the average post-operative follow-up time was 6.0 years.
Of the 76 patients in our study, 34 underwent a biceps tenodesis procedure (45%), 21 underwent a SLAP repair procedure (28%), 6 underwent a combination of both procedures (8%), and 2 underwent a biceps tenotomy (3%).
For the 34 patients in our study who underwent biceps tenodesis, the average age at the time of surgery was 20.0 years with a mean follow-up time of 3.7 years. The mean Andrews-Carson score was 82.2 and KJOC score was 73.7 in this group. The mean ASES-S score was 92.0 for the affected shoulder and 97.8 for the unaffected shoulder. The VAS pain indicator score for this group was 1.4 out of 10.
The 21 patients in the study who underwent SLAP repair had an average age of 20.9 years at the time of surgery. The average age follow-up time was 8.18 years. This group demonstrated a mean Andrews-Carson score of 86.7 and a KJOC score of 80.7. The mean ASES-S score was 93.3 for the affected shoulder and 96.4 for the unaffected shoulder. The VAS pain indicator score for this group was 1.2 out of 10. Of the 21 SLAP repair patients, 20 (95%) returned to full competition at an average of 7.5 months. Of the 34 patients who underwent biceps tenodesis, 31 (91%) returned to full competition at an average of 7.1 months.
Conclusions:
In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcome post-operatively. There was no significant difference between RTP times between the two groups. Further analysis is needed for additional comparisons, including level of play and position data.