Return to Sport After Surgery for Throwing Athletes with SLAP Tears

When it comes to treating superior labral anterior-posterior (SLAP) tears in throwing athletes, achieving a successful return to sport (RTS) can be challenging. SLAP tears are common injuries among overhead athletes, including baseball pitchers, tennis players, and swimmers, where repetitive stress on the shoulder joint leads to labral damage. Among the surgical options available, two primary procedures are often considered: SLAP repair and biceps tenodesis. Recent literature suggests varying outcomes depending on the chosen method, particularly in terms of RTS and overall success rates.

SLAP Repair vs. Biceps Tenodesis: The Dilemma

SLAP repairs, once the standard surgical approach, involve reattaching the torn labrum to the glenoid. However, outcomes for throwing athletes have been mixed. Studies indicate that RTS rates after SLAP repair can be as low as 54% to 63% for elite throwers, with many athletes unable to return to their pre-injury levels of performance . Additionally, some athletes experience persistent pain or require further surgical interventions, highlighting the unpredictability of this approach.

In contrast, biceps tenodesis, which involves detaching the long head of the biceps tendon from the labrum and reattaching it to the humerus, has emerged as a viable alternative, particularly for older athletes or those with recurrent symptoms. This procedure aims to reduce pain and improve shoulder function by alleviating the stress on the labrum. The literature suggests that biceps tenodesis might offer more consistent outcomes, especially in terms of reducing pain and facilitating a quicker RTS.

Return to Sport Outcomes

Recent studies provide a more nuanced understanding of RTS outcomes following biceps tenodesis. For example, a study involving 16 competitive overhead athletes undergoing subpectoral biceps tenodesis reported that 81.3% of patients returned to their previous level of athletic activity at an average of 4.1 months postoperatively . However, not all athletes had the same success, with 12.5% failing to return to sport and 6.3% returning at a lower level of competition. The variability in outcomes underscores the importance of patient selection and setting realistic expectations.

Moreover, another commentary on the subject noted that while biceps tenodesis is promising, RTS in overhead athletes remains inconsistent. The challenge lies in defining what “return to sport” actually means—whether it’s simply participating in the sport, returning to previous levels of competition, or performing at an elite level .

Factors Influencing Success

Several factors influence the success of surgical interventions for SLAP tears in throwing athletes. These include:

1. Age and Activity Level: Older athletes or those with lower demands may fare better with biceps tenodesis, whereas younger, elite-level athletes might struggle to regain their pre-injury form.

2. Type of Sport: Athletes involved in high-stress overhead activities, like pitching, may face more significant challenges in returning to their previous levels of play.

3. Pre-existing Conditions: Athletes with concurrent shoulder issues, such as rotator cuff tears or biceps tendinitis, might experience less favorable outcomes, regardless of the surgical approach.

Conclusion

In conclusion, while biceps tenodesis offers a promising alternative to SLAP repair, especially in terms of pain relief and quicker recovery, the return to high-level athletic performance remains variable. For throwing athletes, the decision between SLAP repair and biceps tenodesis should be individualized, taking into account factors like age, sport, and previous shoulder injuries. Consulting with an orthopedic surgeon who specializes in sports medicine is crucial to determine the best course of action and set realistic goals for recovery and RTS.

For more detailed information on this topic, consider exploring the following resources:

• Arthroscopy: The Journal of Arthroscopic & Related Surgery

• American Journal of Sports Medicine

These insights aim to guide athletes and medical professionals in making informed decisions about managing SLAP tears and optimizing return to sport outcomes.