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Chauhan A, Chalmers PN, Erickson BJ, Thompson R, Pearl GJ, Romeo AA, Hoenecke HR, Ma K, Tenner Z, Fronek J. Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis. Am J Sports Med 2024; 52:1692-1699. [PMID: 38702964 DOI: 10.1177/03635465241243244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players. PURPOSE/HYPOTHESIS The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All professional baseball players who underwent surgical treatment of TOS between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after surgery) for each player were recorded. Performance variables were then compared between players who underwent TOS surgery and matched controls. The matching criteria were no history of previous surgeries on affected arm, age at time of surgery, throwing side, level of play (Major or Minor League Baseball), and years of experience playing professional baseball. RESULTS Overall, 52 players underwent surgery for TOS, of whom 46 (88%) were pitchers. The type of TOS was neurogenic in 69% and venous in 29%. One player had arterial TOS. After TOS surgery, 79% of players returned to play at the same or higher level (RTSP) by 9.5 months and played ≥3 years after surgery. No differences were found in RTSP rate based on the type of TOS. No statistical difference was found in RTP rates between major and minor league players. Pitchers had a 76% RTSP, which was similar to the natural attrition for control pitchers (P = .874). After TOS surgery, pitchers saw a decline in several performance metrics, but these declines were not different from those of control pitchers, indicating that the decline in performance after TOS surgery was no faster than is seen in healthy professional pitchers as they age. CONCLUSION The rate of RTSP after surgery for TOS in professional baseball players was 79%. There was no difference in RTP based on the type of TOS. Pitchers who underwent surgery for TOS had no significant differences in pitching performance metrics after surgery compared with matched controls.
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Affiliation(s)
- Aakash Chauhan
- Department of Orthopedic Surgery, Colorado Permanente Medical Group, Kaiser Permanente, Lafayette, Colorado, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, New York, USA
| | - Robert Thompson
- Department of Surgery, Section of Vascular Surgery, Center for Thoracic Outlet Syndrome, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gregory J Pearl
- Division of Vascular Surgery, Baylor University Medical Center, and Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | | | - Heinz R Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Kevin Ma
- Major League Baseball, New York, New York, USA
| | | | - Jan Fronek
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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Biceps Tenodesis in Patients Age 35 Years and Younger Yields Favorable Clinical Outcomes With Variable Rates of Return to Sport and Complications: A Systematic Review. Arthroscopy 2023; 39:830-837. [PMID: 36528216 DOI: 10.1016/j.arthro.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To systematically evaluate reported clinical outcomes, return-to-sport (RTS) rates, and complications following biceps tenodesis in patients aged 35 years and younger and compare outcomes between overhead and nonoverhead athletes. METHODS A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through August 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies that evaluated clinical outcomes following biceps tenodesis in patients aged 35 years or younger were included. Study quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Clinical outcomes, RTS rates, and complications were aggregated. RESULTS Nine studies from 2011 to 2022 comprising 161 patients (mean age, 25 years; range, 19.7-28.9 years) were included. At an average follow-up of 59 months, postoperative American Shoulder and Elbow Surgeons score ranged from 81.6 to 96 and the mean visual analog scale score ranged from 0 to 2.1. Mean overall RTS rate ranged from 35% to 100% for the entire patient cohort 35% to 86% among overhead athletes, and 46% to 100% among nonoverhead athletes. Among the overhead athletes, 24 were baseball pitchers. 17% to 100% able to return to sport at any level. Complications were reported in 0% to 19% of patients. 0 to 18% of patients underwent revision surgery. CONCLUSIONS Biceps tenodesis in patients 35 years of age and younger yields a wide variability in reported RTS rates, excellent clinical outcome scores, and low but variable reported rates of complications, reoperations, and failure. LEVEL OF EVIDENCE IV; Systematic Review of Level III and IV studies.
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Biagini EK, Peebles LA, Higgins M, Stamm M, Lefante JJ, Mulcahey MK. Return to Play After Shoulder Arthroscopy in Major League Baseball Pitchers vs Position Players. Orthop J Sports Med 2023; 11:23259671221150782. [PMID: 36762205 PMCID: PMC9905020 DOI: 10.1177/23259671221150782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background Recovery from shoulder arthroscopy may vary between professional pitchers and position players in Major League Baseball (MLB). The time that it takes to return to play (RTP) and the level of skills to be regained after surgery are important factors for an athlete to consider when making career decisions. Purpose To identify MLB players who had arthroscopic shoulder surgery and observe their rates of RTP to MLB and the minor league, as well as to compare pre- and postinjury performance statistics and career metrics. Study Design Descriptive epidemiology study. Methods Public records (press releases, http://www.prosportstransactions.com, http://www.baseball-reference.com) were searched and analyzed to determine the number of days from shoulder arthroscopy to RTP and pre- and postinjury statistics for pitchers and position players in the MLB and minor league from 1998 to 2018. To meet inclusion criteria, a player must have undergone shoulder arthroscopy after having played at least 1 game in the MLB and had no identifiable concomitant injuries. Results Of 134 players, 89 (66.4%) returned to MLB. Fifty-four of 89 pitchers (60.7%) and 35 of 45 position players (77.8%) returned to MLB (P = .048). Forty-nine of 54 pitchers (90.7%) and 23 of 35 position players (65.7%) who returned to MLB returned to the minor league first. The mean time to RTP was 469.6 days (range, 100-1079 days) for pitchers and 301.6 days (range, 94-1488) for position players (P = .002). The WAR statistic (wins above replacement) for the pitchers decreased significantly (P = .004) after shoulder arthroscopy. Conclusion MLB position players returned to play at higher rates and more quickly than did pitchers. The WAR statistic declined in pitchers during the first season of RTP. Players undergoing arthroscopic shoulder surgery should be aware of these possible outcomes in time to RTP and postoperative performance.
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Affiliation(s)
- Emily K. Biagini
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Liam A. Peebles
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret Higgins
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Michaela Stamm
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - John J. Lefante
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mary K. Mulcahey
- School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Mary K. Mulcahey, MD, School of Medicine, Tulane University, 1430 Tulane Ave, #8632, New Orleans, LA 70112, USA () (Twitter: @marykmulcaheymd)
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Giberson-Chen CC, Shaw BL, Rudisill SS, Carrier RE, Farina EM, Pearson B, Asnis PD, O’Donnell EA. Return to Play After Shoulder Surgery in Professional Baseball Players: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671221140853. [PMID: 36655019 PMCID: PMC9841850 DOI: 10.1177/23259671221140853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023] Open
Abstract
Background The current literature lacks an updated review examining return to play (RTP) and return to prior performance (RTPP) after shoulder surgery in professional baseball players. Purpose To summarize the RTP rate, RTPP rate, and baseball-specific performance metrics among professional baseball players who underwent shoulder surgery. Study Design Systematic review; Level of evidence, 4. Methods A literature search was performed utilizing the PubMed, MEDLINE, and CINAHL databases and according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language studies reporting on postoperative RTP and/or RTPP in professional baseball players who underwent shoulder surgery between 1976 and 2016. RTP rates, RTPP rates, and baseball-specific performance metrics were extracted from qualifying studies. A total of 2034 articles were identified after the initial search. Meta-analysis was performed where applicable, yielding weighted averages of RTP and RTPP rates and comparisons between pitchers and nonpitchers for each type of surgery. Baseball-specific performance metrics were reported as a narrative summary. Results Overall, 26 studies featuring 1228 professional baseball players were included. Patient-level outcome data were available for 529 players. Surgical interventions included rotator cuff debridement (n = 197), rotator cuff repair (RCR; n = 43), superior labrum from anterior to posterior repair (n = 124), labral repair (n = 103), latissimus dorsi/teres major (LD/TM) repair (n = 21), biceps tenodesis (n = 17), coracoclavicular ligament reconstruction (n = 15), anterior capsular repair (n = 5), and scapulothoracic bursectomy (n = 4). Rotator cuff debridement was the most common surgical procedure, while scapulothoracic bursectomy was the least common (37.2% and 0.8% of interventions, respectively). Meta-analysis revealed that the RTP rate was highest for LD/TM repair (84.5%) and lowest for RCR (53.5%), while the RTPP rate was highest for LD/TM repair (100.0%) and lowest for RCR (27.9%). RTP and RTPP rates were generally higher for position players than for pitchers. Nonvolume performance metrics were unaffected by shoulder surgery, while volume statistics decreased or remained similar. Conclusion RTP and RTPP rates among professional baseball players were modest after most types of shoulder surgery. Among surgical procedures commonly performed on professional baseball players, RTP and RTPP rates were highest for LD/TM repair and lowest for RCR.
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Affiliation(s)
- Carew C. Giberson-Chen
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L. Shaw
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Robert E. Carrier
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Evan M. Farina
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Peter D. Asnis
- Boston Red Sox, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan A. O’Donnell
- Boston Red Sox, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Evan A. O’Donnell, MD, Massachusetts General Hospital, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA ()
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Waterman BR, Newgren J, Richardson C, Romeo AA. High Rate of Return to Sporting Activity Among Overhead Athletes With Subpectoral Biceps Tenodesis for Type II SLAP Tear. Arthroscopy 2023; 39:11-16. [PMID: 35987458 DOI: 10.1016/j.arthro.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tear in overhead athletes. METHODS All competitive elite athletes with type II SLAP tears undergoing biceps tenodesis by a single surgeon were isolated between 2007 and 2015. Exclusion criteria were applied to individuals not involved in overhead athletics, clinical follow-up <24 months, adjacent rotator cuff or labral repair, concomitant SLAP repair, and/or previous arthroscopic shoulder surgery. Patient-reported outcome measures included visual analog scale (VAS), Kerlan Jobe Orthopaedic Clinic shoulder score, and Single Assessment Numerical Assessment. Clinical and sporting outcomes were recorded using a sports-specific questionnaire. RESULTS Of 22 identified patients, 16 competitive overhead athletes (72.7%; 11 men, 5 women) with a mean age of 21.0 years were available at mean 4.5-year follow-up. Baseball or softball comprised the majority of patients (n = 9; 56.3%), followed by gymnastics (n = 2), swimming (n = 2), and other sports (n = 3). At mean 4.1 months postoperatively, 13 patients (81.3%) returned to previous level of athletic activity, whereas 2 patients (12.5%) failed to return to sporting activity and 1 (6.3%) returned at a lower level of competition. VAS pain significantly decreased from an average of 4.4 preoperatively to 1.7 postoperatively (P = .002), and mean Single Assessment Numerical Assessment scores also demonstrated significant improvement (55.4-76.7; P = .008). Final mean Kerlan Jobe Orthopaedic Clinic score was 74.0 (standard deviation 25.9), including 2 patients with suboptimal outcomes due to persistent pain. There were no significant differences in mean forward flexion or rotation in either the adducted or throwing position (P > .05), although small, significant decreases in postoperative active abduction were noted (165° vs 155°; P = .003). CONCLUSIONS In the current series of competitive overhead athletes, 81% of patients returned to previous level of play at an average of 4.1 months postoperatively after subpectoral biceps tenodesis for symptomatic SLAP tear. Athletes reliably experienced significant decreased activity-related pain with athletic function. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
| | - Jon Newgren
- Rush University Medical Center, Chicago, Illinois, USA
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Weber SC. Editorial Commentary: Return to Play in Overhead Athletes After Biceps Tenodesis for SLAP Lesions Is Inconsistent. Arthroscopy 2023; 39:17-19. [PMID: 36543418 DOI: 10.1016/j.arthro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 12/23/2022]
Abstract
The optimal surgical management for the superior labrum anterior to posterior (SLAP) lesion in the overhead athlete remains elusive. Return to play (RTP) or return to sport (RTS) with both SLAP repair and biceps tenodesis in this subgroup has been inconsistent, complicated by incomplete description of what RTP actually involves. While the recent literature regarding biceps tenodesis for SLAP lesions is encouraging, longer-term follow-up and a clear definition of criteria that define what "RTP" looks like will be critical prior to universally embracing biceps tenodesis as a definitive SLAP management option for overhead athletes.
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Tramer JS, Castle JP, Gaudiani MA, Lizzio VA, McGee A, Freehill MT, Lynch TS. Upper-Extremity Injuries Have the Poorest Return to Play and Most Time Lost in Professional Baseball: A Systematic Review of Injuries in Major League Baseball. Arthroscopy 2022:S0749-8063(22)00863-5. [PMID: 36587750 DOI: 10.1016/j.arthro.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To summarize the incidence of injuries occurring in professional baseball and compare player outcomes reported in the literature. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 3 databases (PubMed, MEDLINE, Embase). Inclusion criteria were studies of injury incidences and/or injury outcomes on active Major League Baseball (MLB) athletes and studies published in the English language. Exclusion criteria were non-MLB players, case series and case report studies with a cohort of ≤3 players, and/or review articles. RESULTS A total of 477 articles were identified from the initial search of 3 databases, with 105 studies meeting inclusion criteria. Among these articles, the most common injuries studied were elbow (38%), shoulder (14%), hip/groin (11%), hand/wrist (7%), head/face (7%), knee (7%), spine (5%), and foot/ankle (3%). Injuries with the greatest incidence included hand/wrist (150.3 per year), hamstring (7.8-73.5 per year), ulnar collateral ligament (UCL) tears (0.23-26.8 per year), gastrocnemius strains (24.2 per year), and concussions (3.6-20.5 per year). Lowest rates of return to play were seen following shoulder labral tears (40%-72.5%), rotator cuff tears (33.3%-87%), and UCL tears (51%-87.9%). The injuries leading to most time away from sport included elbow UCL tears (average 90.3 days treated nonoperatively to 622.8 days following revision reconstruction), shoulder labral tears (average 315-492 days), and anterior cruciate ligament (ACL) tears (average 156.2-417.5 days). Following ACL tears, rotator cuff tears, shoulder labral tears, and hip femoroacetabular impingement requiring arthroscopy, athletes had a significantly lower workloads compared with before injury upon return to play. CONCLUSIONS Most published investigations focus on elbow injuries of the UCL, with variable return to play and mixed performance following surgery. UCL tears, shoulder labral tears, and ACL tears result in the most missed time. Upper-extremity injury such as shoulder labral tears, rotator cuff tears, and UCL tears had the poorest return to play rates. Workload was most affected following ACL reconstruction, rotator cuff repair, shoulder labral repair, and hip arthroscopy for femoroacetabular impingement. LEVEL OF EVIDENCE IV, systematic review of level II-IV studies.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Stanford University, Redwood City, California.
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Michael A Gaudiani
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Vincent A Lizzio
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Anna McGee
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Michael T Freehill
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
| | - T Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Klemt C, Toderita D, Reilly P, Bull AMJ. Biceps Tenodesis cannot be used as primary treatment option in baseball pitchers with intact rotator cuff muscles. Clin Biomech (Bristol, Avon) 2022; 100:105819. [PMID: 36410224 DOI: 10.1016/j.clinbiomech.2022.105819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
UNLABELLED Background Surgeons remain hesitant to perform biceps tenodesis in athletes with type II superior labrum anterior-to-posterior tears due to the lack of reported clinical outcomes for individual overhead throwing sports and associated concerns that this may predispose the joint to instability. This study aimed to assess the effect of biceps tenodesis on shoulder stability for major overhead throwing sports to aid sport-specific surgical decision-making for athletes with type II superior labrum anterior-to-posterior tears. METHODS This is a combined modelling and experimental study. Motion data and external forces were measured from 13 participants performing five overhead throwing motions. These data served as input into a musculoskeletal shoulder model that quantifies shoulder stability and muscle loading. FINDINGS The loading of the long head of the biceps brachii decreases significantly following biceps tenodesis in three overhead throwing motions (p = 0.02). The loss in joint stability following biceps tenodesis is compensated by a non-significant increase in rotator cuff muscle force which maintains shoulder stability across all overhead throwing motions, except baseball pitching (p = 0.01). The presence of a full-thickness supraspinatus tear post biceps tenodesis further decreases shoulder stability in four of the five overhead throwing motions (p = 0.01). INTERPRETATION The study findings demonstrate that an increase in rotator cuff muscle force maintains joint stability for all overhead throwing motions post biceps tenodesis, except baseball pitching. As the presence of a full-thickness tear of the supraspinatus significantly reduces joint stability, biceps tenodesis may be used as a primary treatment in overhead throwing athletes with intact rotator cuff muscles, except baseball pitchers. LEVEL OF EVIDENCE Controlled Laboratory Study; Level of Evidence 3.
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Affiliation(s)
- Christian Klemt
- Department of Bioengineering, Imperial College London, London, UK
| | - Diana Toderita
- Department of Bioengineering, Imperial College London, London, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK.
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Sandler AB, Childs BR, Scanaliato JP, Dunn JC, Parnes N. SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis. Orthop J Sports Med 2022; 10:23259671221140364. [PMID: 36479458 PMCID: PMC9720817 DOI: 10.1177/23259671221140364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. HYPOTHESIS In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. STUDY DESIGN Economic and decision analysis; Level of evidence, 4. METHODS A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. RESULTS Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. CONCLUSION In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.
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Affiliation(s)
- Alexis B. Sandler
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Benjamin R. Childs
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John P. Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Department of Orthopedics, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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10
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Recker AJ, Waters TL, Bullock G, Rosas S, Scholten DJ, Nicholson K, Waterman BR. Biceps Tenodesis Has Greater Expected Value Than Repair for Isolated Type II SLAP Tears: A Meta-analysis and Expected-Value Decision Analysis. Arthroscopy 2022; 38:2887-2896.e4. [PMID: 35662668 DOI: 10.1016/j.arthro.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To use an expected-value decision analysis to determine the optimal treatment decision between repair and biceps tenodesis (BT) for an isolated type II SLAP injury. METHODS An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. To determine outcome probabilities, a decision tree was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome utilities, we evaluated 70 patients with a chief complaint of shoulder pain regarding age, sex, Shoulder Activity Level, and visual analog scale score in terms of potential outcome preferences. Statistical fold-back analysis was performed to determine the optimal treatment. One-way sensitivity analysis determined the effect of changing the reinjury rate on the expected value of BT. RESULTS The overall expected value was 8.66 for BT versus 7.19 for SLAP repair. One-way sensitivity analysis showed that BT was the superior choice if reinjury rates were expected to be lower than 28%. Meta-analysis of 23 studies and 908 patients revealed that the probability of a "well" outcome was significantly greater for BT (87.8%; 95% confidence interval [CI], 74.9%-94.6%; I2 = 0.0%) than for SLAP repair (62.9%; 95% CI, 55.9%-69.3%; I2 = 65.9%; P = .0023). The rate of reinjury was 1.5% for BT (95% CI, 0.05%-33.8%; I2 = 0.0%) and 6.4% for repair (95% CI, 4.2%-9.6%; I2 = 24%), which was not statistically significantly different (P = .411). A total of 50 participants (mean age, 25.4 years [standard deviation, 8.9 years]; 76% male patients; 50% overhead athletes) met the inclusion criteria. Forty-six percent of participants had a high Shoulder Activity Level score. CONCLUSIONS Decision analysis showed that BT is preferred over repair for an isolated type II SLAP tear based on greater expected value of BT versus repair. Meta-analysis showed more frequent favorable outcomes with BT. Surgeons can use this information to tailor discussions with patients. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I-IV studies.
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Affiliation(s)
- Andrew J Recker
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Timothy L Waters
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Garrett Bullock
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, England
| | - Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Donald J Scholten
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Kristen Nicholson
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A..
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Primary Double-Pulley SLAP Repair in an Active-Duty Military Population With Type II SLAP Lesions Results in Improved Outcomes and Low Failure Rates at Minimum Six Years of Follow-up. Arthrosc Sports Med Rehabil 2022; 4:e1141-e1149. [PMID: 35747638 PMCID: PMC9210478 DOI: 10.1016/j.asmr.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report mid-term outcomes of active-duty patients younger than the age of 35 years with shoulder type II SLAP lesions following our technique for double-pulley SLAP repair (DPSR). Methods All consecutive patients aged 18 to 35 years from January 2014 through December 2015 who underwent primary DPSR by the senior surgeon with complete outcome scores were identified. The clinical significance measures (patient acceptable symptomatic state [PASS], substantial clinical benefit [SCB], minimal clinically important difference [MCID]) have not yet been fully defined for type II SLAP repair procedures, so the values for biceps tenodesis were used as a stand-in. Patients were excluded if they were lost to follow-up of if they underwent a concomitant rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up. Results Overall, 22 of 41 (53.7%) patients met the inclusion criteria for the study, and all were active-duty military at time of surgery. In total, 21 of 22 (95.5%) patients met the PASS, whereas 20 of 22 (90.9%) achieved SCB and 22 of 22 (100.0%) exceeded the MCID for their operative shoulder as determined by the American Shoulder and Elbow Surgeons score. In total, 19 of 22 (86.4%) patients met the PASS, whereas 22 of 22 (100.0%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the Single Assessment Numeric Evaluation. In addition, 21 of 22 (95.5%) met the PASS, whereas 22 of 22 (100%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the pain visual analog scale. Pre- and postoperative range of motion did not vary significantly. In total, 18 of 22 (81.8%) of patients remained on active duty and were able to return to preinjury work and recreation activity levels. In 2 patients (9.09%), the repair did not heal. Conclusions Mid-term outcomes in this population of young, active-duty patients undergoing DPSR for type II SLAP tears demonstrate a statistically and clinically significant improvement in patient-reported outcomes and an overall return to active-duty rate of 81.8%. Level of Evidence Level IV, therapeutic case series.
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12
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Lacheta L, Horan MP, Nolte PC, Goldenberg BT, Dekker TJ, Millett PJ. SLAP Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP Type 2 Lesions in Overhead Athletes Younger Than 35 Years: Comparison of Minimum 2-Year Outcomes. Orthop J Sports Med 2022; 10:23259671221105239. [PMID: 35757237 PMCID: PMC9218463 DOI: 10.1177/23259671221105239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis. Purpose: To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or SLAP repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (n = 14) or SLAP repair (n = 24) for the treatment of isolated type 2 SLAP lesions. All patients were aged <35 years at time of surgery, participated in overhead sports, and were at least 2 years out from surgery. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; and the 12-Item Short Form (SF-12) physical component score. Return to sport and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported. Results: Preoperative baseline scores in both the tenodesis and SLAP repair groups were similar. There were no significant differences between the groups on any postoperative outcome measure: For biceps tenodesis versus SLAP repair, the ASES score was 92.7 ± 10.4 versus 89.1 ± 16.7, the SANE score was 86.2 ± 13.7 versus 83.0 ± 24.1, the QuickDASH score was 10.0 ± 12.7 versus 9.0 ± 14.3, and SF-12 was 51.2 ± 7.5 versus 52.8 ± 7.7. No group difference in return-to-sports rate (85% vs 79%; P = .640) was noted. More patients in the tenodesis group (80%) reported modifying their sporting/recreational activity postoperatively because of weakness compared with patients in the SLAP repair group (15%; P = .022). One patient in each group progressed to surgery for persistent postoperative stiffness, and 1 patient in the tenodesis group had a postoperative complication related to the index surgery. Conclusion: Both subpectoral biceps tenodesis and SLAP repair provided excellent clinical results for the treatment of isolated SLAP type 2 lesions, with a high rate of return to overhead sports and a low failure rate, in a young and high-demanding patient cohort. More patients reported modifying their sporting/recreational activity because of weakness after subpectoral tenodesis.
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Affiliation(s)
- Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Philip C Nolte
- BG Klinik Ludwigshafen, Department of Trauma and Orthopedic Surgery, Ludwigshafen, Germany
| | | | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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13
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Thomas SJ, Sarver JJ, Ebaugh DD, Paul RW, Osman A, Topley M, Soloff L, Quinlan J, Kelly JD. Chronic adaptations of the long head of the biceps tendon and groove in professional baseball pitchers. J Shoulder Elbow Surg 2022; 31:1047-1054. [PMID: 34861407 DOI: 10.1016/j.jse.2021.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS The long head of the biceps tendon (LHBT) plays a significant shoulder stabilizing role during pitching, with the large forces and repetitions involved in overhead throwing likely contributing to LHBT pathology. Determining whether the LHBT undergoes adaptive changes in baseball pitchers and how these changes relate to bicipital groove morphology can improve our understanding of the biceps function at the glenohumeral joint. Therefore, the purpose of this study was to determine the chronic adaptations of the bicipital groove morphology and the LHBT in professional baseball pitchers, with a secondary purpose of evaluating biceps integrity as it relates to torsional changes of the bicipital groove. We hypothesized that the throwing arm of professional baseball pitchers would exhibit chronic adaptations of the LHBT compared with their nonthrowing arm, and that these adaptations would be related to the bicipital groove morphology. MATERIALS AND METHODS Fifty-three professional baseball pitchers were enrolled at the beginning of the 2015 Major League Baseball spring training. Ultrasound was used to bilaterally measure humeral retroversion and to capture images of the bicipital groove and the LHBT. MATLAB software was used to calculate the area of the bicipital groove, and ImageJ software was used to quantify the area, echogenicity, and circularity of the LHBT. RESULTS The dominant arm LHBT cross-sectional area was significantly smaller than the nondominant arm (9 mm2 vs. 10 mm2; P = .011), whereas the dominant arm LHBT echogenicity was significantly higher than the nondominant arm (65 optical density vs. 59 optical density; P = .002). Pitchers with more bicipital groove rotational adaptation (more retroversion) had significantly more LHBT echogenicity adaptation compared with pitchers with less bicipital groove rotational adaptation (12 vs. 2; P = .023). CONCLUSION There are significant bilateral differences in the LHBT of professional baseball pitchers. An adaptation in bony rotation was associated with a larger bilateral difference in LHBT echogenicity but was not related to bilateral differences in LHBT area or circularity. Therefore, the bilateral difference in echogenicity is impacted by bony morphology, whereas the bilateral difference in cross-sectional area may be independent of bony morphology in this healthy population.
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Affiliation(s)
- Stephen J Thomas
- College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joseph J Sarver
- Department of Bioengineering, Drexel University, Philadelphia, PA, USA
| | - D David Ebaugh
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Ryan W Paul
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alim Osman
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Matthew Topley
- Department of Kinesiology, Temple University, Philadelphia, PA, USA
| | | | | | - John D Kelly
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lorentz NA, Hurley ET, Colasanti CA, Markus DH, Alaia MJ, Campbell KA, Strauss EJ, Jazrawi LM. Return to Play After Biceps Tenodesis for Isolated SLAP Tears in Overhead Athletes. Am J Sports Med 2022; 50:1369-1374. [PMID: 35341336 DOI: 10.1177/03635465211041698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Performing open subpectoral biceps tenodesis in overhead athletes with a superior labrum anterior to posterior (SLAP) tear may affect their ability to return to overhead sports. PURPOSE To investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of overhead athletes who underwent biceps tenodesis for a SLAP tear was performed. The American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, subjective shoulder value (SSV), patient satisfaction, willingness to undergo surgery again, revision procedures, and return to play were evaluated. Psychological readiness to return to sport was evaluated using the SLAP-Return to Sport after Injury (SLAP-RSI) score. A P value of <.05 was considered to be statistically significant. RESULTS The current study included 44 overhead athletes. The mean age was 34.9 years (range, 16-46 years), 79.5% were male, and the mean follow-up was 49.0 months (range, 18-107 months). Overall, 81.8% of patients returned to play their overhead sport after biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients, on average, 8.7 months to return to play after biceps tenodesis. The mean SLAP-RSI score was 69.4, and 70.5% of patients passed the SLAP-RSI threshold of 56. The mean ASES score, VAS score, SSV, and satisfaction were 92.0, 0.8, 80.6, and 87.9%, respectively. No patients in our cohort required revision surgery. CONCLUSION This study found that athletes undergoing biceps tenodesis for the treatment of a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.
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Affiliation(s)
- Nathan A Lorentz
- New York University Langone Health, New York City, New York, USA
| | - Eoghan T Hurley
- New York University Langone Health, New York City, New York, USA
| | | | | | - Michael J Alaia
- New York University Langone Health, New York City, New York, USA
| | - Kirk A Campbell
- New York University Langone Health, New York City, New York, USA
| | - Eric J Strauss
- New York University Langone Health, New York City, New York, USA
| | - Laith M Jazrawi
- New York University Langone Health, New York City, New York, USA
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15
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Rowe D, Ciccotti MG, Dugas JR. Performance and Return to Sports After Meniscectomy in Professional Baseball Players. Am J Sports Med 2022; 50:1006-1012. [PMID: 35148211 DOI: 10.1177/03635465221074021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injuries are common in athletes across many sports. How professional baseball players respond to partial meniscectomy is not well documented. PURPOSE/HYPOTHESIS The purpose was to determine the performance and return-to-sports (RTS) rate in professional baseball players after arthroscopic partial knee meniscectomy and compare the results of partial medial meniscectomy versus partial lateral meniscectomy. The hypothesis was that there would be a high RTS rate in professional baseball players after partial meniscectomy with no difference in the RTS rate or timing of RTS between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All professional baseball players who underwent arthroscopic partial meniscectomy between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after injury) for each player were recorded. The RTS rate and timing of RTS were then compared between players who underwent partial medial meniscectomy versus partial lateral meniscectomy. RESULTS A total of 168 knees (168 players) underwent arthroscopic partial meniscectomy (mean age, 25 ± 5 years; 46% medial meniscectomy, 45% lateral meniscectomy, and 9% both medial and lateral meniscectomy). The most common mechanism of injury was fielding in the infield on natural grass. Injuries were spread evenly across positions: 18% catchers, 24% infielders, 20% outfielders, and 38% pitchers. The overall RTS rate was 80% (76% returned to the same or a higher level, and 4% returned to a lower level). For performance, pitchers saw significant decreases in usage but significant improvements in performance using the advanced statistics of fielding independent pitching (P < .001) and wins above replacement (P = .011). Hitters saw significant decreases in usage but increases in efficiency as seen by improvements in wins above replacement (P = .003). Of the 79 athletes who returned during the same season, the median time to return to play was 42 days. CONCLUSION The RTS rate after meniscectomy in professional baseball players was 80%. Player efficiency improved after surgery in pitchers and position players. No difference in the RTS rate or timing of RTS existed between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Dana Rowe
- Major League Baseball Commissioner's Office, New York, New York, USA
| | | | - Jeffrey R Dugas
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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16
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Erickson BJ, Chalmers PN, D’Angelo J, Ma K, Rowe D, Ciccotti MG, Romeo AA. Update on Performance and Return to Sport After Biceps Tenodesis in Professional Baseball Players. Orthop J Sports Med 2022; 10:23259671221074732. [PMID: 35174251 PMCID: PMC8841927 DOI: 10.1177/23259671221074732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown. Purpose/Hypothesis: The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance. Study Design: Case series; Level of evidence, 4. Methods: All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis). Results: Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls. Conclusion: Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully.
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Affiliation(s)
| | - Peter N. Chalmers
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, Utah, USA
| | - John D’Angelo
- Major League Baseball Commissioner’s Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner’s Office, New York, New York, USA
| | - Dana Rowe
- Major League Baseball Commissioner’s Office, New York, New York, USA
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Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30. Arthroscopy 2022; 38:307-312. [PMID: 34343624 DOI: 10.1016/j.arthro.2021.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the current study is to compare the outcomes of open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under the age of 30 years. METHODS A retrospective review of patients under the age of 30 years who underwent either isolated BT or AR for a diagnosis of a SLAP tear between 2011 and 2019 was performed. Patients were included if they were >16 years old at the time of surgery, had an isolated SLAP tear involving instability of the biceps-labral anchor (types II-IV), were skeletally mature, and had a minimum follow-up of 12 months. The American Shoulder & Elbow Surgeons score, visual analog scale, Subjective Shoulder Value, patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. A P value of <.05 was considered statistically significant. RESULTS Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, and the mean follow-up duration was 60 months. At final follow-up, there was no difference between treatment groups in any of the functional outcome measures assessed (P > .05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; P = .53), timing of RTP (BT: 8.8 months, AR: 9.4 months; P = .61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; P > .99). Among those undergoing AR, 9 required a revision procedure (11.5%) compared to none treated with BT (P = .11). CONCLUSIONS In patients under the age of 30 years with a symptomatic isolated SLAP tear, BT may be a reliable alternative to AR. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Blaeser AM, Markus DH, Hurley ET, Gonzalez-Lomas G, Strauss EJ, Jazrawi LM. Current Controversies and Decision-Making in the Management of Biceps Pathologies. JBJS Rev 2021; 9:01874474-202112000-00008. [PMID: 34962898 DOI: 10.2106/jbjs.rvw.21.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Biceps tendon pathologies include a spectrum of injuries that range from mild tendinosis to complete tendon rupture. » Tendinosis, the most common pathology, occurs more frequently with age and is likely related to chronic degeneration. On the other side of the spectrum of severity lies a rupture of the long head of the biceps tendon (LHBT), which may be accompanied by injury to the glenoid labrum. » Superior labral anterior-posterior (SLAP) tears are frequently associated with biceps pathology. Surgical management for injuries of the bicipital-labral complex includes biceps tenodesis or tenotomy and SLAP repair. A consensus as to which of these procedures is the optimal choice has not been reached, and management may ultimately depend on patient-specific characteristics. » Due to the relatively low incidence of distal biceps tendon rupture, agreement on the optimal management strategy has not been reached. Surgical repair, or reconstruction in the case of a chronic rupture, is often chosen. However, nonoperative management has also been utilized in older, less-active patients.
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Affiliation(s)
- Anna M Blaeser
- Department of Sports Medicine, New York University Langone Health, New York, NY
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19
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Concomitant Biceps Tenodesis Improves Outcomes for SLAP Repair: Minimum 2-Year Clinical Outcomes after SLAP II-IV Repair Versus Tenodesis Versus Both. Arthrosc Sports Med Rehabil 2021; 3:e2007-e2014. [PMID: 34977660 PMCID: PMC8689264 DOI: 10.1016/j.asmr.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 10/11/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To investigate clinical outcomes, return to sport, and complication rate in patients with an isolated SLAP II-IV tear treated with biceps tenodesis (BT), SLAP-repair (SLAP-R), or both (SLAP-R+BT). Methods A retrospective analysis of prospectively collected data was performed in patients who underwent surgery between February 2006 and February 2018 for isolated SLAP II-IV lesions with either BT, SLAP-R, or SLAP-R+BT and had minimum 2-year follow-up. Patients were excluded if they were older than 45 years of age, had anterior shoulder instability, rotator cuff tears, glenohumeral osteoarthritis, or concomitant fractures about the shoulder. Clinical outcomes were assessed by the use of the American Shoulder and Elbow Society Score, Single Assessment Numerical Evaluation Score, Quick Disabilities of the Arm, and Shoulder and Hand Score, the General Health Short Form-12 Physical Component, and patient satisfaction. Results There were 38 shoulders in the isolated BT group with 1 (2.6%) shoulder requiring revision, 13 in the SLAP-R group with no patient requiring revision, and 21 in the SLAP-R+BT group with 2 (9.5%) shoulders requiring revision. Minimum 2-year follow-up was obtained in >85% of each group. Mean age at time of surgery was significantly different between the groups (36.5 years BT vs 27.7 years SLAP-R vs 36.5 years SLAP-R+BT; P = .003). While patient-reported outcomes improved significantly from pre- to postoperatively for the BT (P < .001) and SLAP-R+BT groups (P < .001), they did not significantly improve for the isolated SLAP-R group (P values ranging .635 to .123). The BT and SLAP-R+BT groups showed significant improvement in return to sport pre- to postoperatively whereas the SLAP-R group did not. The SLAP-R+BT group had the most patients reaching minimal clinical important difference, substantial clinical benefit, and patient acceptable symptom state American Shoulder and Elbow Society Score scores; however, this was not statistically significant. Conclusions SLAP II-IV lesions treated with BT or both SLAP-R+BT demonstrated improved outcomes compared with isolated SLAP-R at minimum 2-year follow-up. Concomitant biceps tenodesis should be considered when performing repair of SLAP II-IV tears. Level of Evidence III; Retrospective comparative study.
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Maier J, Oak SR, Soloff L, Schickendantz M, Frangiamore S. Management of common upper extremity injuries in throwing athletes: a critical review of current outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:295-300. [PMID: 37588704 PMCID: PMC10426540 DOI: 10.1016/j.xrrt.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Given the rising incidence and prevalence of shoulder injuries in throwing athletes, this review aims to evaluate management options and outcomes of common shoulder injuries in overhead throwers. Laxity of the glenohumeral joint is often adaptive for overhead athletes to achieve the velocity necessary to compete in the professional ranks. Surgical repair of the stabilizers of the humeral head-specifically the labrum and rotator cuff-often causes inflammation, scarring, and overtensioning of the glenohumeral joint which lead to poor postoperative performance. Thus, nonsurgical management should be exhausted in this population before considering surgical intervention.
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Affiliation(s)
- Jacob Maier
- University of Toledo College of Medicine, Toledo, OH, USA
| | | | - Lonnie Soloff
- Cleveland Indians Baseball Organization, Cleveland, OH, USA
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21
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Siebenlist S, Hinz M, Scheiderer B. Behandlung der SLAP-Verletzung des jungen Sportlers. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Agarwalla A, Gowd AK, Liu JN, Beck EC, Cole BJ, Yanke AB, Nicholson GP, Romeo AA, Verma NN, Forsythe B. Predicting Patient Satisfaction With Maximal Outcome Improvement After Biceps Tenodesis. Orthopedics 2021; 44:e359-e366. [PMID: 34039198 DOI: 10.3928/01477447-20210414-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The goal of this study was to determine the threshold for achieving maximal outcome improvement (MOI) on the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (CM) questionnaires that predict satisfaction after isolated biceps tenodesis without concomitant rotator cuff repair. A retrospective analysis of prospectively collected data was performed for patients undergoing isolated biceps tenodesis from 2014 to 2017 at a single institution with minimum 6-month follow-up. Receiver operating characteristic curve analysis was used to determine thresholds for MOI for the ASES, SANE, and CM questionnaires. Stepwise multivariate logistical regression analysis was performed to identify predictors for achieving the threshold for MOI. A total of 123 patients were included in the final analysis. Receiver operating characteristic analysis determined that achieving 43.1%, 62.1%, and 61.4% MOI was the threshold for satisfaction for the ASES, SANE, and CM questionnaires, respectively. Regression analysis showed that concomitant superior labrum anterior-posterior (SLAP) repair was predictive of achieving MOI on the ASES and SANE questionnaires, whereas partial rotator cuff tear was predictive of achieving MOI on the CM questionnaire (P<.05 for both). Further, workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors of achieving MOI on the SANE and CM questionnaires (P<.05 for all). Achieving MOI of 43.1%, 62.1%, and 61.4% is the threshold for satisfaction after biceps tenodesis for the ASES, SANE, and CM questionnaires, respectively. Concomitant SLAP repair was positively predictive of achieving MOI, whereas workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors. [Orthopedics. 2021;44(3):e359-e366.].
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Christensen GV, Smith KM, Kawakami J, Chalmers PN. Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. Open Access J Sports Med 2021; 12:61-71. [PMID: 33981168 PMCID: PMC8107051 DOI: 10.2147/oajsm.s266226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/02/2023] Open
Abstract
Superior labrum anterior-posterior (SLAP) lesions are common in overhead athletes. Though some patients have asymptomatic lesions, many tears cause pain and diminished athletic performance. Accurate diagnosis of SLAP lesions can be challenging as the sensitivity and specificity of both the physical exam and advanced imaging is questionable. Management is also difficult, as treatment can be life-altering or career-ending for many athletes. If first-line nonoperative treatment fails, surgical options may be considered. The optimal surgical management of SLAP lesions in athletes is debated. Historically, return to play (RTP) rates among athletes who have undergone arthroscopic SLAP repair have been unsatisfactory, prompting clinicians to seek alternate surgical options. Biceps tenodesis (BT) has been postulated to eliminate biceps tendon-related pain in the shoulder and is increasingly used as a primary procedure for SLAP lesions. The purpose of this text is to review the current literature on the surgical management of SLAP lesions in athletes with an emphasis on the role of BT.
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Affiliation(s)
- Garrett V Christensen
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Karch M Smith
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
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Grubhofer F, Muniz Martinez AR, Ernstbrunner L, Haberli J, Selig ME, Yi K, Warner JJ. Speed of recovery of the most commonly performed shoulder surgeries. JSES Int 2021; 5:776-781. [PMID: 34223429 PMCID: PMC8245973 DOI: 10.1016/j.jseint.2021.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder surgery results in several months of rehabilitation, which is often underestimated by patients preoperatively. Currently, there is little written about this process of recovery. Information on this would help patients to anticipate the trajectory of their recovery. This would also provide a reference point allowing surgeons to compare a patient's progress in their recovery. The purpose of our study was to analyze and document the expected rate of recovery for the most common shoulder operations. Methods A retrospective analysis of all patients who underwent total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), arthroscopic rotator cuff repair (ARCR), and arthroscopic biceps tenodesis (BT) using prospectively collected data from the Surgical Outcomes System registry was performed. All patients included had a complete 2-year follow-up data set. The pain score (visual analog scale) was measured preoperatively at 2, 6, and 12 weeks and 6, 12, and 24 months. The American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) score were recorded preoperatively and after 6, 12, and 24 months. The speed of recovery, defined as the percentage of total improvement, for each procedure was assessed as the primary outcome parameter at all time points. Results All shoulder interventions resulted in significant improvement of the pain, SANE, and ASES scores 2 years after shoulder surgery. The speed of recovery of all 3 scores was highest after TSA at all measured time points and slowest after ARCR and BT. Measured by the pain score, 90% and 82% of the total improvement after TSA and RTSA was completed after 6 weeks compared to 58% and 59% after ARCR and BT, respectively. Six months postoperatively the ASES recovery rate was significantly higher after arthroplasty (TSA 96% and RTSA 85%) compared to ARCR and BT (76% and 77%, respectively). The SANE score recovery rate was between 82% and 92% (TSA 92%, RTSA 89%, ARCR 87%, BT 82%) 6 months after surgery. After 1 year all patient groups reached 89% or more of the total improvement in all scores, except for the pain after ARCR (89%). Conclusion The improvement in pain is fastest after TSA and slowest after ARCR and BT. After TSA and RTSA, >80% of the total pain reduction is achieved 6 weeks postoperatively, whereas after ARCR and BT, >80% of the pain reduction is achieved only 6 months postoperatively. At 12 months postoperatively, the differences in recovery curves were not significant.
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Affiliation(s)
- Florian Grubhofer
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Corresponding author: Florian Grubhofer, MD, Department of Orthopedic Surgery, Harvard Medical School, Fruit Street 55, Boston, MA 02114, USA.
| | - Andres R. Muniz Martinez
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Lukas Ernstbrunner
- Balgrist University Hospital, Department of Orthopedic Surgery, University of Zürich, Zürich, Switzerland
| | - Jillian Haberli
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Megan E. Selig
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Karen Yi
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Jon J.P. Warner
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS 2021; 6:204-211. [PMID: 34272296 DOI: 10.1136/jisakos-2020-000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.
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Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Anthony A Romeo
- Musculoskeletal Institute, DuPage Medical Group, Downers Grove, Illinois, USA
| | - Emilio Calvo
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Verma N. In Adults with Lesions of the Long Head of the Biceps Tendon, Tenodesis and Tenotomy Did Not Differ for Pain and Function at 2 Years. J Bone Joint Surg Am 2021; 103:357. [PMID: 33369979 DOI: 10.2106/jbjs.20.02086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nikhil Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Frantz TL, Shacklett AG, Martin AS, Barlow JD, Jones GL, Neviaser AS, Cvetanovich GL. Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review. Am J Sports Med 2021; 49:522-528. [PMID: 32579853 DOI: 10.1177/0363546520921177] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. PURPOSE To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. STUDY DESIGN Systematic review. METHODS A systematic review was performed for any articles published before July 2019. The search phrase "labral tear" was used to capture maximum results, followed by keyword inclusion of "SLAP tear" and "biceps tenodesis." Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. RESULTS After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. CONCLUSION BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.
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Affiliation(s)
- Travis L Frantz
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew G Shacklett
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Grant L Jones
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew S Neviaser
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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SLAP Tears in the Throwing Shoulder: A Review of the Current Concepts in Management and Outcomes. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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The majority of patients return to athletic activity following biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:216-222. [PMID: 32185452 DOI: 10.1007/s00167-020-05930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Biceps tenodesis is widely used as a primary treatment for long head of the biceps brachii pathology and superior labral anterior and posterior (SLAP) lesions. However, rates and timing of full return to sports (RTSs)/duty have not been systematically analysed. This systematic review examines the literature to ascertain the rate and timing of return to athletic activity, and the availability of specific criteria for safe return to atheletic activity following the biceps tenodesis. METHODS Based on PRISMA guidelines, this systematic review utilised the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to athletic activity following biceps tenodesis. Statistical analysis was performed using SPSS. RESULTS This review identified 17 studies including 374 cases meeting the inclusion criteria. The majority of patients were men 260 (69.7%), with an median age of 42.2 years (range 16-88) and a mean follow-up of 37.4 months. The overall rate of RTS was 217/269 (80.7%), with 43/59 (72.9%) returning to the same level. In overhead athletes, the overall rate of return to play was 39/49 (79.6%). Among military personnel, the overall rate of return to duty was 61/74 (82.4%). The average time to RTS was 5.4 (range 3-11) months. 10 (58.8%) Studies reported a recommended time window within which patients were allowed to return to full activity. Specific criteria for return to play were not reported in any of the identified studies. CONCLUSION While overall rate of return to athletic activity was reportedly high following biceps tenodesis, one in four patients were not able to resume athletic activity at the same level. At present, there is no objective assessment of when patients can return to full activity reported in the literature. LEVEL OF EVIDENCE IV.
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[Injuries of the biceps-labrum complex : Principles, pathologies and treatment concepts]. Unfallchirurg 2020; 124:96-107. [PMID: 33301084 DOI: 10.1007/s00113-020-00927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The biceps-labrum complex is prone to acute lesions and degenerative changes due to its anatomical structure and the high load it has to endure. Pathological changes of these structures are common pain generators and can significantly impair shoulder function. Anatomically, the biceps-labrum complex can be divided into three zones: inside, junction and bicipital tunnel. DIAGNOSTIC PROCEDURE Despite the focused physical examination and advancements in imaging techniques, the exact localization of pathologies remains challenging. Arthroscopy can be used to accurately diagnose inside and junctional pathologies but extra-articular changes in the region of the bicipital tunnel can only be partially visualized. TREATMENT In cases of unsuccessful conservative treatment and correct indications, a high level of patient satisfaction can be surgically achieved. In young patients an anatomical reconstruction of inside lesions or tenodesis of the long head of the biceps tendon is performed; however, even tenotomy is a valuable option and can achieve equally satisfactory results. Unaddressed pathological changes of the bicipital tunnel can lead to persistence of pain. In clinical procedures performing tenodesis, both the different techniques and the implants used have been found to show similar results. This article describes the anatomical principles, pathological changes, the focused clinical instrumental diagnostics and discusses the different treatment philosophies as well as the outcome according to the recent literature.
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Toale JP, Hurley ET, Davey MS, Cassidy JT, Pauzenberger L, Mullett H. Return to Play after Arthroscopic Bankart Repair Combined with Open Subpectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2020; 2:e499-e503. [PMID: 33134986 PMCID: PMC7588640 DOI: 10.1016/j.asmr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/21/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis. Methods A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated. Results The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder. Conclusion Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability. Level of Evidence IV, Therapeutic Case Series.
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Affiliation(s)
- James P. Toale
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- National University of Ireland Galway, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Address correspondence to Eoghan T. Hurley, M.B., B.Ch., M.Ch., Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.
| | - Martin S. Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Tristan Cassidy
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Hepp P, Henkelmann R. ["Handball shoulder" in the focus of diagnosis and treatment]. SPORTVERLETZUNG-SPORTSCHADEN 2020; 34:153-162. [PMID: 32823344 DOI: 10.1055/a-1107-8514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Handball is one of the most popular team sports in Germany. In the diagnosis and treatment of shoulder injuries and shoulder complaints, a distinction must be made between sports-specific adaptation over many years and supposed decompensation. In contrast to throwing sports such as baseball or javelin, intended movement sequences in handball are often disrupted suddenly and abruptly by simultaneous contact with an opponent. This can result in a potential for further injuries. There is usually a gradual transition from a physiologically adapted handball shoulder to a pathological throwing shoulder requiring therapy. A throwing shoulder is characterised by a limitation of performance caused by pain in the shoulder during repeated sports-specific stress. In addition to a thorough clinical examination, MRI is the preferred method of examination due to the fact that changes in a handball shoulder are reflected in muscular tissue, tendons and bone in the form of overstrain reactions (bone bruise). Patients should not only take a break from sports and receive adequate pain treatment, but also undergo a specific physiotherapy regimen. MRI results should always be interpreted in due consideration of symptoms and clinical examination results. Surgery is indicated if there is a lack of improvement after specific pain treatment and physiotherapy, or structural damage corresponding to the symptoms without a chance of recovery or with a higher probability of symptoms and function improving in response to surgery. After surgical treatment, the subsequent rehabilitation plays a major role. Depending on the injury, up to 90 % of the patients may be able to return to sports.
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Affiliation(s)
- Pierre Hepp
- Klinik für Orthopädie, Unfallchirurgie, plastische Chirurgie, Universität Leipzig
| | - Ralf Henkelmann
- Klinik für Orthopädie, Unfallchirurgie, plastische Chirurgie, Universität Leipzig
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Lu Y, Agarwalla A, Patel BH, Nwachukwu BU, Baker JD, Verma NN, Cole BJ, Forsythe B. Relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing and legacy instruments in patients undergoing isolated biceps tenodesis. J Shoulder Elbow Surg 2020; 29:1214-1222. [PMID: 32113866 DOI: 10.1016/j.jse.2019.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
HYPOTHESIS The purpose of this study was to correlate the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) domains with commonly used legacy patient-reported outcome measures (PROMs) preoperatively in a population of patients presenting to a tertiary care orthopedic center for biceps and labral pathology. METHODS Prospective data were collected on 175 patients scheduled to undergo isolated biceps tenodesis at a tertiary center. Enrollees completed legacy scores (Veterans RAND 12-Item Health Survey, Short Form 12, American Shoulder and Elbow Surgeons [ASES] Assessment Form, Single Assessment Numeric Evaluation, and Constant-Murley score) and PROMIS CAT questionnaires (Upper Extremity [UE], Pain Interference [PIF], and Depression). In addition, patients were asked to provide an assessment of the strength, function, and pain of the affected shoulder using a custom visual analog scale (VAS) questionnaire. Spearman rank correlations of the PROMIS CAT with legacy measures and the custom VAS were calculated. Floor and ceiling effects were assessed. RESULTS The UE CAT yielded moderate correlations with the ASES score (r = 0.57) and the custom VAS strength score (r = 0.50-0.57). The PIF CAT demonstrated moderate correlations with the VAS pain score (r = 0.45) and high-moderate correlations with the ASES score, VR6D score, and UE CAT (r = 0.61-0.66). The Depression CAT demonstrated high-moderate correlations with the mental health legacy measures (r = -0.64 to -0.61). There was a significant relative floor effect for the Depression CAT at a score of 34.2 (19%). CONCLUSION The PIF CAT was comparable to the ASES score, the current gold standard. Compared with legacy measures, both the UE CAT and PIF CAT are less burdensome and have few floor or ceiling effects. The PIF CAT may be a viable alternative to describe the physical and psychosocial impact of pain in biceps tenodesis patients.
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Affiliation(s)
- Yining Lu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - James D Baker
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Khalid MA, Morris RP, Black N, Maassen NH. Biomechanical Evaluation of Humerus Fracture After Subpectoral Biceps Tenodesis With Interference Screw Versus Unicortical Button. Arthroscopy 2020; 36:1253-1260. [PMID: 31973991 DOI: 10.1016/j.arthro.2019.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the torsional failure strength of the humerus after subpectoral biceps tenodesis with an interference screw versus a unicortical button in a human cadaveric model. METHODS Thirteen matched pairs of fresh-frozen human cadaveric upper extremities were randomized to receive either 2.6 × 12 mm unicortical button or 6.25-mm interference screw subpectoral biceps tenodesis. After the procedure, the humeri were loaded into a materials testing machine. The humeri were loaded in external rotation with respect to the elbow at 1.0°/s until failure. Rotation angle to failure, failure torque, energy absorbed, and stiffness were compared by paired t-tests with alpha set at 0.05. RESULTS Humeri that were fixed with unicortical buttons showed statistically significant higher rotation to failure (26.87 ± 5.83 vs 19.04 ± 3.86°, P < .001), failure torque (54.11 ± 22.01 vs 44.95 ± 17.47 Nm, P < .001), and energy absorbed (883.93 ± 582.28 vs 451.40 ± 216.19 Nm-Deg, P = .002) than humeri fixed with interference screws. CONCLUSIONS In a cadaveric biomechanical model, at time 0, the use of a 2.7 × 12-mm unicortical button fixation in biceps tenodesis resulted in higher loads required to fracture the humerus when compared with a 6.25-mm interference screw fixation in a torsion model. CLINICAL RELEVANCE This study demonstrates a significant biomechanical difference with regards to fracture of the humerus, between 2 commonly used fixations methods and implant sizes, interference screw, and unicortical button. The results of this study can aid surgeons in implant selection as well as help to improve patient education prior to surgery.
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Affiliation(s)
- Mohammed A Khalid
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas, U.S.A
| | - Randal P Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas, U.S.A
| | - Natalie Black
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas, U.S.A
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Sullivan S, Hutchinson ID, Curry EJ, Marinko L, Li X. Surgical management of type II superior labrum anterior posterior (SLAP) lesions: a review of outcomes and prognostic indicators. PHYSICIAN SPORTSMED 2019; 47:375-386. [PMID: 30977691 DOI: 10.1080/00913847.2019.1607601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A Type II SLAP (superior labrum anterior posterior) lesion is a tear of the superior glenoid labrum with involvement of the long head of the biceps tendon insertion. In patients that do not improve with conservative treatment, there is a great deal of variability in the surgical management of these injuries that includes arthroscopic SLAP repair, arthroscopic SLAP repair with biceps tenodesis, biceps tenodesis alone and biceps tenotomy. Each surgical technique has specific effects on a patient's postoperative course and functional recovery. Rehabilitation strategies may be best formulated on an individual basis with an open line of communication between the operating surgeon and the physical therapist. Despite an increased incidence in treatment, there is currently no consensus on the optimal surgical procedure or treatment algorithm for Type II SLAP injuries. However, in middle-aged or older patients (>35) with Type II SLAP tears, either arthroscopic suprapectoral or mini-open subpectoral biceps tenodesis is recommended due to the higher failure rates observed with arthroscopic SLAP repair in this patient group. Although more patients present with a 'Popeye' sign after biceps tenotomy, long-term functional outcome is similar between biceps tenodesis compared to tenotomy. However, more patients will experience biceps fatigue or cramping after the tenotomy procedure. Biceps tenodesis is preferred in younger, more active patients, while tenotomy is preferred in the middle-aged or older and lower demand patients. The aim of this paper is to provide a brief description of the different surgical techniques employed to address Type II SLAP lesions (arthroscopic repair, biceps tenodesis, and biceps tenotomy) and provide a review of available literature regarding outcomes and prognostic factors associated with each technique.
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Affiliation(s)
- Sean Sullivan
- Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Ian D Hutchinson
- Department of Orthopaedic Surgery, Albany Medical Medical Center, Albany, NY, USA
| | - Emily J Curry
- School of Public Health, Boston University, Boston, MA, USA
| | - Lee Marinko
- Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
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Lubowitz JH, Brand JC, Rossi MJ. What You Don't Know Until It's Too Late! Arthroscopy Podcasts Could Change Your Practice. Arthroscopy 2019; 35:2539-2541. [PMID: 31500738 DOI: 10.1016/j.arthro.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
Podcasts provide a follow-up on articles from Arthroscopy, Arthroscopy Techniques, and Arthroscopy, Sports Medicine, and Rehabilitation. Readers could learn a great deal by interviewing the authors of scientific studies, and Podcasters do exactly that.
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Stetson WB, Polinsky S, Morgan SA, Strawbridge J, Carcione J. Arthroscopic Repair of Type II SLAP Lesions in Overhead Athletes. Arthrosc Tech 2019; 8:e781-e792. [PMID: 31485407 PMCID: PMC6714522 DOI: 10.1016/j.eats.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/13/2019] [Indexed: 02/03/2023] Open
Abstract
For overhead athletes and, in particular, baseball pitchers, the rates of success and return to play for those who have undergone arthroscopic repair of type II SLAP lesions are poor, ranging from 7% to 62%. The reasons for the poor results and high failure rates in overhead athletes with type II SLAP repairs are multifactorial and are a combination of many factors. These factors include the failure to establish the diagnosis and treat these athletes preoperatively; the inability of the operating surgeon to differentiate normal anatomic variants from pathologic SLAP lesions at the time of surgery; the surgical technique, which may violate the rotator cuff; or the placement of suture anchors, which restricts external rotation and alters overhead throwing mechanics. The proper diagnosis of SLAP lesions can be difficult because SLAP tears rarely occur in isolation and are often associated with other shoulder pathology. A proper history detailing the onset of symptoms and whether there was an acute episode of trauma or a history of repetitive use is critical. It is important to remember that no single physical examination finding is pathognomonic for SLAP tears. When seen in isolation, SLAP tears may mimic impingement syndrome (52%) or even anterior instability (39%). Surgical treatment of type II SLAP lesions should not be undertaken lightly in overhead athletes. If a 3-month rehabilitation period followed by a return to sports over the following 3 months does not allow the athlete to return to his or her preinjury level, diagnostic arthroscopy with SLAP repair is a reasonable option and can yield excellent results using the proper techniques. The technique described in detail in this article and our video can be technically demanding, but with the key points outlined, it can be reproduced and provide excellent results for overhead athletes undergoing SLAP repair. By not violating the rotator cuff, using a mattress configuration and keeping the suture knot away from the articular surface, and by not going anterior to the biceps tendon for repair, external rotation and strength can be preserved, leading to an excellent result with a predictable return to play for overhead athletes.
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Affiliation(s)
- William B. Stetson
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.,Address correspondence to William B. Stetson, M.D., Stetson Powell Orthopedics and Sports Medicine, 191 S Buena Vista St, Ste 470, Burbank, CA 91505, U.S.A.
| | - Samuel Polinsky
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A
| | | | - Jason Strawbridge
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A
| | - Jonathan Carcione
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A
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Grant JA. Outcomes Associated with Return to Sports Following Osteochondral Allograft Transplant in the Knee: a Scoping Review. Curr Rev Musculoskelet Med 2019; 12:181-189. [PMID: 31037518 PMCID: PMC6542899 DOI: 10.1007/s12178-019-09557-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The purposes of this review were to report the currently validated outcomes for OCA transplant patients, discuss the benefits and challenges associated with "return to sports" as an outcome measure, and summarize the currently available data on patients' ability to return to sports after OCA transplant. RECENT FINDINGS College athletes may take less time than professionals to return to basketball, but there are many factors that can influence this timeframe. Player productivity is decreased ~ 40% and future career length is only 1 to 2 years following return to play. When evaluating all OCA transplant patients, 75-88% of patients return to sport and 38-80% return to their previous level of play at approximately 8-10 months following surgery. Overall graft failure rates are low (0-9.4%) but are based on limited short- to medium-term data. Data on the return to professional and college sports after OCA transplant is limited. Surgeons should consider collecting patient outcomes across multiple domains and contributing data to aggregate databases to allow for better quality outcome data to be reported.
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Affiliation(s)
- John A Grant
- MedSport, University of Michigan, 24 Frank Lloyd Wright Dr. Suite 1000, Box 391, Ann Arbor, MI, 48106, USA.
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Editorial Commentary: Which to Fix-the Biceps or the Labrum? The Shoulder SLAP Tear Is Still Controversial. Arthroscopy 2019; 35:1939-1940. [PMID: 31159973 DOI: 10.1016/j.arthro.2019.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
A type II SLAP tear in a young and active patient remains a controversial and challenging clinical entity. Arthroscopic repair is generally a successful procedure for type II SLAP lesions, but the results can be unpredictable. Biceps tenodesis has become increasingly popular for the management of these lesions, with recent clinical literature suggesting that the results may be equivalent or superior to those of SLAP repair. Recent meta-analyses have summarized the available clinical data and offered some guidance on which patients may benefit most from either procedure.
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Abstract
The long head of the biceps and the biceps pulley sling are prone to acute or degenerative injury. As they both were identified as major pain generators, adequate diagnosis and treatment is vital for successful treatment of shoulder pain. Although the basic principles to address either pathology have not changed over the last decades, new trends have evolved to simplify surgical options. SLAP (superior labral tear from anterior to posterior) repair is seen more restrictive and is mostly performed in young individuals, whereas tenotomy or tenodesis are more often used in patients over 30. The long head of the biceps and pulley lesions are treated with either tenotomy or tenodesis. Surgical techniques for tenodesis are especially less invasive using current implants. Tenodesis is performed either intraarticular, supra- or subpectoral with tenodesis screws or suture anchors. Soft tissue tenodesis has become unpopular over the last decade. Surgical treatment of the long head of the biceps pathologies allows highly satisfying results if the indication is chosen thoroughly.
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Abdul-Rassoul H, Defazio M, Curry EJ, Galvin JW, Li X. Return to Sport After the Surgical Treatment of Superior Labrum Anterior to Posterior Tears: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119841892. [PMID: 31106221 PMCID: PMC6506928 DOI: 10.1177/2325967119841892] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Controversy exists as to the optimal treatment of superior labrum anterior to
posterior (SLAP) tears in athletes. There are no systematic reviews
evaluating return-to-sport (RTS) rates after arthroscopic SLAP repair and
biceps tenodesis. Purpose: To compare the overall RTS rates in patients with primary type 2 SLAP tears
who were managed with arthroscopic SLAP repair versus biceps tenodesis. Study Design: Systematic review; Level of evidence, 4. Methods: A review was performed according to the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines by searching the MEDLINE
(PubMed), Embase (Elsevier), and Cochrane Library databases. Inclusion
criteria were clinical studies that evaluated RTS rates after arthroscopic
SLAP repair, arthroscopic SLAP repair with partial rotator cuff debridement,
and biceps tenodesis. The studies were analyzed for quality and inclusion in
the final analysis. Data relevant to RTS rates were then extracted and
compiled, and outcomes were compared. Results: Of the 337 studies initially identified, 15 (501 patient-athletes) met
inclusion criteria. These consisted of 195 patients who underwent isolated
arthroscopic SLAP repair (mean age, 31 years; mean follow-up, 3.2 years),
222 patients who underwent arthroscopic SLAP repair with partial rotator
cuff debridement (mean age, 22 years; mean follow-up, 5.1 years), and 84
patients who underwent biceps tenodesis (mean age, 42 years; mean follow-up,
3.3 years). The overall RTS rates were high for all 3 procedures (SLAP
repair, 79.5%; SLAP repair with rotator cuff debridement, 76.6%; biceps
tenodesis, 84.5%), with biceps tenodesis having the highest overall rate.
Biceps tenodesis also had the highest RTS rate at the preinjury level
(78.6%) compared with SLAP repair (63.6%) and SLAP repair with rotator cuff
debridement (66.7%). Conclusion: Primary arthroscopic SLAP repair, arthroscopic SLAP repair with partial
rotator cuff debridement, and biceps tenodesis all provide high RTS rates.
Biceps tenodesis as an operative treatment of primary SLAP lesions may
demonstrate an overall higher RTS rate when compared with traditional SLAP
repair in older athletes. More, higher level studies are needed that control
for age, level of activity, and type of sport (overhead vs nonoverhead) to
determine the efficacy of biceps tenodesis as a primary alternative to
arthroscopic SLAP repair in young athletes who present with type 2 SLAP
tears.
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Affiliation(s)
- Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Defazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph W Galvin
- Department of Orthopedics, Blanchfield Army Community Hospital Orthopedic Clinic, Fort Campbell, Kentucky, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Tauro JC. Editorial Commentary: Silly Biceps, Tenodesis Is for Kids! Arthroscopy 2019; 35:1042-1043. [PMID: 30954098 DOI: 10.1016/j.arthro.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 02/02/2023]
Abstract
There is now a strong consensus that the best surgical treatment of a SLAP lesion is often something different from a primary direct repair, especially in older patients in whom postoperative stiffness and persistent pain have led most of us to perform a biceps tenodesis instead. However, treatment of younger patients and especially the overhead athlete group is more problematic and thus controversial. This study demonstrates that biceps tenodesis in these patients can be more successful and have a higher return to sport than SLAP repair alone. There may also be a role for biceps tenodesis AND a SLAP repair but the numbers presented in this paper preclude an analysis of exactly who that group is. When it comes to the treatment of patients with SLAP lesions for whom a very well executed rehabilitation program has failed, understanding the symptoms and demographics of your patients is critical to surgical decision making. The pendulum may swing toward tenodesis, but beware: The correct answer is usually near the center of the arc!
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Chalmers PN, Erickson BJ, D'Angelo J, Ma K, Romeo AA. Epidemiology of Shoulder Surgery Among Professional Baseball Players. Am J Sports Med 2019; 47:1068-1073. [PMID: 30883189 DOI: 10.1177/0363546519832525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries remain a significant problem for professional baseball players. There is little information regarding the incidence and outcomes of shoulder surgical procedures among these athletes. PURPOSE/HYPOTHESIS To report the incidence, pathology, procedure type, demographics, and return-to-sport (RTS) rate of shoulder surgery among Major League Baseball (MLB) players. Most shoulder procedures would be performed on pitchers with a history of injury; the labrum would be the most commonly involved; and that the RTS rate would be >50%. STUDY DESIGN Descriptive epidemiology study. METHODS All MLB players who underwent surgery between 2012 and 2016 were identified from a database prospectively maintained by MLB. Demographic information and details regarding the procedure were recorded and RTS rates determined. Only those players with a minimum 2-year follow-up were included. RESULTS There were 581 shoulder procedures performed (542 players; pitchers, 60%; incidence, 1.48%). Overall, 19% of surgical procedures were performed on major league players and 81% on minor league players. Most players were between 20 and 25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within rotator cuff surgery, 84% involved debridement; most tears were articular sided (87%); and 75% involved the supraspinatus. Overall, 11% of players had prior shoulder surgery, and 76% spent time on the disabled list before surgery. The overall rate of RTS was 63%. Of those who returned, 86% returned to at least the same level of play or higher as before surgery. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or could not ascend to a higher level because they were already in the majors. CONCLUSION Shoulder surgery is uncommon among professional baseball players. Of those players who require surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular-sided supraspinatus tears. The overall RTS rate is 63%. Of those who return, 86% are able to return to the same or higher level of play as before surgery.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
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Erickson BJ, Petronico N, Romeo AA. Approach to Latissimus Dorsi and Teres Minor Injuries in the Baseball Pitcher. Curr Rev Musculoskelet Med 2019; 12:24-29. [PMID: 30707407 DOI: 10.1007/s12178-019-09532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Tears of the latissimus dorsi and teres major are uncommon but significant injuries, most frequently seen in high-level, overhead throwing athletes. Diagnosis can be challenging, as there are no pathognomonic signs, symptoms, or physical exam findings associated with latissimus dorsi/teres major tears, and the clinician must have a high suspicion for this injury. While many of these tears can be treated non-operatively, a subset of these benefits from surgical intervention. Rehabilitation following operative and non-operative treatments of these injuries is extensive, and timing of return to sport can be variable from 3 to 12 months. RECENT FINDINGS The literature surrounding latissimus dorsi/teres major injuries is sparse. Several small studies have shown good results in patients with mild to moderate tears that were treated non-operatively. Recent evidence has shown good results following operative repair of larger tears, with excellent return to sport rates. Furthermore, focused rehabilitation is imperative when treating patients with latissimus dorsi/teres major injuries to allow these athletes to return to sport. Latissimus dorsi/teres major tears are uncommon but significant injuries in the throwing athlete. Prompt diagnosis, proper treatment, and focused rehabilitation will allow these patients to return to sport in a safe and efficient manner.
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Affiliation(s)
- Brandon J Erickson
- Sports Medicine/Shoulder and Elbow Division, Rothman Orthopaedic Institute, New York, NY, 10065, USA. .,Rothman Orthopaedic Institute, 658 White Plains Rd, Tarrytown, NY, 10591, USA.
| | - Nina Petronico
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Anthony A Romeo
- Sports Medicine/Shoulder and Elbow Division, Rothman Orthopaedic Institute, New York, NY, 10065, USA
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Abstract
Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear.Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons.First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous.Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries.Third, SLAP lesions have no specific associated pain pattern.Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics.Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
| | - Gazi Huri
- Department of Orthopaedic and Traumatology, Hacettepe University, Ankara, Turkey
| | | | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Abstract
Disorders of the long head of the biceps tendon can make a significant contribution to shoulder pain and dysfunction. Historically, open biceps tenotomy or a proximal tenodesis of the tendon through a deltopectoral approach was used to manage biceps tendonitis and instability. Recent developments have added additional options. Arthroscopic techniques offer minimally invasive methods to secure the biceps in the suprapectoral region at the appropriate length. An open subpectoral tenodesis provides for simple exposure that secures the tendon just proximal to the musculotendinous junction and eliminates potentially diseased tendon and synovium from the biceps groove. Common fixation methods include the use of interference screws, suture anchors, and button devices. Future developments will likely add modified tenotomy techniques that will minimize the Popeye deformity in low-demand individuals. Simpler, but secure methods of fixation for higher demand patients will minimize the operative time required.
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Hurley ET, Fat DL, Duigenan CM, Miller JC, Mullett H, Moran CJ. Biceps tenodesis versus labral repair for superior labrum anterior-to-posterior tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2018; 27:1913-1919. [PMID: 29803502 DOI: 10.1016/j.jse.2018.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study systematically reviewed the comparative studies in the literature to ascertain whether biceps tenodesis or labral repair results in superior clinical outcomes in the treatment of superior labrum anterior-to-posterior (SLAP) tears. METHODS A systematic search of articles in PubMed, EMBASE and The Cochrane Library databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cohort studies of biceps tenodesis compared with labral repair of SLAP tears were included. Statistical analysis was performed using Review Manager software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A P value of <.05 was considered to be statistically significant. RESULTS Included were 5 studies with 234 patients. Biceps tenodesis resulted in improved rates of patient satisfaction (95.6% vs. 76.2%, P = .01) and rate of return to sport (81.3% vs, 64.3%, P = .02), compared with SLAP repair. Although the difference in reoperation rates was not statistically significant, there was a trend toward higher reoperation rates in patients treated with SLAP repair (14.2% vs 6.5%, P = .09). In addition, there was no difference in complication rates or functional outcomes. CONCLUSION Our study found that biceps tenodesis resulted in higher rates of patient satisfaction and return to sport in the studies published in the literature and that biceps tenodesis and SLAP repair resulted in similar functional outcome scores.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland; Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Daren Lim Fat
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Cliona M Duigenan
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - J Chance Miller
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Hannan Mullett
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Cathal J Moran
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland; Department of Orthopaedics and Sports Medicine, Trinity College Dublin, Dublin, Ireland
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Balazs GC, Wang D, Burge AJ, Sinatro AL, Wong AC, Williams RJ. Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions. Orthop J Sports Med 2018; 6:2325967118786941. [PMID: 30109237 PMCID: PMC6083754 DOI: 10.1177/2325967118786941] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Osteochondral allograft transplantation (OCA) is a recognized option for full-thickness articular cartilage defects of the knee, especially in the setting of large lesions or those involving the subchondral bone. Previous heterogenous studies of athletes have shown a 75% to 79% rate of return to play after the procedure. Purpose: To define return-to-play rates in a cohort of elite collegiate and professional basketball players following osteochondral allograft of the knee. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data from an institutional cartilage repair registry were retrospectively reviewed. Patients were eligible for inclusion if they were collegiate or professional basketball players at the time of surgery. Patient demographics, lesion size and location, and surgical details were collected. Postoperative magnetic resonance imaging scans were scored with the OCAMRISS system. Time to return to play and pre- versus postoperative player performance were determined with publicly available internet resources. Results: Eleven athletes (4 professional, 7 collegiate) with a total of 14 treated lesions (1 to the medial femoral condyle, 6 to the lateral femoral condyle, 5 to the trochlea, and 2 to the patella) were eligible for study inclusion. Mean lesion size was 509 mm2. All patients underwent OCA through an arthrotomy, with fresh grafts. The overall rate of return to play at the same level of competition was 80%. Median time to return to play was 14 months (range, 6-26 months). Among players with available statistics, there was no significant reduction in any performance category. Conclusion: OCA in elite basketball players results in an 80% return to previous level of competition, which is consistent with previous reports of athletes playing other sports. Osteochondral allografting is a reasonable option to consider for full-thickness cartilage lesions of the knee, even for elite jumping athletes.
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Affiliation(s)
- George C Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Dean Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Alissa J Burge
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Alec L Sinatro
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Alexandra C Wong
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
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Rose MB, Noonan T. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med 2018; 9:69-78. [PMID: 29593438 PMCID: PMC5865552 DOI: 10.2147/oajsm.s138975] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.
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Affiliation(s)
- Michael B Rose
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas Noonan
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
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Ahmad CS. Editorial Commentary: The Shoulder Biceps Tendon and Baseball Continue Their Controversial Relationship. Arthroscopy 2018; 34:752-753. [PMID: 29502695 DOI: 10.1016/j.arthro.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
The optimal treatment of shoulder SLAP tears in high-level baseball players remains highly controversial. In pitchers, many SLAP lesions are found incidentally on magnetic resonance imaging and may in fact be adaptive to the baseball pitcher's mechanics of throwing. Surgical repair of SLAP lesions requires lengthy rehabilitation, and outcomes have been similar to or worse than the results after nonoperative treatment. The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined.
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