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Partial cuff tears affect return to same level of overhead sport after SLAP repairs
Investigators support using the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score.
After elite overhead athletes undergo arthroscopic repair of type II superior labral anterior posterior lesions, many do not return to the same pre-injury level of play when concomitant partial thickness rotator cuff tears are present, a recent study has shown.
Researchers who conducted the study also found weaknesses in the scoring systems typically used with these patients, since the level of play they expected to attain postoperatively did not correspond to what actually occurred. As a result, the researchers have identified an outcome tool they said correlates well to actual outcomes and may help sports medicine specialists better manage these athletes in the future.
“There is a statistically significant correlation between the presence of partial thickness rotator cuff (RC) tears and an inability to return to pre-injury level and the presence of partial thickness tears with a negative correlation is not brought out in traditional scoring systems,” such as the American Shoulder & Elbow Surgeons (ASES) questionnaire, Kevin C. Owsley, MD, said at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting.
Owsley, Brian Neri, MD, and colleagues studied 23 elite overhead athletes, mostly college and professional baseball players, with isolated type II superior labral anterior posterior (SLAP) lesions. At a mean age of 25 years, they were all treated arthroscopically by the study’s senior authors, Neal S. ElAttrache, MD, and Lewis A. Yocum, MD, and followed up for a mean 38 months.
SLAP repairs were performed with standard arthroscopic techniques followed by identical postoperative protocols, Owsley said.
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Images: ElAttrache NS |
Assessments
Patients assessed their outcomes with the ASES questionnaire and Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow score. Part one of the 2-part KJOC score has patients categorize their play on a scale of 1 to 3 (1 = playing without arm problems, 2 = playing with arm trouble, 3 = not playing due to arm trouble). In part two, they provide a 10-question pain self-assessment.
Investigators found 57% of patients resumed playing their prior sport at the same level, but for those with concomitant partial thickness RC tears the return to play rate was 12%; 80% of patients without such tears returned, Owsley said.
Scoring accuracy
“Our results showed 57% of our patients rated themselves as category 1, returning to their level of sport. When we looked at the ASES scores their mean was 93%, despite only 57% returning to their sport. The KJOC score was 76,” he said.
Most ASES scores rated the outcomes as excellent or good or about 95%, but KJOC scores were more widely distributed, Owsley noted.
“Statistically, looking at this, the ASES score was less sensitive to changes; 1 unit of change of the KJOC score correlated to 0.21 units of ASES score. The ASES score did not correlate to changes over time.”
For more information:
- Kevin C. Owsley, MD, can be reached at Orthopaedic Surgical Associates, 15525 Pomerado Road, Ste. A-1, Poway, CA 92064; 858-485-0050; e-mail: kcowsley@gmail.com. He has no direct financial interest in products or companies mentioned in this article.
Reference:
- Neri BR, Owsley KC, Mohr K, et al. Outcome of Type II SLAP repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. Presented at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting. July 9-12, 2009. Keystone, Colo.