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Baseball players see low return to play after biceps tenodesis for SLAP tears
Professional baseball players should be made aware of low return to play rates following biceps tenodesis, alternate SLAP tear treatments.
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Professional baseball players have a difficult time returning to play after biceps tenodesis for treatment of superior labral anterior-posterior tears, according to recently presented data.
“The take-home message of this study is that in professional baseball pitchers who undergo biceps tenodesis, return to play is unpredictable,” Peter N. Chalmers, MD, told Orthopedics Today.
Prospective database study
“The outcomes of this procedure are completely unknown in [Major League Baseball] MLB players,” Chalmers said. “Specifically, it remains unknown that there may be an important biomechanical role for the superior labral and biceps tendon during the overhand throwing motion.”
To study this, Chalmers and his colleagues used a prospective database maintained by the MLB of both major and minor league baseball players who underwent shoulder surgery since 2010. They used the database to determine demographics, incidence, playing position, prior surgical history, concomitant procedures, rate of return to play, time to return to play and performance after return to play in professional players who underwent biceps tenodesis for superior labral anterior-posterior (SLAP) tears. The baseball players were followed for a minimum of 2 years.
Pitchers vs position players
Chalmers said there were 17 professional baseball players who underwent biceps tenodesis between 2010 and 2013. Of these players, 71% were pitchers and 29% were position players. He also noted 47% of the players had a history of prior surgery and 47% of players had undergone a concomitant labral repair.
Overall, “[professional] baseball players who undergo tenodesis have a 35% return to play. Pitchers have a 16% rate of return to play, which is even lower, while position players have a much higher rate of 80%,” Chalmers said. “But, of those who were able to get back, 100% were able to get back to at least 10 games and there was no significant decline in their performance.”
It was significantly more common for position players to return to professional play than pitchers. It was also less common for players who had prior shoulder surgery to return to play; however, it was not statistically significant. The preoperative and postoperative performance was unchanged in the players who did return to play, Chalmers said.
Future research
The biggest limitation of the study was that because it was based on data from a database, there were no details on the reasons why the professional baseball players who could not return to play did not return to play, according to Chalmers.
“I do not know if there was a problem with the pathology, problem with the procedure [or] problem with the rehab,” he said. “Unfortunately, this study design does not give us the information going forward. It just tells us how big of a problem it is and what the problem is.”
Chalmers noted that because this study did not demonstrate consistent and good outcomes in these high-level athletes, the next step in his group’s research will be to understand how to best diagnose and treat superior labral tears.
“We are doing further motion analysis research to better understand the pitching motion and alterations within the pitching motion as they relate to these injuries,” he said.
He added, “[Ultimately], research regarding baseball players and SLAP tears is unfortunately always going to be more complicated because the pathways players take to get from the field to the operating table create significant selection bias and because concomitant pathology and concomitant procedures are the rule rather than the exception,” – by Monica Jaramillo
- Reference:
- Chalmers PN, et al. Paper #7. Presented at: American Orthopaedic Society for Sports Medicine Specialty Day; March 18, 2017; San Diego.
- For more information:
- Peter N. Chalmers, MD, can be reached at University of Utah, 50 North Medical Dr., Salt Lake City, Utah 84132; email: peter.chalmers@hsc.utah.edu.
Disclosure: Chalmers reports no relevant financial disclosures.
Perspective
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Matthew J. Bollier, MD
We know the percent of MLB pitchers who return to their previous level of performance after shoulder surgery is low. Biceps tenodesis has become an accepted treatment for patients older than 30 years with SLAP tears and patients with failed SLAP repair. It is unclear if biceps tenodesis is a good idea in overhead throwing athletes. This study looked at biceps tenodesis in 17 MLB players and found a 35% rate of return in pitchers compared to an 80% return in position players. This is valuable information to use when counseling overhead throwing athletes with SLAP tears, but it is important to keep in mind that half of the players in the study had previous shoulder surgery and others had concomitant pathology. We know rotator cuff tears in pitchers have a poor prognosis. Unfortunately, biceps tenodesis does not seem to improve return to play in pitchers. However, based on this small sample size, it seems to be a reasonable option for position players with SLAP tears or failed shoulder repair.
Perspective
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Robert A. Arciero, MD
The study by Chalmers and colleagues, although it reports on a small group of patients, is important. The spectrum of pathology of internal impingement in the overhead athlete, particularly the professional, MLB player continues to represent one of the most challenging problems for players and treating physicians, accounting for significant disability and shortened careers. The patho-anatomy of partial rotator cuff tears, SLAP tears and motion deficits present difficult treatment dilemmas.
Specifically, surgical outcomes of SLAP tears with repair have been unpredictable and have had sporadic success in MLB pitchers. Biceps tenodesis as the salvage treatment for unsuccessful SLAP repair in laborers and the general population has led surgeons to the concept of biceps tenodesis primarily to treat throwers with SLAP tears.
This work by Chalmers and colleagues represents the first comprehensive report of the application of biceps tenodesis in professional throwers. What have we learned? The rates of successful outcomes in major league, elite pitchers are low. We can expect a low percentage of pitchers will return to pre-injury level of competition. But, the return to sport by position players is better. Because half of the patients had prior shoulder surgery, this undoubtedly represents a challenging situation. Also, less is more with those athletes who had concomitant labral repair, and biceps tenodesis had the worst result.
Unfortunately, this practical and useful information leaves us with many unanswered questions and challenging decisions when we are caring for this unique group of athletes.
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