Systematic Review| Volume 38, ISSUE 10, P2909-2918, October 2022

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Moderate Return to Play and Previous Performance After SLAP Repairs in Competitive Overhead Athletes: A Systematic Review


      To perform a systematic review of return to play (RTP) and return to previous level of performance (RPP) in competitive overhead athletes after SLAP repair to identify factors associated with failure to RTP.


      Systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Review was registered with PROSPERO International prospective register of systematic reviews (CRD42020215488). Inclusion criteria were literature reporting RTP or RPP following SLAP repair in overhead athletes were run in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Categories for data collection for each full article included (1) article information; (2) patient demographics; (3) surgical techniques; (4) level of competition; (5) rotator cuff treatment; (6) player position; (7) patient-reported outcome measures; and (8) RTP and RPP rates. The Methodological Index for Non-randomized Studies checklist was used to evaluate quality of all included studies.


      Eight studies with 333 subjects were identified. Overall RTP and RPP rates were 50% to 83.6% and 35.3% to 64%, respectively. Patients with surgically treated rotator cuff pathology had lower RTP (12.5%-64.7%) rates compared with those without (80.0%-83.6%). Professional athletes had similar RTP rates (62.5%-81.5%) compared with high-school (75.0%-90.0%) and college athletes (12.5%-83.3%). However, professional athletes demonstrated the lowest relative range of reported RPP rates (27.7%-55.6%). Pitchers had lower RTP (62.5%-80.0%) and RPP (52.0%-58.9%) compared with position players (91.3% RTP, 76.3%-78.2% RPP).


      Studies reviewed reported moderate RTP and RPP rates following SLAP repairs in competitive overhead athletes. Those with associated rotator cuff tear requiring treatment, and baseball pitchers were less likely to RTP and RPP. Professional athletes had similar RTP to an amateur; however, they were less likely to RPP.

      Level of Evidence

      Level IV, systematic review of Level III-IV studies.
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        • Andrews J.R.
        • Carson W.G.
        • McLeod W.D.
        Glenoid labrum tears related to the long head of the biceps.
        Am J Sports Med. 1985; 13: 337-341
        • Camp C.L.
        • Zajac J.M.
        • Pearson D.B.
        • et al.
        Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: Analysis of 132 pitcher-seasons in professional baseball.
        Arthroscopy. 2017; 33: 1629-1636
        • Knesek M.
        • Skendzel J.G.
        • Dines J.S.
        • Altchek D.W.
        • Allen A.A.
        • Bedi A.
        Diagnosis and management of superior labral anterior posterior tears in throwing athletes.
        Am J Sports Med. 2013; 41: 444-460
        • Burkhart S.S.
        • Morgan C.D.
        The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation.
        Arthroscopy. 1998; 14: 637-640
        • McGarry M.H.
        • Nguyen M.L.
        • Quigley R.J.
        • Hanypsiak B.
        • Gupta R.
        • Lee T.Q.
        The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1979-1987
        • Fedoriw W.W.
        • Ramkumar P.
        • McCulloch P.C.
        • Lintner D.M.
        Return to play after treatment of superior labral tears in professional baseball players.
        Am J Sports Med. 2014; 42: 1155-1160
        • Edwards S.L.
        • Lee J.A.
        • Bell J.E.
        • et al.
        Nonoperative treatment of superior labrum anterior posterior tears: Improvements in pain, function, and quality of life.
        Am J Sports Med. 2010; 38: 1456-1461
        • Dines J.S.
        • Elattrache N.S.
        Horizontal mattress with a knotless anchor to better recreate the normal superior labrum anatomy.
        Arthroscopy. 2008; 24: 1422-1425
        • Griffin J.W.
        • Leroux T.S.
        • Romeo A.A.
        Management of proximal biceps pathology in overhead athletes: What is the role of biceps tenodesis?.
        Am J Orthop Belle Mead NJ. 2017; 46: E71-E78
        • Morse K.W.
        • Eno J.J.
        • Altchek D.W.
        • Dines J.S.
        Injuries of the biceps and superior labral complex in overhead athletes.
        Curr Rev Musculoskelet Med. 2019; 12: 72-79
        • Provencher M.T.
        • McCormick F.
        • Dewing C.
        • McIntire S.
        • Solomon D.
        A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: Outcomes and factors associated with success and failure.
        Am J Sports Med. 2013; 41: 880-886
        • Boileau P.
        • Parratte S.
        • Chuinard C.
        • Roussanne Y.
        • Shia D.
        • Bicknell R.
        Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion.
        Am J Sports Med. 2009; 37: 929-936
        • Ek E.T.H.
        • Shi L.L.
        • Tompson J.D.
        • Freehill M.T.
        • Warner J.J.P.
        Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: Repair versus biceps tenodesis.
        J Shoulder Elbow Surg. 2014; 23: 1059-1065
        • Gottschalk M.B.
        • Karas S.G.
        • Ghattas T.N.
        • Burdette R.
        Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions.
        Am J Sports Med. 2014; 42: 2128-2135
        • Frantz T.L.
        • Shacklett A.G.
        • Martin A.S.
        • et al.
        Biceps tenodesis for superior labrum anterior-posterior tear in the overhead athlete: A systematic review.
        Am J Sports Med. 2021; 49: 522-528
        • Erickson B.J.
        • Jain A.
        • Abrams G.D.
        • et al.
        SLAP lesions: Trends in treatment.
        Arthroscopy. 2016; 32: 976-981
        • Erickson B.J.
        • Harris J.D.
        • Fillingham Y.A.
        • et al.
        Treatment of ulnar collateral ligament injuries and superior labral tears by major league baseball team physicians.
        Arthroscopy. 2016; 32: 1271-1276
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Wright J.G.
        • Swiontkowski M.F.
        • Heckman J.D.
        Introducing levels of evidence to the journal.
        J Bone Joint Surg Am. 2003; 85: 1-3
        • Fourman M.S.
        • Arner J.W.
        • Bayer S.
        • Vyas D.
        • Bradley J.P.
        Type VIII SLAP repair at midterm follow-up: Throwers have greater pain, decreased function, and poorer return to play.
        Arthroscopy. 2018; 34: 3159-3164
        • Douglas L.
        • Whitaker J.
        • Nyland J.
        • et al.
        Return to play and performance perceptions of baseball players after isolated SLAP Tear repair.
        Orthop J Sports Med. 2019; 7 (2325967119829486)
        • Friel N.A.
        • Karas V.
        • Slabaugh M.A.
        • Cole B.J.
        Outcomes of type II superior labrum, anterior to posterior (SLAP) repair: Prospective evaluation at a minimum two-year follow-up.
        J Shoulder Elbow Surg. 2010; 19: 859-867
        • Gilliam B.D.
        • Douglas L.
        • Fleisig G.S.
        • et al.
        Return to play and outcomes in baseball players after superior labral anterior-posterior repairs.
        Am J Sports Med. 2018; 46: 109-115
        • Neri B.R.
        • ElAttrache N.S.
        • Owsley K.C.
        • Mohr K.
        • Yocum L.A.
        Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears.
        Am J Sports Med. 2011; 39: 114-120
        • Park J.Y.
        • Chung S.W.
        • Jeon S.H.
        • Lee J.G.
        • Oh K.S.
        Clinical and radiological outcomes of type 2 superior labral anterior posterior repairs in elite overhead athletes.
        Am J Sports Med. 2013; 41: 1372-1379
        • Smith R.
        • Lombardo D.J.
        • Petersen-Fitts G.R.
        • et al.
        Return to play and prior performance in Major League Baseball pitchers after repair of superior labral anterior-posterior tears.
        Orthop J Sports Med. 2016; 4 (2325967116675822)
        • Van Kleunen J.P.
        • Tucker S.A.
        • Field L.D.
        • Savoie F.H.
        Return to high-level throwing after combination infraspinatus repair, SLAP repair, and release of glenohumeral internal rotation deficit.
        Am J Sports Med. 2012; 40: 2536-2541
        • Cohen D.B.
        • Coleman S.
        • Drakos M.C.
        • et al.
        Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack.
        Arthroscopy. 2006; 22: 136-142
        • Kim S.H.
        • Ha K.I.
        • Kim S.H.
        • Choi H.J.
        Results of arthroscopic treatment of superior labral lesions.
        J Bone Joint Surg Am. 2002; 84: 981-985
        • Sayde W.M.
        • Cohen S.B.
        • Ciccotti M.G.
        • Dodson C.C.
        Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: A systematic review.
        Clin Orthop. 2012; 470: 1595-1600
        • Matache B.A.
        • Hurley E.T.
        • Kanakamedala A.C.
        • et al.
        Knotted versus knotless anchors for labral repair in the shoulder: A systematic review.
        Arthroscopy. 2021; 37: 1314-1321
        • Mostello A.J.
        • Caldwell P.E.
        • Pearson S.E.
        Arthroscopic low-profile knotless repair of SLAP tears with suture tape.
        Arthrosc Tech. 2020; 9: e1505-e1509
        • Lesniak B.P.
        • Baraga M.G.
        • Jose J.
        • Smith M.K.
        • Cunningham S.
        • Kaplan L.D.
        Glenohumeral findings on magnetic resonance imaging correlate with innings pitched in asymptomatic pitchers.
        Am J Sports Med. 2013; 41: 2022-2027
        • Levy H.J.
        • Schachter A.K.
        • Hurd J.L.
        • Lassen B.
        • Panagopoulos G.
        The effect of rotator cuff tears on surgical outcomes after type II superior labrum anterior posterior tears in patients younger than 50 years.
        Am J Sports Med. 2010; 38: 318-322
        • Wilk K.E.
        • Meister K.
        • Fleisig G.
        • Andrews J.R.
        Biomechanics of the overhead throwing motion.
        Sports Med Arthrosc Rev. 2000; 8: 124-134
        • Placzek J.D.
        • Lukens S.C.
        • Badalanmenti S.
        • et al.
        Shoulder outcome measures: A comparison of 6 functional tests.
        Am J Sports Med. 2004; 32: 1270-1277