Return to High Level Throwing After Combination Infraspinatus Repair, SLAP Repair, and Release of Glenohumeral Internal Rotation Deficit (SS-08)

Abstract

Introduction The overhead throwing athlete is a unique patient, requiring an elite, precise functional ability. Superior labral tears are quite common, and the percentage of return to play after SLAP repair has been quite good. A tear of the infraspinatus due to either internal impingement or tension overload may compromise this return. Recent reports have documented an inability to return after mini-open or arthroscopic takedown and repair of infraspinatus tears in throwing athletes. It has been our policy to treat these lesions with debridement or in more severe cases with oblique side to side stabilization with absorbable sutures in order to minimize scar tissue and improve return to play. This study represents a retrospective review of the most severely injured of our throwing athletes in order to determine the efficacy of this approach. Methods In the current study we examined a series of overhead athletes with diagnoses of both a SLAP tear and a significant (>50%) tear of the infraspinatus tendon who underwent surgical repair of both injuries. We identified 20 overhead high level throwing athletes younger than 25 years age who underwent simultaneous arthroscopic repairs of a SLAP tear with standard suture anchor technique and an infraspinatus tear with PDS suture between 2005 to 2008. The postoperative records of all patients were reviewed to determine their ability to return to play and their postoperative level of performance. All patients were then contacted to determine their KJOC score and their current sport participation level. Results All 20 patients in the series attempted to return to their prior sport following completion of postoperative rehabilitation. Only 8 patients (40%) were able to return to the same or a superior pre-injury level of performance. Nine of the remaining 12 patients returned to play at a lower level, either playing the same position or else were forced to switch to another position of play due to a decline in throwing velocity. Three patients were unable to return to play. All 3 were pitchers, who although they were able to throw without pain were unable to regain satisfactory velocity that would allow them to compete in their level of play. No complications or reoperations occurred in any of the patients following surgery. Conclusion A significant (>50%) tear of the infraspinatus in combination with GIRD and SLAP tears in the throwing athlete seems to cause a significant worsening of the prognosis in return to play at the same level. While the rates of return to play in overhead athletes with an isolated SLAP tear are encouraging, the prognosis for an athlete with both a SLAP and infraspinatus tear is more guarded. These patients are less likely than those with less complex injuries to return to their pre-injury level of play, and several will be unable to return to their prior sport on any level.