David M. Lintner, Houston Methodist Orthopedics and Sports Medicine, Houston Methodist Hospital, Smith Tower, 6550 Fannin Street, Suite 2600, Houston, TX 77030, USA.
Am J Sports Med. 2014 May;42(5):1155-60. doi: 10.1177/0363546514528096. Epub 2014 Mar 27.
The published return-to-play (RTP) rates for athletes who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of nonsurgical treatment for this group is unknown.
Nonsurgical treatment of SLAP tears in professional baseball players leads to RTP before consideration of surgical treatment. Incorporating performance statistics and level of competition will result in lower calculated RTP rates than have been previously reported.
Case series; Level of evidence, 4.
A retrospective review of 119 consecutive patients in a single professional baseball organization with persistent shoulder pain that limited the ability to compete was performed. Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions. All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy. Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit (GIRD), followed by pain-free return to throwing. Those who failed 2 cycles of nonsurgical treatment were treated surgically. Success was defined by 2 different standards: (1) RTP, in accordance with previous studies; and (2) a more stringent standard of return to the same level/quality of professional competition (A, AA, AAA, etc) with the incorporation of a return to preinjury individual performance statistics (earned run average, walks plus hits per inning pitched), termed "return to prior performance" (RPP).
Sixty-eight athletes were identified with SLAP lesions. Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return. Their RTP rate was 40%, and their RPP rate was 22%. The RTP rate for 27 pitchers who underwent 30 procedures was 48%, and the RPP rate was 7%. For 10 position players treated nonsurgically, the RTP rate was 39%, and the RPP rate was 26%. The RTP rate for 13 position players who underwent 15 procedures was 85%, with an RPP rate of 54%.
Nonsurgical treatment correcting scapular dyskinesia and GIRD had a reasonable success rate in professional baseball players with painful shoulders and documented SLAP lesions. The rate of return after surgical treatment of SLAP lesions was low for pitchers. The RTP and RPP rates were higher for position players than for pitchers. Nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable RTP and RPP rates.
接受过前上盂唇前后撕裂（SLAP）修复手术的运动员重返赛场（RTP）率差异很大，在竞技投掷运动员亚组中通常被认为较低。对于该组患者，非手术治疗的疗效尚不清楚。
在考虑手术治疗之前，对职业棒球运动员的 SLAP 撕裂进行非手术治疗可导致 RTP。纳入表现统计数据和比赛水平将导致比以前报道的计算 RTP 率更低。
病例系列；证据水平，4 级。
对单一职业棒球组织中 119 例持续肩部疼痛限制其竞争能力的连续患者进行回顾性研究。68 例患者有磁共振成像记录的 SLAP 病变。所有患者均有 1 次康复尝试失败，但继续接受监督物理治疗。治疗根据算法进行，重点是纠正肩胛运动障碍和后侧囊挛缩伴盂肱关节内旋不足（GIRD），然后无痛返回投掷。对 2 次非手术治疗失败的患者进行手术治疗。成功的标准有 2 种：（1）符合既往研究的 RTP；（2）“恢复到先前的表现”（RPP），即回归到相同水平/质量的职业比赛（A、AA、AAA 等），并纳入回归到受伤前的个人表现统计数据（平均得分，每局投球的安打和保送）。
确定了 68 例有 SLAP 病变的运动员。21 名投手成功完成非手术算法并尝试复出。他们的 RTP 率为 40%，RPP 率为 22%。27 名接受 30 次手术的投手的 RTP 率为 48%，RPP 率为 7%。10 名接受非手术治疗的位置球员的 RTP 率为 39%，RPP 率为 26%。13 名接受 15 次手术的位置球员的 RTP 率为 85%，RPP 率为 54%。
对有疼痛性肩部和记录的 SLAP 病变的职业棒球运动员进行纠正肩胛运动障碍和 GIRD 的非手术治疗具有合理的成功率。SLAP 病变手术后的回归率较低，对投手而言。位置球员的 RTP 和 RPP 率高于投手。对于有记录的 SLAP 病变的职业棒球运动员，应考虑非手术治疗，因为它可以导致可接受的 RTP 和 RPP 率。
