Chalmers Peter N, Trombley Robert, Cip Johannes, Monson Brett, Forsythe Brian, Nicholson Gregory P, Bush-Joseph Charles A, Cole Brian J, Wimmer Markus A, Romeo Anthony A, Verma Nikhil N
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2014 Dec;42(12):2825-36. doi: 10.1177/0363546514551924. Epub 2014 Oct 17.
Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhand throwers. Treatment outcomes remain unpredictable, with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis.
Labral repair more closely restores neuromuscular control and motion during the overhand pitch than tenodesis of the long head of the biceps.
Controlled laboratory study.
Eighteen pitchers, including 7 uninjured controls, 6 players pitching after SLAP repair, and 5 players pitching after subpectoral biceps tenodesis (BT), underwent simultaneous surface electromyographic measurement at 1500 Hz and motion analysis at 120 Hz with a 14-camera markerless motion analysis system and high-speed video (120 Hz) to confirm accurate motion tracking. Patients had undergone surgery at least 1 year previously and had returned to pitching with a painless shoulder.
No significant differences were observed in the long head of the biceps muscle, short head of the biceps muscle, deltoid, infraspinatus, or latissimus activity between controls, patients after SLAP repair, and patients after BT. The variability from pitch to pitch for each study participant was similar between groups. Based on visual inspection of the activity time plots, BT appeared to more closely restore the normal pattern of muscular activation within the long head of the biceps muscle than did SLAP repair. There were no significant differences between controls and postoperative patients in the majority of pitching kinematics; however, pitchers after SLAP repair showed significantly altered patterns of thoracic rotation (P = .034) compared with controls and were significantly less likely to fall into previously published normal values for lead knee flexion at front foot contact (P = .019).
While both BT and SLAP repair can restore physiologic neuromuscular control, pitchers who undergo SLAP repair may exhibit altered patterns of thoracic rotation when compared with controls and pitchers who undergo BT.
While both tenodesis and SLAP repair can restore physiologic neuromuscular control, SLAP repair may alter pitching biomechanics.
上盂唇前后部（SLAP）撕裂是过顶投掷运动员肩部疼痛和功能障碍的常见原因。治疗结果仍然不可预测，很大一部分运动员无法恢复运动。关于清创、修复和腱固定之间的最佳治疗方法存在相当大的争议。
与肱二头肌长头腱固定相比，盂唇修复在过顶投球过程中能更接近地恢复神经肌肉控制和运动。
对照实验室研究。
18名投手，包括7名未受伤的对照者、6名SLAP修复后投球的运动员和5名胸小肌下肱二头肌腱固定（BT）后投球的运动员，使用14台无标记运动分析系统以1500Hz进行同步表面肌电图测量，以120Hz进行运动分析，并使用高速视频（120Hz）来确认准确的运动跟踪。患者至少在1年前接受了手术，并且已恢复无痛肩部投球。
在肱二头肌长头、肱二头肌短头、三角肌、冈下肌或背阔肌活动方面，对照者、SLAP修复后的患者和BT后的患者之间未观察到显著差异。各组之间每个研究参与者每次投球的变异性相似。基于对活动时间图的目视检查，BT似乎比SLAP修复更接近地恢复了肱二头肌长头内肌肉激活的正常模式。在大多数投球运动学方面，对照者和术后患者之间没有显著差异；然而，与对照者相比，SLAP修复后的投手胸段旋转模式有显著改变（P = 0.034），并且在前脚着地时前导膝屈曲落入先前公布的正常值的可能性显著降低（P = 0.019）。
虽然BT和SLAP修复都可以恢复生理神经肌肉控制，但与对照者和接受BT的投手相比，接受SLAP修复的投手可能表现出胸段旋转模式的改变。
虽然腱固定和SLAP修复都可以恢复生理神经肌肉控制，但SLAP修复可能会改变投球生物力学。
