Sciascia Aaron, Myers Natalie, Kibler W Ben, Uhl Timothy L
Shoulder Center of Kentucky, Lexington;
Division of Athletic Training, University of Kentucky, Lexington.
J Athl Train. 2015 Jul;50(7):767-77. doi: 10.4085/1062-6050-50.3.06. Epub 2015 May 6.
Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery.
To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair.
The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013.
The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation.
We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures.
Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater odds for full return than overhead athletes after labral repair with soft tissue debridement. In 1 study, researchers compared surgical procedures and found that overhead athletes who underwent isolated superior labral repair were 28 times more likely to return to full participation than those who underwent concurrent labral repair and soft tissue debridement (P < .05).
The rate of return to participation after shoulder surgery within the literature is inconsistent. Odds of returning to preinjury levels of participation after arthroscopic superior labral repair with or without soft tissue debridement are consistently lower in overhead/throwing athletes than in nonoverhead/nonthrowing athletes. The variable rates of return within each group could be due to multiple confounding variables not consistently accounted for in the articles.
运动员术前常权衡选择接受骨科手术修复受损组织的风险与益处。运动员普遍关心的一个问题是肩部手术后能否恢复到最高竞技水平，而临床医生则难以对术后成功恢复参赛的情况提供一致的预后判断。现有文献中研究细节和恢复率的差异，并未为临床医生提供足够证据，以便在决定让 overhead 运动员接受肩部手术时，为他们提供关于成功恢复参赛的充分信息。
研究 overhead 运动员在关节镜下上盂唇修复术后恢复到伤前参赛水平的几率。
1972 年至 2013 年的 CINAHL、MEDLINE 和 SPORTDiscus 数据库。
文章选择标准为：（1）研究用英文撰写。（2）研究报告了孤立性上盂唇损伤或伴有软组织清创的上盂唇损伤的手术修复情况。（3）研究涉及年龄等于或小于 40 岁的 overhead 运动员。（4）研究评估了恢复到伤前参赛水平的情况。
我们严格审查文章的质量和偏倚，并计算和比较二分群体或手术程序恢复到完全参赛的优势比。
在识别出的 215 篇文章中，保留了 11 篇：5 篇关于孤立性上盂唇修复，6 篇关于伴有软组织清创的上盂唇修复。质量范围为可能的 24 分中的 11 至 17 分（42%至 70%）。11 项研究中有 8 项可以生成优势比。在孤立性上盂唇修复后，非棒球、非 overhead 和非投掷运动员完全恢复参赛的几率比 overhead/投掷运动员高 2.3 至 5.8 倍。同样，在伴有软组织清创的上盂唇修复后，非 overhead 运动员完全恢复的几率比 overhead 运动员高 1.5 至 3.5 倍。在 1 项研究中，研究人员比较了手术程序，发现接受孤立性上盂唇修复的 overhead 运动员恢复到完全参赛的可能性是接受同期上盂唇修复和软组织清创的运动员的 28 倍（P <.05）。
文献中肩部手术后恢复参赛的比率不一致。在进行或未进行软组织清创的关节镜下上盂唇修复术后，overhead/投掷运动员恢复到伤前参赛水平的几率始终低于非 overhead/非投掷运动员。每组恢复率的差异可能是由于文章中未始终考虑的多个混杂变量所致。
