Stetson William B, Polinsky Samuel, Morgan Stephanie A, Strawbridge Jason, Carcione Jonathan
Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.
Arthrosc Tech. 2019 Jul 18;8(7):e781-e792. doi: 10.1016/j.eats.2019.03.013. eCollection 2019 Jul.
For overhead athletes and, in particular, baseball pitchers, the rates of success and return to play for those who have undergone arthroscopic repair of type II SLAP lesions are poor, ranging from 7% to 62%. The reasons for the poor results and high failure rates in overhead athletes with type II SLAP repairs are multifactorial and are a combination of many factors. These factors include the failure to establish the diagnosis and treat these athletes preoperatively; the inability of the operating surgeon to differentiate normal anatomic variants from pathologic SLAP lesions at the time of surgery; the surgical technique, which may violate the rotator cuff; or the placement of suture anchors, which restricts external rotation and alters overhead throwing mechanics. The proper diagnosis of SLAP lesions can be difficult because SLAP tears rarely occur in isolation and are often associated with other shoulder pathology. A proper history detailing the onset of symptoms and whether there was an acute episode of trauma or a history of repetitive use is critical. It is important to remember that no single physical examination finding is pathognomonic for SLAP tears. When seen in isolation, SLAP tears may mimic impingement syndrome (52%) or even anterior instability (39%). Surgical treatment of type II SLAP lesions should not be undertaken lightly in overhead athletes. If a 3-month rehabilitation period followed by a return to sports over the following 3 months does not allow the athlete to return to his or her preinjury level, diagnostic arthroscopy with SLAP repair is a reasonable option and can yield excellent results using the proper techniques. The technique described in detail in this article and our video can be technically demanding, but with the key points outlined, it can be reproduced and provide excellent results for overhead athletes undergoing SLAP repair. By not violating the rotator cuff, using a mattress configuration and keeping the suture knot away from the articular surface, and by not going anterior to the biceps tendon for repair, external rotation and strength can be preserved, leading to an excellent result with a predictable return to play for overhead athletes.
对于从事过头运动的运动员，尤其是棒球投手，接受II型上盂唇从前到后（SLAP）损伤关节镜修复的患者，其成功恢复运动的比例很低，在7%至62%之间。II型SLAP损伤的过头运动运动员治疗效果不佳和失败率高的原因是多方面的，是多种因素共同作用的结果。这些因素包括术前未能确诊并治疗这些运动员；手术医生在手术时无法区分正常解剖变异与病理性SLAP损伤；手术技术可能会损伤肩袖；或者缝线锚钉的放置限制了外旋并改变了过头投掷力学。SLAP损伤的正确诊断可能很困难，因为SLAP撕裂很少单独发生，且常与其他肩部病变相关。详细了解症状的发作情况以及是否有急性创伤事件或反复使用史的病史至关重要。请记住，没有单一的体格检查结果对SLAP撕裂具有确诊意义。单独出现时，SLAP撕裂可能会模仿撞击综合征（52%）甚至前向不稳（39%）。对于过头运动的运动员，不应轻易进行II型SLAP损伤的手术治疗。如果经过3个月的康复期，随后在接下来的3个月内恢复运动，但运动员仍无法恢复到受伤前的水平，那么进行诊断性关节镜检查并进行SLAP修复是一个合理的选择，并且使用适当的技术可以取得优异的效果。本文及我们视频中详细描述的技术可能在技术上要求较高，但按照概述的关键点操作，它可以被复制，并为接受SLAP修复的过头运动运动员带来优异的效果。通过不损伤肩袖、采用褥式缝合并使缝线结远离关节面，以及不在肱二头肌肌腱前方进行修复，可以保留外旋和力量，从而为过头运动运动员带来优异的效果，并可预测其恢复运动的情况。
