Colasanti Christopher A, Akpinar Berkcan, Rynecki Nicole, Anil Utkarsh, Hurley Eoghan T, Virk Mandeep S, Simovitch Ryan W, Strauss Eric J, Jazrawi Laith M, Zuckerman Joseph D, Campbell Kirk A
Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A.
Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Mar 3;5(2):e359-e366. doi: 10.1016/j.asmr.2023.01.001. eCollection 2023 Apr.
The purposes of this study were to determine why athletes did not return to play (RTP) following operative management of superior-labrum anterior-posterior (SLAP) tears, compare these athletes to those who did RTP, and evaluate the SLAP-Return to Sport after Injury (SLAP-RSI) score to assess the psychological readiness of athletes to RTP after operative management of SLAP tears.
A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 24-month follow-up was performed. Outcome data, including visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, patient satisfaction, and whether they would undergo the same surgery again was collected. Additionally, the rate and timing of return to work (RTW), the rate and timing of RTP, SLAP-RSI score, and VAS during sport were evaluated, with subgroup analysis among overhead and contact athletes. The SLAP-RSI is a modification of the Shoulder Instability-Return to Sport after Injury (SI-RSI) score, with a score >56 considered to be a passing score for being psychologically ready to RTP.
The study included 209 athletes who underwent operative management of SLAP tears. A significantly higher percentage of patients who were able to return to play passed the SLAP-RSI benchmark of 56 compared to those who were unable to return (82.3% vs 10.1%; < .001), and the mean overall SLAP-RSI scores were also significantly higher among those capable of returning to play (76.8 vs 50.0; < .0001). Additionally, there was a significant difference between the two groups in every component of the SLAP-RSI score ( < .05 for all). Fear of reinjury and the feeling of instability were the most common reasons for not returning to play among contact athletes. Residual pain was the most common complaint among overhead athletes. A binary regression model predicting return to sports was performed, which demonstrated ASES score (odds ratio [OR]: 1.04, 95%; (confidence interval [CI]: 1.01-1.07; = .009), RTW within 1 month after surgery (OR: 3.52, 95%; CI: 1.01-12.3; = .048), and SLAP-RSI score (OR: 1.03, 95%; CI: 1.01-1.05; = .001) were all associated with greater likelihood of return to sports at final follow-up.
Following the operative management of SLAP tears, patients who are unable to RTP exhibit poor psychological readiness to return, which may be due to residual pain in overhead athletes or fear of reinjury in contact athletes. Lastly, the SLAP-RSI tool in combination with ASES proved to be useful in identifying patients' psychological and physical readiness to RTP.
Level IV, prognostic case series.
本研究的目的是确定运动员在接受上盂唇前后部（SLAP）撕裂的手术治疗后未恢复运动（RTP）的原因，将这些运动员与恢复运动的运动员进行比较，并评估SLAP损伤后恢复运动（SLAP-RSI）评分，以评估运动员在接受SLAP撕裂手术治疗后恢复运动的心理准备情况。
对接受SLAP撕裂手术治疗且随访至少24个月的运动员进行回顾性研究。收集结果数据，包括视觉模拟量表（VAS）评分、主观肩部评分（SSV）、美国肩肘外科医师学会（ASES）评分、患者满意度以及他们是否愿意再次接受相同手术。此外，评估恢复工作（RTW）的速率和时间、RTP的速率和时间、运动期间的SLAP-RSI评分和VAS评分，并对上肢运动和接触性运动的运动员进行亚组分析。SLAP-RSI是对肩部不稳定损伤后恢复运动（SI-RSI）评分的修改，评分>56被认为是心理上准备好恢复运动的及格分数。
该研究纳入了209例接受SLAP撕裂手术治疗的运动员。与未能恢复运动的患者相比，能够恢复运动的患者通过SLAP-RSI基准评分56的比例显著更高（82.3%对10.1%；P<.001），并且能够恢复运动的患者的平均总体SLAP-RSI评分也显著更高（76.8对50.0；P<.0001）。此外，两组在SLAP-RSI评分的每个组成部分上均存在显著差异（所有P<.05）。害怕再次受伤和不稳定感是接触性运动运动员未恢复运动的最常见原因。残留疼痛是上肢运动运动员最常见的主诉。进行了一个预测恢复运动的二元回归模型，结果显示ASES评分（比值比[OR]：1.04，95%；置信区间[CI]：1.01-1.07；P=.009）、术后1个月内恢复工作（OR：3.52，95%；CI：1.01-12.3；P=.048）以及SLAP-RSI评分（OR：1.03，95%；CI：1.01-1.05；P=.001）均与最终随访时恢复运动的可能性更大相关。
在接受SLAP撕裂的手术治疗后，未能恢复运动的患者表现出恢复运动的心理准备较差，这可能是由于上肢运动运动员的残留疼痛或接触性运动运动员害怕再次受伤所致。最后，SLAP-RSI工具与ASES评分相结合被证明有助于识别患者恢复运动的心理和身体准备情况。
IV级，预后病例系列。
