Purpose
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.
Methods
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.
Results
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%; P < .001), and the mean overall SLAP-RSI scores were also significantly higher among
those capable of returning to play (76.8 vs 50.0; P < .0001). Additionally, there was a significant difference between the two groups
in every component of the SLAP-RSI score (P < .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; P = .009), RTW within 1 month after surgery (OR: 3.52, 95%; CI: 1.01–12.3; P = .048), and SLAP-RSI score (OR: 1.03, 95%; CI: 1.01–1.05; P = .001) were all associated with greater likelihood of return to sports at final
follow-up.
Conclusions
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 of Evidence
Level IV, prognostic case series.
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Article info
Publication history
Published online: March 03, 2023
Accepted:
January 3,
2023
Received:
July 27,
2022
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