Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears

Abstract

Background:The published return-to-play (RTP) rates for Major League Baseball (MLB) pitchers who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of surgical treatment for MLB players is largely unknown.Purpose:To examine the RTP rate and performance of MLB pitchers who have undergone SLAP tear repair between 2003 and 2010.Study Design:Descriptive epidemiological study.Methods:A retrospective review of MLB pitchers undergoing SLAP repair was performed using the MLB disabled list. Data collected included the following player statistics: earned run average (ERA), walks plus hits per inning pitched (WHIP), and innings pitched (IP). The mean values for performance variables both before and after surgery were compared. A definition of return to prior performance (RTPP) was established as an ERA within 2.00 and WHIP within 0.500 of preoperative values.Results:Twenty-four MLB players met inclusion criteria, of which 62.5% were able to RTP at the MLB level after SLAP repair surgery. Of those able to RTP, 86.7% were able to RTPP. However, the overall rate of RTPP, including those unable to RTP, was 54.2%. Mean performance analysis of the RTP group revealed a statistically significant decrease in IP for MLB pitchers throwing a mean 101.8 innings before injury and 65.53 innings after injury (P = .004).Conclusion:Of those pitchers able to RTP, chances of a full recovery were good (86.7%). Our results indicate the need for future research aimed at proper surgical selection of who will return to play, as they will likely achieve full recovery. We believe this information can help surgeons advise high-level overhead-throwing athletes about expected outcomes for surgical treatment of SLAP tears.

Editorial Commentary: Buyer Beware—Throwers Undergoing Type VIII SLAP Repair Should Do So With Very Reasonable Expectations

“…Unfortunately, this study only adds to the existing literature highlighting poor rates of return to sport for throwing athletes after SLAP repair. Even in the most expert of hands, published rates of a successful return to the preinjury level of performance range from 38% to 60%, [2][3][4] with a rate as low as 10% for pitchers. 5 For throwing and nonthrowing athletes alike, the posterior extension of these injuries would logically entail a more extensive and posteriorly based repair (and subsequent rehabilitation) than in typical type II injuries.…”

An Age and Activity Algorithm for Treatment of Type II SLAP Tears

“…Baseball players, specifically pitchers, are susceptible to SLAP tears and have the lowest return to sport outcomes [ 58 ]. While overall shoulder scores improve with surgical treatment of Type II SLAP tears, the return to play outcome is significantly lower then other athletic populations [ 44 , 59 ]. Smith et al [ 59 ] found that only 62.5% of Major League Baseball pitchers were able to return to the major league level, and only 54% returned to their previous level of performance.…”

“…While overall shoulder scores improve with surgical treatment of Type II SLAP tears, the return to play outcome is significantly lower then other athletic populations [ 44 , 59 ]. Smith et al [ 59 ] found that only 62.5% of Major League Baseball pitchers were able to return to the major league level, and only 54% returned to their previous level of performance. This is still an improvement compared to non-operative outcomes report by Fedoriw et al [ 44 ].…”

Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors

“…24 Previous studies reporting outcomes in patients undergoing repair for type II SLAP lesions have demonstrated inconsistent return to activity and functional scores, especially in overhead athletes. 5,7,19,24,27,37 While knotted anchors have traditionally been utilized during arthroscopic repair, 18,30 concerns over knot migration and knot abrasion within the shoulder have led to an increased interest in the use of knotless anchors over the past decade. 2,3,13,31,32,40 However, no investigation has examined postoperative outcomes based on differences in implant type in patients undergoing arthroscopic management of isolated type II SLAP lesions using suture anchors.…”