Superior Labral Injuries in Elite Gymnasts: Symptoms, Pathology, and Outcomes After Surgical Repair

Abstract

Background: Superior labral anterior-posterior (SLAP) lesions are common among elite gymnasts and throwing athletes. Although SLAP lesions in throwers are well-described in the literature, no study has described the characteristics of SLAP lesions in gymnasts. We aimed to reveal the characteristics of SLAP lesions in gymnasts by comparing the location and extension of these lesions between gymnasts and throwers. Hypothesis: The location and arc of SLAP lesions in gymnasts will be different from those in throwing athletes. Study Design: Case series; Level of evidence, 4. Methods: This study included 27 shoulders in 20 males and 3 females with a mean ± SD age of 20 ± 2.5 years (range, 16-25 years). We performed debridement alone for shoulders with a stable lesion. Anterior and/or posterior labral repair was added for unstable SLAP lesions depending on the extension and stability of the lesions. We investigated symptoms, onset, return to sport (based on patient records), and subjective shoulder values. SLAP lesions were evaluated through use of the Snyder classification. The location and arc of SLAP lesions were determined from surgical records and videos and described by use of the right shoulder clockface method. During the same period, 65 baseball players (65 shoulders; all males; mean age, 23 ± 7.0 years; range, 16-44 years) underwent arthroscopic SLAP surgery. We compared the location and arc of SLAP lesions between gymnasts and baseball players. Results: Symptoms during gymnastics included pain (100%), apprehension (48%), or catching (11%). We found that 20 shoulders had symptom onset during gymnastics, most commonly during rings events. Type II SLAP lesions were found in 17 shoulders, type III in 2 shoulders, and type IV in 8 shoulders. The mean center of SLAP lesions was at the 11:40 clockface position in 27 gymnasts and 10:40 clockface position in 65 baseball players, and the difference was statistically significant ( P < .001). The mean arc of SLAP lesions was 125° in gymnasts and 140° in baseball players, and the difference was not significant. We performed debridement in 2 shoulders (7%) and labral repair in 25 shoulders (93%). After surgery, all patients returned to gymnastics. The mean subjective shoulder value was 35 (range, 10-90) preoperatively and 76 (range, 40-100) postoperatively. Conclusion: SLAP lesions in gymnasts were significantly located anteriorly compared with those in baseball players. All patients returned to gymnastics after arthroscopic surgery. Secure repair of SLAP lesions may be important for good surgical outcomes, because 50% of patients experienced preoperative shoulder apprehension.

Surgical Treatment of Shoulder Pathologies in Professional Gymnasts: Findings, Treatment, and Clinical Outcomes

“…Caraffa et al [23] reported that the traction force to the intraarticular structure reaches the maximum level during the rings event. Moreover, a paper by Takeuchi et al [10] proposed how, in gymnasts, the traction force to the LHB during suspension events (i.e., hanging from rings or bars) can exert pressure on the superior labrum through the LHB and could potentially result in the formation of a SLAP lesion that extends both anteriorly and posteriorly. This unique injury mechanism, distinct from that seen in throwing athletes, might explain why gymnasts tend to experience SLAP lesions primarily in the anterior part of their shoulders.…”

“…As an example, a deep partial supraspinatus tear can be present alone or combined with an anteroinferior labral tear (in the case of shoulder instability) or with a posterosuperior labral tear (in the case of posterosuperior glenoid impingement) [8,9]. SLAP lesions occur at a high frequency in gymnastics, and even though they are well described in overhead throwing athletes, they are less studied in gymnasts and seem to have a different arc of lesion [10,11]. Moreover, even though dislocation and subluxation are commonly observed injuries, both in training and competition, it is important to underline that in gymnasts, inferior subluxation can be considered physiologic since it is necessary for the athlete to perform some of the routines and as such, it is considered part of the training and shall not be overcorrected [9].…”

Return to Sport and Patient-Reported Outcomes After Subpectoral Biceps Tenodesis for SLAP Tear in Collegiate Gymnasts

“…While gymnasts are often grouped with overhead athletes, independent evaluation should be considered because of the unique needs of the gymnast's shoulder compared with other overhead athletes. 32 Further evaluation of PROs in gymnasts could provide essential insights that would improve treatments and recovery after SLAP tears.…”

“…2,3,19,22,27,31 Gymnastics is a sport commonly associated with superior labral anterior-posterior (SLAP) tears, with pathologies presenting similarly to those of overhead athletes. 4,9,12,14,32 Historically, operative treatment of SLAP pathologies in young patients consisted of labral and biceps anchor repair. Outcomes were unsatisfactory, with variable § postoperative satisfaction and functional outcomes.…”

“…20,26,29 Despite many studies characterizing the shoulder pathology encountered in gymnasts, these athletes remain a relatively understudied demographic group with regard to SLAP pathology. 9,12,14,32 Moreover, few studies have evaluated patient-reported outcomes (PROs) and RTS after biceps tenodesis in gymnasts. Thus, the purpose of this study was to evaluate RTS and PROs after biceps tenodesis in collegiate gymnasts aged 25 years.…”