The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery?

Gendre, Patrick; Boileau, Pascal

doi:10.1177/23259671211043468

Cited by 4 publications

(10 citation statements)

References 33 publications

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“…The objectives of part 1 were (1) to assess the surgical epidemiology of high-level gymnasts' shoulder lesions, (2) to describe the type of injuries seen and assess which maneuvers and equipment put the gymnast most at risk, and (3) to present a pathoanatomic classification of the gymnast's shoulder. In part 2, 17 we evaluated the results of shoulder surgery in these gymnasts.…”

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confidence: 99%

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

Gendre

Boileau

2021

Orthopaedic Journal of Sports Medicine

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Background: Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. Purpose: To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. Results: The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts’ shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. Conclusion: The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

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The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

Gendre

Boileau

2021

Orthopaedic Journal of Sports Medicine

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“…To our knowledge, the Gendre and Boileau 13 study is the only study focusing exclusively on gymnasts after biceps tenodesis. In this case series, 100% of gymnasts returned to sport after biceps tenodesis.…”

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confidence: 99%

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

Ulrich

Cvetanovich

Meeks

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: The biceps superior labral complex is a known source of shoulder dysfunction in young, high-level athletes. Superior labral anterior-posterior (SLAP) repairs are often unsatisfactory for treating biceps-labral pathology in this demographic group, with high failure rates and poor return to sport (RTS). Minimal data have been published to demonstrate patient-reported outcomes (PROs) and RTS in gymnasts after treatment of SLAP pathologies. Hypothesis: Gymnasts undergoing biceps tenodesis for SLAP pathologies would have satisfactory PROs and satisfactory RTS. Study Design: Case series; Level of evidence, 4. Methods: Gymnasts aged ≤25 years who underwent open subpectoral biceps tenodesis for SLAP tears with or without biceps tendon pathology between August 20, 2014, and August 20, 2019, and who had minimum 2-year follow-up data were included in this study. Tenodesis was performed using a subpectoral technique with bicortical button fixation. The following PROs were included: RTS, postoperative activity level, 10-point visual analog scale for pain (VAS–Pain), American Shoulder and Elbow Surgeons (ASES), and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: Of 16 shoulders in 14 gymnasts undergoing biceps tenodesis for SLAP tear during the study period, a follow-up was obtained for 13 of 16 shoulders (81%) at 4.3 ± 1.5 years. The mean age of patients at the time of surgery was 21.8 ± 2.2 years, with 12 (92%) male patients. Biceps tenodesis was performed as the primary procedure for the diagnosis of SLAP tear in 12 patients (92%) and for failed prior SLAP repair in 1 patient (8%). PROs were excellent at the follow-up, with VAS–Pain scores of 1.8 ± 1.7, ASES scores of 89.1 ± 9.1, and DASH scores of 2.4 ± 3.2. After surgery, 8 (62%) patients returned to their prior level of collegiate gymnastics. Three (60%) of 5 patients did not return to collegiate gymnastics because of the end of eligibility, and 2 (40%) patients did not return to collegiate gymnastics because of knee injuries. Significantly higher DASH scores were noted in the group that did not RTS ( P = .04). No patients experienced postoperative complications or reoperation. Conclusion: Biceps tenodesis was an effective primary operation for high-level gymnasts with SLAP tears, with a satisfactory rate of return to the same level of sport and excellent PROs.

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“…Multiple lesions can occur in the same patient. To better stratify the athlete's pathology, the patients were divided based on the clinical, radiological (with MRI and arthroMRI), and arthroscopic findings into 2 groups (painful or unstable shoulder) according to the pathoanatomic classification of the gymnast's shoulder proposed by Gendre and Boileau [3,9]. More specifically, regarding the clinical evaluation, gymnasts with mainly self-reported pain during specific shoulder movements were classified into the 'painful shoulder' group, while those exhibiting clinical signs of instability were categorized into the 'unstable shoulder' group.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, an immediate single diagnosis can be difficult due to the high incidence of combined lesions. 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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Ranieri,

Illuminati,

Conti

et al. 2024

JCM

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Background: This study aims to investigate the impact of shoulder surgery on professional gymnasts through a case series, analyzing the mechanisms of injury and the shoulder lesion patterns, and reporting the clinical outcomes and return to sport. Methods: Twenty-nine surgically treated shoulders in twenty-seven professional gymnasts were retrospectively analyzed. Patients were stratified based on predominant symptoms and anatomical lesions in painful or unstable shoulders. Demographic and injury data, pathological findings, surgical procedure information, and data on time and level of return to sport were collected. Results: The average age of participants was 20.2 ± 3.8 years. Acute traumatic onset was reported in 51.8% of cases. Shoulders were categorized as painful in 13 cases and unstable in 16 cases. The most common pathologies were capsulolabral injuries (72%), biceps injuries (48%), and rotator cuff injuries (40%). All of the athletes returned to training within an average of 7.3 months, while the return to competition rate was 56%, achieved in an average of 10.3 months. The sport-specific subjective shoulder value was 84.8% ± 16.6%. Half of the patients who stopped competition reported reasons related to symptom persistence, while the other half reported personal reasons. No significant difference in the return to sport was reported in the cases of painful or unstable shoulder. Conclusions: Professional gymnasts requiring shoulder surgery commonly present multiple and complex lesions. Returning to training was possible in all cases; however, the possibility of persisting symptoms and other personal factors which may compromise the return to competition should be discussed with the athlete to give them insights into the possible outcomes.

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The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery?

Cited by 4 publications

References 33 publications

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

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

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

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