Type V superior labral anterior-posterior tears results in lower rates of return to play

PURPOSE

The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability.

METHODS

A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed.

RESULTS

The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59 months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group.

CONCLUSION

Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group.

LEVEL OF EVIDENCE

III.

The kinematics of 1-on-1 rugby tackling: a study using 3-dimensional motion analysis

BACKGROUND

Although past studies using video analysis indicated that the arm tackle and head-in-front shoulder tackle are possible risks for shoulder dislocation, the underlying mechanisms of tackling-related shoulder dislocation have not been sufficiently investigated. This study aimed to analyze the kinematic aspects of these tackling motions in 1-on-1 tackles in an experimental setting using a 3-dimensional motion-capture system.

METHODS

A total of 65 one-on-one tackles were recorded using a marker-based, automatic, digitizing motion-capture system. A documented tackle was classified into 1 of 3 types, which was decided based on the first point of contact on the ball carrier and the head position at the time of impact: shoulder tackle (reference tackle), arm tackle, and head-in-front tackle. The orientations of the head, trunk, and shoulder at impact were calculated and statistically compared with each other.

RESULTS

The distribution of tackles recorded in this study was as follows: 38 shoulder, 23 arm, and 4 head-in-front tackles. In comparison with the shoulder tackle as a reference, shoulder abduction on the side of impact was higher in both the arm and head-in-front tackles, while shoulder external rotation was lower in the head-in-front tackles. In the latter type of tackle, significant decreases in neck extension and ipsilateral neck rotation were also indicated.

CONCLUSION

The kinematics in both the arm tackle and the head-in-front tackle is significantly different from that in the shoulder tackle and may represent a distinct risk factor for shoulder dislocation.