title: Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review.
abstract: BACKGROUND
  Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery.
  
  
  OBJECTIVE
  To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair.
  
  
  METHODS
  The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013.
  
  
  METHODS
  The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation.
  
  
  METHODS
  We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures.
  
  
  RESULTS
  Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater odds for full return than overhead athletes after labral repair with soft tissue debridement. In 1 study, researchers compared surgical procedures and found that overhead athletes who underwent isolated superior labral repair were 28 times more likely to return to full participation than those who underwent concurrent labral repair and soft tissue debridement (P < .05).
  
  
  CONCLUSIONS
  The rate of return to participation after shoulder surgery within the literature is inconsistent. Odds of returning to preinjury levels of participation after arthroscopic superior labral repair with or without soft tissue debridement are consistently lower in overhead/throwing athletes than in nonoverhead/nonthrowing athletes. The variable rates of return within each group could be due to multiple confounding variables not consistently accounted for in the articles.
authors.affiliation: Shoulder Center of Kentucky, Lexington;
authors.forename: Aaron
authors.initials: A
authors.lastname: Sciascia
authors.affiliation: Division of Athletic Training, University of Kentucky, Lexington.
authors.forename: Natalie
authors.initials: N
authors.lastname: Myers
authors.affiliation: Shoulder Center of Kentucky, Lexington;
authors.forename: W Ben
authors.initials: WB
authors.lastname: Kibler
authors.affiliation: Division of Athletic Training, University of Kentucky, Lexington.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Uhl
mesh_terms: D001182:Arthroscopy / Q000379:methods / Q000534:rehabilitation; D056352:Athletes / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery*; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D006801:Humans; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology
keywords: odds of return; return to play; shoulder injuries