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

Abstract

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented.

Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level.

Study design: Case series; Level of evidence, 4.

Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%).

Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%.

Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.

Keywords: Bankart procedure; SLAP repair; arthroscopy; biceps tenodesis; cuff repair; gymnasts.

Figure 1.

Measurements of strength in (A) elbow flexion and (B) forearm supination using mechanical dynamometers. These measurements were made on the operated side and the contralateral side in all patients who underwent a SLAP (superior labral anterior and posterior) repair or a biceps tenodesis.

Figure 2.

(A) French gymnast on the rings during the 2003 world championship 2 years after Bankart repair on the left shoulder and (B, C) 1 year after cuff repair and biceps tenodesis with interference screw on the right shoulder.

Figure 3.

Successful shoulder stabilization with an open Latarjet procedure after failed Bankart procedure in an international-level French gymnast. The need for male gymnasts to dislocate their shoulders during some acrobatic figures may explain the partial lysis of the coracoid bone block and the broken screw seen on radiographs taken 2 years after surgery. The sling effect given by the transposed conjoint tendon may contribute to stabilization of the shoulder.