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Decision making in the Contact athlete

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Decision making in the Contact athlete
www.shoulderdoc.co.uk

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Decision making in the Contact athlete

  1. 1. Lennard Funk Wrightington Upper Limb Unit Salford University lenfunk@shoulderdoc.co.uk CONTACT ATHLETES DECISION MAKING
  2. 2. Sport Popularity in UK SPORT TV Viewing Participation Interest Football 46% 10% 45% Rugby Union 21% 6% 27% Tennis 18% 3% 23% Cricket 18% 2% 19% Athletics 18% 2% 21% Snooker 17% 5% 24% Motorsport 16% NA 20% Rugby League 12% 2% 15% Boxing 11% NA 14% Golf 11% 6% 16%
  3. 3. My Elite Athletes (2010-2013) = 663 SPORT Percent Commonest Path.Rugby Union 37% (247) Anterior Labral Rugby League 28% (182) Posterior Labral Football/ Soccer 8% (54) Anterior Labral Motorsport 3% (22) Mixed Labral TearsClimbers 3% (20) SLAP Swimming 3% (18) Int Imping/ SLAPCricket 2% (14) Anterior Labral Paralympics 2% (13) Mixed Labral TearsOthers 14% (93)
  4. 4. Three P’s Patient Pathology Participation 1. Age 2. Gender 3. Laxity 4. Fatigue 5. Sport 6. Position 1. Major 1. Bony 2. ALPSA 3. HAGL 4. FTCT 2. Minor 1. Labral 2. PTCT 1. Season 2. Events 3. Pressure 4. Age
  5. 5. Recurrent Instability Rates (after arthroscopic stabilisation) [Cho et al. Arthroscopy 2006] CONTACT / COLLISION OVERHEADFLEXIBILITY 29% 7%
  6. 6. Recurrent Instability Rates in Contact Sports • Non-operative = 80% [Arciero, 1994] • Open Bankart repair = 12% • Arthroscopic Stabilisation = 14% [Larrain, 2006] – First dislocation = 4% – Recurrent dislocations = 24% – Under 18yrs age = 30% [Nixon & Funk, 2013]
  7. 7. • RCT of Latarjet vs. Arthroscopic Bankart • Recurrence rate at 5 years: – Latarjet = 12% – Arth. Bankart = 24% • Return to sport the same! • Complication Rates higher (20%) Latarjet Procedure 
 [Bessier et al. JOST. 2013]
  8. 8. Recurrence Summary • Higher in contact/collision sport • Higher in young • Higher after surgery for recurrent dislocations • Arthroscopic = Open Bankart • Lower after Latarjet procedure
  9. 9. WHY?
  10. 10. PATIENT
  11. 11. Predisposing Factors • Player: 1.Laxity
 Cheng et al. JBJSB 2007; 
 Akhtar & Robinson. BJSM 2010 2.Proprioception
 Herrington, 2011 3.Isokinetics
 Jones & Funk, 2010 4.Mass 5.Running Speed 6.Aerobic ability 7.Previous Injury • Sport: 1. Speed of play 2. Timing 3. Fatigue 1. Physical 2. Mental
  12. 12. Injury Reduction Predispostion Model Meeuwisse
  13. 13. PATHOLOGY
  14. 14. Pathology
  15. 15. Mechanisms of Injury video analysis study Direct Impact Complex Labral Bony Bankart PTCT Flexed Fall Posterior Labral RHAGL Try Scorer Bankart SLAP Rotator Cuff Tackler Bankart SLAP HAGL Crichton, Jones & Funk - BJSM 2012
  16. 16. Player Position • 25 Professional Footballers – 15 Field players – 10 Goalkeepers Funk & Sargent, 2010
  17. 17. Injury Patterns
  18. 18. Clinical Examination: Instability in Athletes • True Instability – Dislocation – Subluxation – Apprehension – Large lesions • Subclinical Instability – Dead Arm in ABER – Pain in ABER – Clunking – No Apprehension – Smaller lesions
  19. 19. Investigations • No previous Surgery = MR Arthrogram • Previous Surgery = CT Arthrogram
  20. 20. MR Arthrogram v. Scope Sensitivity Specificity Accuracy SLAP 0.42 0.92 77% Rotator Cuff Tear 0.50 0.86 83% Hill Sachs 0.91 0.78 90% Bankart 0.85 0.83 86% N Karlson, J Geoghan, L Funk; 2008
  21. 21. • An experienced Shoulder Surgeon better • Can correlate with clinical context • Experience of reviewing Scopes & Scans
  22. 22. Pathology Major ‘Minor’ • Bony Bankart • ALPSA • Rotator Cuff Tear • HAGL • Undisplaced Labral Tear • Partial Cuff Tear
  23. 23. Timing of Surgery (Participation) • Early Surgery: – Large structural lesions – Late in Season – Unable to Return • Rehab & Return: – Minor lesions – Early season
  24. 24. Types of Surgery • Mostly Arthroscopic Direct Repairs • Latarjet for High-Risk/Revision
  25. 25. • Anterior Instability – Revision surgery (even without bone loss) – Chronic Bony Bankart (> 3months) – Any Bony Glenoid Loss – True dislocation in Front Row forward 
 (Rugby Union) – Higher level of sports Latarjet in Athletes
  26. 26. Three P’s Patient Pathology Participation 1. Age 2. Gender 3. Laxity 4. Fatigue 5. Sport 6. Position 1. Major 1. Bony 2. ALPSA 3. HAGL 4. FTCT 2. Minor 1. Labral 2. PTCT 1. Season 2. Events 3. Pressure 4. Age
  27. 27. lenfunk@shoulderdoc.co.uk THANK YOU

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