Mr Amol Tambe Upper Limb Fellow, Wrightington Mr Ravi Badge Clinical Fellow, RAEI, Wigan Mr Lennard Funk Consultant, Shoulder & Upper Limb Surgeon Honorary Professor, Salford University

ARTHROSCOPIC ROTATOR CUFF REPAIR IN

ELITE RUGBY PLAYERS

ABER Direct

Bankart Soft tissue 79 % 33%

Bony 26% 11%

SLAP 7% 35%

Cuff Lesions 32% 12%

Significant Cuff Injury can occur in the athlete in the absence of a frank dislocation

Background:

Methods:

Subject Selection:

• Elite rugby professionals • Had arthroscopic rotator cuff repair • January 2005 – December 2006

Data Collection:

• Pre-operative scores and injury mechanisms • Operative records • Post-operative outcome scores – Constant & Oxford

• Patients recalled for outcome scoring and ultrasound scans.

Pre-operative:

Cuff pain and weakness Suboptimal performance Pain on eccentric / weight training Loss of confidence

None were able to return to rugby after injury

1 player - true dislocation 9 players - ABER impact, no dislocation 1 player - not known

Beach chair position Standard portals Assessment of cuff tear, dimensions, mobility of tear Assess associated injuries Debridement of bursa and cuff edge Foot print preparation

Variety of anchors(5mm Mitek, Fastin, Spiralok) Suture material: Ultrabraid or Orthocord. Cuff repaired to the footprint in all but one case

Operative:

Post-op protocol: supervised accelerated rehab

Operative:

Total Shoulder Arthroscopic Procedures

1054

Athletes 164 (15.6%)

Rugby Players 120 (11.4% of total; 74% of athletes)

ARCRs Total 167 ARCRs Rugby 11 (6.5%)

Of the procedures on the rugby players:

9.1% required ARCR (11/120). The rest were mostly labral repairs.

11 elite rugby players

7 Rugby league and 4 rugby union players

Including 6 internationals

Mean age was 25.7 years (range= 19 to 31 years)

Results:

Small (<1 cm) 3 Moderate (1-3 cm) 5 Large (3-5 cm) 2 Massive (>5 cm) 1

Cuff tear sizes: Mean =1.8 cm Range: 1cm to > 5cm

Bateman Classification

Small (<1cm) Moderate (1-3cm) Large (3-5cm)

3 5 2

Associated Injury:

2

360 deg Labral lesion = 2

3

1

No post-operative complications

Mean follow-up = 18 months (3-28)

All but one player had CS and OS at FU

Results:

Pre-op 3m FinalCS 44 95 101

OS 34 18 12

Mean time of return to full match play = 4.8 months (3-8)

Results:

10 players went back to play at the same level of sport

1 retired for personal reasons , went to heavy manual job

Ultrasound:

Post-operative scans in 9 cases (81%)

All were intact

Update 2015

54 Athletes (14%)

14 Non-rugby 38 Rugby (70%)

16 League (42%) 22 Union (58%)

382 cuff repairs betw. 2005-2015

Tendon Involvement:

Conclusions:

1. Cuff tears not uncommon in rugby

2. Posterior Cuff involvement

3. Good results with arthroscopic repair

Thank you !