Surgical management of internal impingement in overhead athletes: a systematic review

BACKGROUND: We aimed to review all published evidence on the surgical management of internal impingement and associated conditions in athletes of overhead sports. METHODS: Our search included studies reporting outcomes of any surgical intervention on shoulder internal impingement and its sequelae in overhead athletes. The primary outcome was return to sport at pre-injury level or higher in the main text (RTS+). Secondary outcomes included return to sport at any level (RTS), shoulder function, and complications. No quantitative analyses were possible due to the nature of the evidence included. RESULTS: Forty-two observational studies were eligible. They included 1,420 overhead athletes with a mean age of 27.3 years. RTS+ across all surgical procedures ranged from 25% to 94%. In patients treated with debridement of articular-sided partial-thickness rotator cuff tears, the RTS+ ranged from 50% to 85%, and in those who underwent posterior glenoidplasty for glenoid spurs, it ranged from 55% to 63.6%. Comparative studies for superior labrum anterior to posterior (SLAP) tears demonstrated similar RTS+ after open subpectoral tenodesis and arthroscopic SLAP repair. RTS+ after the two procedures in all observational studies ranged from 35% to 100% and 54.2% to 100%, respectively. RTS+ after capsulorrhaphy, when performed concomitantly with other procedures, ranged from 25% to 93%. CONCLUSIONS: Outcomes associated with the surgical management of internal impingement are variable. Surgical decision-making should prioritize patient-specific factors following unsuccessful conservative management. We provide surgical recommendations and considerations.