Rehabilitation and Return to Play Following Superior Labral Anterior to Posterior Repair

Superior labral anterior to posterior (SLAP) tears are a pathology seen in the athletic population with greater frequency in the overhead athlete. Treatment is guided to some degree based on the type of the SLAP tear. In degenerative conditions, conservative treatment or debridement back to a stable base is indicated. In the case where the biceps-labral complex is detached from the glenoid, repair is the preferred method of treatment. However, some controversy exists surrounding how to treat the biceps, with either direct repair back to the labrum or tenodesis. Outcomes in either case tend to be good; however, they are less favorable in the overhead athlete. Part of the successful outcome of this surgery necessitates following a structured rehabilitation protocol, that is, based on biological healing timeframes, a graded range of motion program, targeted strengthening program, and in the case of the throwing athlete completion of an interval-throwing program with biomechanical evaluation from a professional pitching coach. Components that can be missed but are vital to a successful outcome, especially in the overhead throwing athlete, are optimization of the kinetic chain and completion of a return to throwing program. Objective return-to-play criteria is important to meet before releasing the athlete back to sport. The focus of this article is to outline the rehabilitation and return-to-play criteria following SLAP repair of a type II lesion with restoration of the biceps anchor, emphasizing the overhead throwing athlete.