Return to Play After Arthroscopic Stabilization for Posterior Shoulder Instability—A Systematic Review

Abstract

Purpose To ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after arthroscopic posterior shoulder stabilization. Methods Medline, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies on arthroscopic posterior shoulder stabilization. Studies were included if they reported RTP data or rehabilitation protocols and excluded if concomitant procedures influenced the rehabilitation protocol. Rate and timing of RTP, along with rehabilitation protocols, were assessed. Results This review found 25 studies, including 895 cases, meeting the study’s inclusion criteria. The majority of patients were male (82.7%), with an age range of 14 to 66 years and a follow-up range of 4 to 148.8 months. The overall RTP rate ranged from 62.7% to 100.0%, and 50.0% to 100.0% returned to the same level of play. Among collision athletes, the overall rate of RTP was 80.0% to 100.0%, with 69.2%-100.0% returning to the same level of play. In overhead athletes, the overall rate of RTP was 85.2% to 100.0%, with 55.6% to 100.0% returning to the same level of play. Four studies (128 patients) specifically addressed the timing of RTP, and the range to RTP was 4.3 to 8.6 months. Specific RTP criteria were reported in a majority of studies (60%), with the most reported item being restoration of strength (44%). Conclusion There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery. Return to preinjury level is higher for collision athletes compared with overhead athletes. However, there is inadequate reporting of RTP criteria in the current literature, with no clear timeline for when it is safe to return to sport. Level of Evidence IV, systematic review of level II to IV studies

Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury

“…65 Athletes typically target return to sports at around 6 to 8 months after surgery. 65,67,68,70,72 Success in return to play after surgical treatment for anterior and posterior shoulder instability is also variable depending on the sport, position, and nature and severity of injury. In 66 collision athletes, the return to play rate after arthroscopic Bankart repair was 90.9% at a mean of 6 months.…”

“…73 In a recent systematic review of posterior shoulder stabilization procedures, 25 studies found an overall 62.7% to 100% RTP, with higher return to preinjury level for collision athletes compared with overhead athletes. 72…”

Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and Inform Return-to-Play Decision Making

“…5 Most return at 5.8 months (range, 3.2-8 months). 5 In a recent systematic review of the rate, timing, and criteria for return to play after posterior shoulder instability, Fried et al 6 reported that both collision and overhead athletes return to play at similar rates (62.7%-100%) but overhead athletes are more likely to return at a lower level of play. Reinjury rates between 3.4% and 7% were reported.…”

“…The findings were similar: Time, imaging, clinical examination, strength, pain, and range of motion were listed as criteria, but none of the studies described objective means of assessment or predetermined thresholds to be met prior to release to unrestricted activity. After procedures addressing posterior instability, Fried et al 6 found no consensus for guidelines to determine when it is safe to return an athlete to play. Again, however, strength, range of motion, time (4-6 months with 6 months most commonly used), absence of pain, completion of a sport-specific rehabilitation protocol, and proprioception were reported.…”

Single-Portal Arthroscopic Posterior Shoulder Stabilization

“…The timing of return to sports ranges from 4.3 to 8.6 months postoperatively, and collision athletes report a greater rate of return to the preinjury competition level than overhead athletes. 21 Moreover, Katthagen et al 22 found that patients with traumatic posterior instability returned to sports at a higher rate than those with an atraumatic origin (90% vs 72%).…”