Return to sport testing at 6 months after arthroscopic shoulder stabilization reveals residual strength and functional deficits

Wilson, Kevin; Popchak, Adam; Li, Ryan T.; Kane, Gillian; Lin, Albert

doi:10.1016/j.jse.2020.04.035

Cited by 39 publications

(46 citation statements)

References 20 publications

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“…However, a recent study found that a majority of athletes did not meet the expected goals for their operative shoulder at 6 months after arthroscopic shoulder stabilization when following an objective CBRTS testing protocol. 19 Similarly, in our cohort, the majority of athletes (83.8%) failed at least 1 component of the test. In this previous study, despite the strength deficits identified, some subjects were able to pass functional testing, 19 suggesting that athletes may be able to compensate functionally for focal and detectable strength deficits.…”

Section: Discussionsupporting

confidence: 65%

“…19 Similarly, in our cohort, the majority of athletes (83.8%) failed at least 1 component of the test. In this previous study, despite the strength deficits identified, some subjects were able to pass functional testing, 19 suggesting that athletes may be able to compensate functionally for focal and detectable strength deficits. These findings were also present in our study and call into question whether patients who appear well on physical examination in the clinic at 6 months postoperatively are truly ready to RTS.…”

Section: Discussionsupporting

confidence: 65%

“…The results of the previous study suggest that if our control group had undergone CBRTS testing, these patients likely would have had detectable deficits. 19 It is possible that these athletes may have been at increased risk of recurrence on RTS owing to uncorrected residual strength and/or functional deficits.…”

Section: Discussionmentioning

confidence: 99%

“…At 6 months postoperatively, patients underwent complete CBRTS testing, performed by a physical therapist, using a previously published protocol. 19 The battery of tests consisted of analysis of strength, which included isokinetic and isometric internal rotation and external rotation, as well as the external rotation endurance test. The goal of strength testing was to reach 90% of the values for the contralateral extremity.…”

Section: Methodsmentioning

confidence: 99%

“…A criteria-based return-to-sport (CBRTS) test popularized following anterior cruciate ligament (ACL) reconstruction has been shown to substantially decrease the reinjury risk after RTS following ACL reconstruction. 8 Similarly, a recent study by Wilson et al 19 analyzing a CBRTS test at 6 months after arthroscopic shoulder stabilization surgery revealed residual strength and/or functional deficits in 88% of the consecutive athletes tested. This finding suggests that an objective assessment of strength and function may be more effective than clinical examination findings in identifying potential hidden deficits before RTS.…”

mentioning

confidence: 90%

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Criteria-based return-to-sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

Drummond

Popchak

Wilson

et al. 2021

Journal of Shoulder and Elbow Surgery

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Hypothesis and background: This study aimed to analyze the impact of a criteria-based return-to-sport (CBRTS) testing protocol on recurrent instability following arthroscopic Bankart repair. We hypothesized that patients who underwent an objective CBRTS testing protocol to guide their clearance to return to sports would have less recurrent instability than those who did not undergo testing. Methods: Thirty-six consecutive patients who underwent arthroscopic Bankart repair from 2016 to 2018, had a minimum of 1 year of follow-up, and completed functional and strength testing to evaluate readiness to return to sports were included in this retrospective case-control study. Patients with critical glenoid bone loss > 13.5%, multidirectional instability, and off-track Hill-Sachs lesions necessitating a remplissage or bone augmentation procedure were excluded from the study. Recurrence was defined as dislocation or subluxation symptoms requiring revision surgery. Statistical analysis included analysis of variance and the independent t test.Results: There was no difference between the study and control groups regarding age (P ¼ .15), sex (P ¼ .11), hand dominance (P ¼ .56), or participation in contact sports (P ¼ .78). Patients who underwent the CBRTS testing protocol had a reduced rate of recurrent shoulder instability (5% vs. 22%; odds ratio, 4.85; P < .001). There was no difference in the time from surgery to recurrence between the groups (12 months vs. 13.6 months, P ¼ .43). Conclusion: Athletes who underwent an objective CBRTS testing protocol to guide their clearance to return to sports had a lower rate of recurrent instability following arthroscopic Bankart repair than those cleared to return based on the time from surgery. Athletes who did not undergo CBRTS testing after arthroscopic shoulder stabilization had a 4.85 times increased likelihood of recurrent instability development after return to sports.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 90%

See 3 more Smart Citations

Criteria-based return-to-sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

Drummond

Popchak

Wilson

et al. 2021

Journal of Shoulder and Elbow Surgery

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Inhalte und Ziele der Rehabilitation an der oberen Extremität

Buchmann¹,

Dyrna²

2023

Arthroskopie

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Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits

Ehmann

Berthold

Reuter

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To determine the sensorimotor and clinical function of patients with confirmed successful outcome after either undergoing acromioclavicular joint (ACJ) stabilization, Bankart repair (BR), or rotator cuff repair (RC), and to compare these measures to the contralateral, healthy side without history of previous injuries or surgeries of the upper extremity. It was hypothesized that patients of each interventional group would have inferior sensorimotor function of the shoulder joint compared to the contralateral, healthy side, while presenting with successful clinical and functional outcomes. Methods Three intervention groups including ten patients who had confirmed successful clinical and functional outcomes after either undergoing ACJ stabilization, BR, or RC were evaluated postoperatively at an average follow-up of 31.7 ± 11.6 months. Additionally, a healthy control group (CG) of ten patients was included. Clinical outcomes were assessed using the Constant–Murley (CM) and American Shoulder and Elbow Surgeons (ASES) Score. Pain was evaluated using the visual analogue scale (VAS). Sensorimotor function was assessed by determining the center of pressure (COP) of the shoulder joint in a one-handed support task in supine position on a validated pressure plate. Results Each interventional group demonstrated excellent clinical outcome scores including the CM Score (ACJ 83.3 ± 11.8; BR 89.0 ± 10.3; RC 81.4 ± 8.8), ASES Score (ACJ 95.5 ± 7.0; BR 92.5 ± 9.6; RC 96.5 ± 5.2), and VAS (ACJ 0.5 ± 0.9; BR 0.5 ± 0.8; RC 0.5 ± 0.8). Overall, the CG showed no significant side-to-side difference in COP, whereas the ACJ-group and the BR-group demonstrated significantly increased COP compared to the healthy side (ACJ 103 cm vs. 98 cm, p = 0.049; BR: 116 cm vs. 102 cm, p = 0.006). The RC-group revealed no significant side-to-side difference (120 cm vs. 108 cm, n.s.). Conclusion Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. This may indicate that specific postoperative training and rehabilitation protocols should be established for patients who underwent surgery of the upper extremity. These results underline that sensorimotor training should be an important component of postoperative rehabilitation and physiotherapeutic activities to improve postoperative function and joint control. Level of evidence IV.

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Return to sport testing at 6 months after arthroscopic shoulder stabilization reveals residual strength and functional deficits

Cited by 39 publications

References 20 publications

Criteria-based return-to-sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

Criteria-based return-to-sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

Inhalte und Ziele der Rehabilitation an der oberen Extremität

Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits

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