Substantial influence of psychological factors on return to sports after anterior shoulder instability surgery: a systematic review and meta‐analysis

Abstract

Purpose This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals. ResultsThe search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score (P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24. 95-35.53; I 2 = 0%; n.s.). Conclusions Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes' readiness to return to sports. Level of evidence Level IV.

Increased kinesiophobia leads to lower return to sport rate and clinical outcomes following osteochondral allograft transplantation of the knee

“…Growing evidence suggests psychosocial factors such as kinesiophobia (fear of movement/reinjury), preoperative mental health and pain catastrophizing may influence return to sport [9, 10]. While kinesiophobia has been predominantly recognized as affecting outcomes following anterior cruciate ligament reconstruction (ACLR) [11–13], shoulder arthroscopy [14–16], hip [17] and total knee arthroplasty (TKA) [18, 19], there is still limited evidence describing it's effects on RTS and clinical outcomes after OCA transplantation of the knee [20].…”