Summary

A high percentage of healthy individuals are unable to pass post-Bankart repair criteria-based return-to-sport protocol tests.

Abstract

Background

The rate of recurrent shoulder instability following return to sport (RTS) after Bankart repair remains unsatisfactory. Criteria-based return to sport (CBRTS) protocols have been developed to determine if athletes are ready to return to their previous activity levels. However, there is a lack of evidence supporting passing thresholds for CBRTS protocols

Purpose

This study aims to evaluate whether healthy volunteers can pass a previously published CBRTS protocol.

Study Design: This was a single-institution prospective single cohort study.

Methods

Conducted in March 2024, this study included 26 volunteers with no history of upper extremity injury or surgery. Volunteers were assessed according to a published CBRTS protocol: (i) isometric testing of external rotation (ER) and internal rotation (IR) in the supine and prone position assessed by hand–held dynamometry; (ii) isokinetic strength testing of ER and IR assessed by isokinetic dynamometry; (iii) endurance testing of side lying ER, prone ER, and prone Y test; and (iv) functional testing via closed kinetic chain upper extremity (CKCUE) stability test and unilateral shot put test. A limb symmetry index (LSI) and proportion of volunteers that passed each test were calculated. A passing LSI value was defined as LSI within 10% of the contralateral side, except for the shot put test, for which a passing value was defined as 80% ≤ LSI ≤ 110%. A passing score for the CKCUE stability test was ≥ 21.

Results

The proportion of the 26 participants (average age 24.8 years (23-25); 14 males, 12 females) that passed isokinetic testing ranged from 30.8% to 57.7%. For isometric testing, passing ranged from 46.2% to 69.2%. For endurance testing, passing ranged from 19.2% to 30.8%. 50% of participants passed the CKCUE stability test, while 96.2% passed the unilateral shot put test. A non-dominant arm deficit was apparent in 10 of the 12 bilateral arm tests.

Conclusion

A high percentage of healthy individuals are unable to pass post-Bankart repair CBRTS protocol tests. Clinicians should consider these findings when using CBRTS testing for athletes after Bankart repair. The benchmark LSI should be practical while still protecting against recurrent instability