Summary
Return to Sports (RTS) Testing leads to higher postoperative patient reported outcomes with comparable rate of failure to those who do not undergo RTS testing.
Abstract
Introduction
Return to play after anterior shoulder stabilization has generally been dependent on postoperative time, typically 6 months, and subjective recommendation from surgeons and physical therapists. However, recent efforts to define and implement objective testing, including various range of motion and strength benchmarks, have increased in order to determine the most appropriate time for an athlete’s return to sport [1]. The aim of this study was to determine whether objective return to sport (RTS) testing after arthroscopic anterior shoulder stabilization would increase postoperative patient reported outcomes (PROs) and decrease failure rates.
Methods
This was a prospective analysis of patients who underwent primary arthroscopic Bankart repair with or without remplissage followed by a validated, RTS testing with at least 18 months follow-up. The RTS group was matched 1:4 according to age, gender, contact sports participation, and procedure to a control group who underwent arthroscopic stabilization but not RTS testing. Preoperative and postoperative PROs, including subjective shoulder value (SSV), American Shoulder and Elbow Surgeon (ASES) score, and Western Ontario Shoulder Index (WOSI). Postoperative instability events were also recorded, with failure defined as recurrent dislocation or subluxation of the operative shoulder. Statistical analysis used chi-square tests, two-sample t-tests, or Welch’s t-tests.
Results
This study included 31 RTS patients (70.97% male, 51.6% contact athlete), with a mean age of 21.15±5.4 years old and average follow up of 2.31±1.09 years. These patients were matched to 124 patients in the control group with a mean age of 21.35± 5.18 and average follow up of 3.09±1.72 years. Among RTS patients, 70.97% passed the RTS testing, which occurred on average 6.3±1.9 months postoperatively. There was no difference between the RTS and control group with respect to gender (p=1.00), contact sport participation (p=0.87), age (p=0.85), procedure (p=0.31), and follow-up time (p=0.20). Postoperatively, there was no significant difference in the rate of failure between the cohorts (p=0.84). Regarding PROs, there was no significant difference in SSV; however, RTS had significantly higher ASES scores (RTS: 98.32±3.45, Control: 93.31±9.56, p<0.01) and WOSI scores (RTS: 228.5±306.6, Control: 468.1±535.8, p<0.01).
Conclusions
After surgical intervention for shoulder instability, RTS testing leads to higher postoperative patient reported outcomes, including ASES and WOSI scores, with comparable rate of failure to those who do not undergo RTS testing. This information may help guide postoperative care for those undergoing arthroscopic anterior shoulder stabilization.