Rehabilitation and Return to Sport following Operative and Nonoperative Treatment of Anterior Shoulder Instability.

There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.

Criteria-based return to sport testing after open Latarjet reveals residual deficits and can be utilized for sports clearance with excellent outcomes at mean 3.6 year follow-up: A small case series of competitive athletes.

OBJECTIVE: The purpose of this study was to assess the use of a criteria-based return to sport (CBRTS) test to evaluate readiness for return to play (RTP) in competitive athletes that underwent open Latarjet. DESIGN: Retrospective case series. METHODS: Ten competitive athletes (mean age 19.9 years) treated with open Latarjet for recurrent glenohumeral instability underwent CBRTS testing at a mean of 5.3 months postoperatively. Testing consisted of four components: 1. isometric strength, 2. isokinetic strength, 3. endurance, and 4. function. Patients failing 0 or 1 component of the test were cleared to RTP. Patients failing multiple components underwent additional deficit-based rehabilitation. RESULTS: Of the 10 patients that tested, 4 passed their overall CBRTS test and were cleared to RTP. The remaining 6 patients failed the overall CBRTS test. Seven patients (70%) failed at least one section of the strength testing, two patients (20%) failed endurance testing, and two patients (20%) failed functional testing. At final follow-up (mean 3.6 years), 1 patient had recurrent instability (10%) and 9 patients returned to play (90%). CONCLUSIONS: CBRTS testing may be clinically useful for return to play clearance decisions after open Latarjet procedure, as it can reveal deficits that may not be identified with time-based clearance alone.

Criteria-based return-to-sport testing helps identify functional deficits in young athletes following posterior labral repair but may not reduce recurrence or increase return to play.

Background: The purpose of this study was to compare recurrent instability and return to play (RTP) in young athletes who underwent clearance to full activity based on a validated return-to-sport (RTS) test to those who underwent time-based clearance following primary posterior labral repair. Methods: This was a retrospective review of athletes with posterior shoulder instability who underwent primary arthroscopic posterior labral repair from 2012 to 2021 with minimum 1-year follow-up. Patients who underwent RTS testing at a minimum of 5 months postoperatively were compared to a historic control cohort of patients who underwent time-based clearance. Results: There were 30 patients in the RTS cohort and 67 patients in the control cohort (mean follow-up 32.1 and 38.6 months, respectively). Of the 30 patients who underwent RTS testing, 11 passed without failing any sections, 10 passed while failing 1 section, and 9 failed the RTS test by failing 2+ sections. No differences were found between the RTS and control cohort in the incidence of recurrent instability (6.7% vs. 9.0%), overall RTP (94.7% vs. 94.3%), RTP at the same level as before injury (84.2% vs. 80.0%), recurrent pain/weakness (23.3% vs. 25.4%), or revision surgery (0% vs. 3.0%), respectively. Discussion: While RTS testing in young athletes after posterior labral repair did not reduce recurrence or improve return to play compared to time-based clearance, two-thirds of athletes who underwent testing failed at least 1 section, indicating some functional deficit. Thus, RTS testing may help guide postoperative rehabilitation following posterior stabilization.