Summary

The Purpose of this study is to identify in the existing literature the return to play criteria utilized after shoulder stabilization surgery and to analyze the rates of return to play and recurrent instability.

Abstract

Background

Instability of the glenohumeral joint is common among young, active patients. Most surgeons advocate surgical stabilization, but the timing for safe return to play is not well defined and recurrent instability remains a significant risk.

Purpose

To identify in the existing literature the return to play criteria utilized after shoulder stabilization surgery and to analyze the rates of return to play and recurrent instability.

Hypothesis

There is limited evidence-based criteria for safe return to play after shoulder stabilization surgery for traumatic, anterior shoulder instability.

Study Design: Systematic Review, Level IV

Methods

We performed a systematic review evaluating surgical stabilization for primary traumatic anterior shoulder instability in predominantly adult patients with a minimum of one-year follow-up utilizing level I-IV studies in PubMed and EMBASE from January 1994 until June 2015.

Results

Fifty-two studies with at least one explicitly stated criterion for return to play were identified from a review of 5,100 published articles. Seven different criteria were utilized, including: time from surgery (47 studies), range of motion (7), strength (10), stability (2), pain (3), proprioception (2), and postoperative radiographic evaluation (2). Thirty-nine studies (75%) used time as the sole criterion for return to play. Recurrence rates ranged from 0.0% to 49.0%, and reoperation ranged from 0.0% to 33.9%. Thirty –three studies (63.4%) reported return to play rates, ranging from 31% to 100%.

Conclusion

There is a paucity of substantive return to play criteria in the existing literature. This systematic review identifies 7 criteria used. Further study is needed to establish evidence-based return to play criteria after surgical stabilization of traumatic, anterior shoulder instability.

Clinical Relevance: By identifying the criteria used in the existing literature, we hope to ultimately develop an evidence-based checklist for return to play after shoulder stabilization.

What is known about the subject: Despite voluminous shoulder stabilization literature this is the first study to identify the existing return to play criteria.

What this study adds to existing knowledge: This study provides the foundation for developing evidence-based criteria for return to play following surgical stabilization of traumatic, anterior instability.