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Ranges of Return to Sport Outcomes Following Anterior Shoulder Instability Surgery Are Influenced by Procedure,
Josiah Valk1, Viraj Deshpande2, Hunter Hitchens3
1Department of Orthopedic Surgery, San Diego Arthroscopy and Sports Medicine, San Diego, California, U.S.A.
Purpose:
To evaluate and qualitatively synthesize studies performed in the past decade that report return to sport (RTS) after anterior shoulder instability surgery and identify study, patient, and surgical characteristics that reduce heterogeneity in RTS outcomes, to help guide surgeons and patients in collaborative decision-making and set appropriate expectations of postoperative athletic performance.
Methods:
A systematic review of PubMed, Embase, and Web of Science databases was conducted for all studies published between January 2015 and March 2025 reporting RTS or return to preinjury level (RTPL) following surgical treatment for anterior shoulder instability. Exclusion criteria included non-English studies, studies reporting less than a 2-year follow-up, and studies reporting any shoulder instability other than anterior, including atraumatic instability. The risk of bias was assessed, and data were extracted. Heterogeneity in procedure-specific RTS outcomes was qualitatively assessed through subgroup analyses of study, patient, and surgical characteristics.
Results:
A total of 123 studies encompassing 10,992 athletes were included. Across 9,581 patients, RTS rates ranged from 50% to 100%, and RTPL ranged from 19.4% to 100%. RTS was most consistent following open iliac crest (100%) and open Bankart repair (91.6%-100%), while wider ranges were observed after arthroscopic Bankart (50%-100%) and open Latarjet (50%-100%). RTPL exhibited rates of 100% after open iliac crest and 19.4% to 97.1% after open Latarjet. Female athletes had higher and more consistent RTS (91.4%-100%) and RTPL (74.1%-76.9%) compared to males (RTS, 73.9%-100%; RTPL, 39.4%-97.1%). Ranges of RTS and RTPL narrowed in studies with a prospective design (RTS, 87%-98%; RTPL, 38%-97%), revision procedures (RTS, 77.9%-100%; RTPL, 42.9%-95.4%), and among elite athletes (RTS, 81.8%-100%). Patients with >20% glenoid bone loss exhibited narrower RTPL (78.3%-95.4%) than those with <20% (70%-100%). Sport type, athlete level, and bone defect tracking status further influenced RTS variability.
Conclusions:
Anterior shoulder stabilization procedures lead to high, though varied, reported RTS and return to preinjury rates across all studied cohorts. Ranges of RTS rates are influenced by procedure type, clinical follow-up duration, athletic level, and revision surgery status.
Level Of Evidence:
Level IV, systematic review of Level I to IV studies.
