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Published on: July 5, 2011
Return to Competitive Sport After Anterior Shoulder Stabilization: A Scoping Review of Current Outcomes and Clearance
1Physical Therapy University of Pittsburgh.
Background:
Reported rates of return to sport at prior levels (RTSP) and recurrent instability are varied after anterior shoulder stabilization procedures and standardized criteria for clearance decision-making are lacking.
Purpose:
To 1) describe the current state of RTSP and recurrence rates for competitive athletes undergoing the most frequently performed anterior shoulder stabilization procedures and the factors potentially associated with these outcomes and to 2) describe RTS clearance timeframes and how RTS clearance decisions were made in the included studies.
Study Design:
Scoping review.
Methods:
A systematic literature search over the past 10 years was conducted using the MEDLINE, EMBASE, and OVID databases to find articles that analyzed RTSP and recurrent instability with at least two-year follow-up in competitive athletes after common anterior shoulder stabilization procedures. The Methodological Index for Non-randomized studies (MINORS) scale was used to assess study quality.
Results:
Twenty-nine articles were included, analyzing a total of 2,237 shoulders in 2,187 competitive athletes. Overall, 82.3% were able to RTSP and 7.0% had recurrent instability. For those undergoing Bankart repair, the RTSP rate was 79.7% and 9.2% had recurrent instability. For the Latarjet procedure, these rates were 87.4% and 3.1%, respectively. Reported times for return ranged from 11 weeks to 8.4 months and ten unique criteria for clearance were identified by the included articles. Strength and range-of-motion (44.8% each) were the most common criteria. The average MINORS score for non-comparative studies was 8.58 ± 1.35 (maximum score of 16). For comparative studies, the average MINORS score was 14.00 ± 1.56 (maximum score of 24).
Conclusion:
Competitive athletes may RTSP at relatively high rates after anterior shoulder stabilization. However, high-level prospective evidence is lacking and there is a need to standardize clearance decision-making processes and reporting in the literature.
Level Of Evidence:
Level 4 (Scoping Review).
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