Six-Month SIRSI Scores and Return to Sport After Shoulder Stabilization in Adolescent Athletes

Psychological readiness is increasingly recognized as a return-to-sport (RTS) determinant after shoulder stabilization surgery. The Shoulder Instability-Return to Sport After Injury (SIRSI) score is a tool to assess psychological recovery, yet prognostic value at intermediate postoperative milestones remains unclear.

The purpose was to evaluate whether 6-month SIRSI scores relate to 1-year patient-reported outcome measures (PROMs) and RTS in adolescents after shoulder stabilization surgery. It was hypothesized that higher 6-month SIRSI scores would be associated with improved 1-year PROMs and RTS rates.

Case series; Level of evidence, 4.

This study included patients aged 14 to 18 years who underwent surgical shoulder stabilization between August 2022 and August 2023 with follow-up at 6 months and ≥1 year. Psychological readiness was assessed with the SIRSI score, and the following PROMs were collected: American Shoulder and Elbow Surgeons assessment form, Tegner Activity Scale, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Pediatric/Adolescent Shoulder Survey. Associations between 6-month SIRSI scores and 1-year PROMs and RTS were analyzed.

Twenty-three athletes were included (mean ± SD age, 16.7 ± 1.1 years; 65.2% male; 69.6% dominant-arm surgery), including 5 (21.7%) anterior labral repairs, 1 (4.3%) posterior labral repair, and 17 (74.0%) combined anterior-posterior labral repairs. At 1 year, 17 athletes (73.9%) returned to their primary sport. Six-month SIRSI scores demonstrated moderate positive correlations with 1-year American Shoulder and Elbow Surgeons score (ρ = 0.42) and Tegner score (ρ = 0.51). Athletes who returned to their primary sport had higher median 6-month SIRSI scores (78.3) as compared with those who did not (46.7; P = .006). Improvements were observed across all PROMs from 6 months to 1 year.

Six-month SIRSI scores are associated with 1-year functional outcomes and RTS success in adolescent athletes after shoulder stabilization surgery. Incorporating SIRSI into routine 6-month postoperative assessment may help identify athletes whose recovery-related confidence and readiness to RTS lag postoperative milestones, particularly in the context of limitations such as weakness, stiffness, or pain. Future research should stratify by surgical technique, sex, and other variables to better understand individualized recovery patterns and explore interventions that target psychological as well as physical readiness.