Return to play following operative management of anterior shoulder instability in overhead athletes

Abstract

Background

The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability.

Methods

A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure.

Results

There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play.

Discussion

Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.

Keywords

shoulder instability overhead athlete Bankart Latarjet Remplissage

Introduction

Traumatic anterior shoulder instability is a common injury among young, athletic populations with risk being greatest among males and athletes involved in collision sports. The incidence of anterior shoulder instability in the general population is estimated to be 1% to 2%,^1,2 but in a collegiate athletic population it was estimated to be as high as 0.12 per 1,000 athlete exposures.³ Operative management has been shown to not only reduce the rate of recurrent instability,^4,5 but also result in subsequently higher rates of return to play (RTP) among athletic populations.^6,7

In overhead athletes, surgical management of anterior shoulder instability may result in a loss of external rotation, which may limit the athlete's ability to RTP at their pre-injury level⁸; therefore, special attention needs to be placed in the management of this specific population. There are multiple operative treatment options for anterior shoulder instability, including arthroscopic Bankart repair, the Latarjet procedure, and the Remplissage procedure, with each having their own relative indications based on the type of defect or lesion and potential advantages and disadvantages.^2,9–13 Even though RTP after shoulder instability surgery has been thoroughly studied among other high-shoulder-demanding populations, such as collision athletes, RTP outcomes in overhead athletes are lacking. As such, despite RTP being a critical gauge for postoperative success in athletes, to date, there is a need for studies to systematically evaluate rates and times of RTP after shoulder instability surgery in overhead athletes.

The purpose of this study was to systematically review the rate and timing of RTP in overhead athletes following operative management of anterior shoulder instability. Our hypothesis was that there would be a low rate of RTP among overhead athletes due to potential decrease in range of shoulder motion following operative management of anterior shoulder instability.

Methods

Study selection

The literature search was performed by two authors (K.L. and M.B.), who used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and reviewed the search results; a senior author (E.H.) arbitrated on any disagreement. The titles and abstracts identified in the search were screened, and potentially eligible studies received a full-text review.

Search strategy

The following search terms were used in PubMed, and EMBASE databases in August 2022 as the search algorithm: (Bankart or Latarjet or Remplissage) and (overhead or athlete or sport or return to sport [RTS] or play or RTP). No time limit was given to publication date.

Eligibility criteria

The inclusion criteria were the following: (1) clinical study on athletes, amateurs and professionals, participating in overhead sports, such as baseball, basketball, football, volleyball, handball, badminton, tennis, softball, weightlifting, judo, swimming, and rock climbing, (2) reported on RTP, ((3) operative management of anterior shoulder instability, including both primary and revision stabilization, (4) published in a peer-reviewed journal, and 5) published in English. The exclusion criteria were the following: (1) review studies, (2) cadaveric studies, (3) biomechanical studies, (4) case reports, and (5) abstract only.

Data extraction and analysis

The relevant information regarding the study characteristics, including the study design, the level of evidence (LOE), the methodological quality of evidence (MQOE), the population, clinical outcome measures, and the follow-up time points, was collected by two blinded reviewers (K.L. and M.B.) using a predetermined data sheet, with the results compared by a third independent reviewer (E.H.). The LOE was evaluated based on the guidelines by the Oxford Centre for Evidence-Based Medicine.¹⁴ The MQOE was evaluated by use of a modified Coleman methodology score.¹⁵ Studies were considered excellent quality if they scored 85–100, good quality if they scored 70–84, fair quality if they scored 55–69, and poor quality if they scored less than 55. The criteria for quality of RTP were based on the previously published criteria of Zaman et al.¹⁶ These criteria consisted of RTP timeline, conditional criteria, measurement of conditional criteria, and rehabilitation protocol. A score of 4 indicated well-defined RTP criteria, a score of 1–3 indicated poorly defined criteria, and a score of 0 indicated no criteria. Clinical outcomes extracted and analyzed were (1) overall rate of RTP and return to previous levels among overhead athletes; (2) time of RTP; (3) sports-specific RTP; (4) RTP criteria; and (5) recurrent instability; defined as subluxation or dislocation after stabilization.

Statistics

Quantitative statistical analysis was performed by use of Microsoft Excel.

Results

Literature search

The initial literature search resulted in 2222 total studies. After removal of duplicates, the articles were screened for inclusion and exclusion criteria, and 1652 unique studies were evaluated, and full texts were assessed for eligibility. This review included 23 clinical studies (Figure 1).

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study selection flow diagram.

Study characteristics and patient demographics

Our review found 23 studies including 961 patients that met our inclusion criteria. The mean MQOE of the studies was 68, which is the top end of fair quality evidence. Out of the studies that reported sex demographics for overhead sports most patients were male (86.1%), with a mean age of 25.1 years and a mean follow-up of 42.7 months. The study characteristics and patient demographics are shown in Table 1.

Table 1.

Study demographics.

Author	Year	No. of patients	LOE	MQOE	RTPQ	Male	Age (yrs)	Follow-up (mo)	Procedure	Sport
Beranger	2016	17	IV	75 (good)	1	17	27.9	46.8	Bristow–Latarjet	Not specified
Bohu	2021	173	IV	62 (fair)	4	NR	26.8	8	Latarjet	Not specified
Boileau	2012	9	IV	70 (good)	3	NR	29	24	Remplissage	Not specified
Buckup	2020	7	IV	76 (good)	2	NR	24.5	27.8	Latarjet	Soccer, volleyball, handball
Cavalier	2021	17	IV	60 (fair)	3	NR	30	48	Remplissage	Not specified
Clesham	2019	37	IV	66 (fair)	3	NR	26.28	60.48	Bankart	Gaelic football and hurling
Davey	2022	200	III	48 (poor)	3	194	23.9	50.4	Bankart, Latarjet	Gaelic football and hurling
Feng	2021	35	III	62 (fair)	2	35	26.3	67.2	Bankart, Remplissage	Not specified
Garcia	2016	46	IV	74 (good)	2	NR	29.8	60.7	Remplissage	volleyball, basketball, baseball, football, swimming, rock climbing
Gerometta	2014	20	IV	61 (fair)	1	NR	28.9	24.4	Bankart	Not specified
Gowd	2021	28	IV	66 (fair)	2	NR	26.7	53.8	Latarjet	Not specified
Harada	2021	24	IV	63 (fair)	2	13	17.6	39.7	Bankart	Baseball, softball, handball, badminton, volleyball, and tennis
Ide	2004	25	II	88 (excellent)	2	NR	19.5	42	Bankart	Baseball, softball, handball, volleyball, basketball, badminton, goalkeeping
Lima	2022	11	IV	64 (fair)	1	0	29.23	36	Latarjet	Volleyball, basketball, handball, judo, or weight training
Neviaser	2017	29	IV	75 (good)	2	29	31	17.1	Bankart	Not specified
Park	2018	51	IV	63 (fair)	2	51	20.9	24	Bankart	Baseball
Pavlik	1996	19	IV	71 (good)	2	NR	23.3	14.2	Bankart	Handball, basketball, waterpolo, baseball, weight lifting
Pavlik	2021	47	IV	74 (good)	2	24	21.6	52.2	Bankart	Handball
Perret	2021	32	III	36 (poor)	4	29	23.5	NR	Latarjet	Australian football
Ranalletta	2018	9	IV	85 (excellent)	4	9	26.8	44	Latarjet	Not specified
Rossi	2020	62	IV	83 (good)	4	41	21.2	66.7	Bankart	Handball and basketball
Rossi	2020	30	III	76 (good)	4	NR	26.5	40.3	Latarjet	Not specified
Saper	2022	33	IV	66 (fair)	3	33	23.8	75.6	Bankart	Football

LOE, level of evidence; MQOE, methodological quality of evidence; RTPQ, return to play quality; mo, months; N/R, not reported; yrs, years.

Arthroscopic Bankart repair

Among those undergoing arthroscopic Bankart repair, the rate of RTP was 85.5%, with 70.6% returning to the same level of play. Furthermore, the mean time to RTP was 7.1 months. Recurrent instability occurred in 5.8% of athletes.^8,17–27

Open Latarjet procedure

Among those undergoing an open Latarjet procedure, the rate of RTP was 80.9%, with 77.7% returning to the same level of play. Furthermore, the mean time to RTP was 5.1 months. Recurrent instability occurred in 4.4% of athletes.^25,28–35

Remplissage procedure

Among those undergoing a Remplissage procedure, the rate of RTP was 70.6% with 70% returning to the same level of play. No studies reported on the mean time of RTP for a Remplissage procedure. One study reported recurrent instability in one athlete after stabilization.^23,36–38

RTP is shown in Table 2. Recurrent instability is shown in Table 3.

Table 2.

Return to play.

Outcome	Studies	Result (N)
Bankart RTP	11	86.2% (381/442)
Bankart RTP at same/higher level	10	70.6% (276/391)
Latarjet RTP	9	80.9% (327/404)
Latarjet RTP at same/higher level	4	77.7% (122/157)
Remplissage RTP	4	70.6% (60/85)
Remplissage RTP at same/higher level	2	70.0% (21/30)

RTP, return to play for overhead athletes.

Sports-specific return to play

Analysis of sports-specific RTP demonstrated that majority of athletes were able to return to their sport and return at a similar or higher level. Athletes participating in swimming, judo, or weight training had the greatest rate of RTP, 100%, while rock climbers had the lowest, 50%.^34,36 However, 100% of the volleyball players that returned to play were able to return at the same or higher level of intensity alongside athletes participating in weight training and judo.^8,34,36 Tennis and softball had the lowest rate of return to pre-injury level, 50%.⁸ Sports-specific RTP is shown in Table 4.

Table 4.

Sports-specific return to play.

Sport	Studies	RTP (%)	Studies	RTP at same/higher level (%)
Baseball	2	78.9 (45/57)	2	76.7 (46/60)
Basketball	3	83.3 (40/48)	2	78.1 (25/32)
Football	2	85 (34/40)	1	87.5 (28/32)
Gaelic football and hurling	2	88.3 (204/231)	2	75.3 (174/231)
Volleyball	4	88.9 (8/9)	2	100 (4/4)
Handball	4	86 (74/86)	4	67.5 (56/83)
Weight training	1	100 (4/4)	1	100 (4/4)
Judo	1	100 (1/1)	1	100 (1/1)
Australian football	1	96.9 (31/32)	1	96.9 (31/32)
Swimming	1	100 (8/8)	0	NR
Rock climbing	1	50 (2/4)	0	NR
Softball	0	NR	1	50 (2/4)
Badminton	0	NR	1	80 (4/5)
Tennis	0	NR	1	50 (1/2)

RTP: return to play.

Return to play criteria

The overall RTP criteria were reported in the majority of the studies (100%); time to RTS was the most commonly reported item (100%). A wide discrepancy was found in reported time of return, ranging from 3 to 11 months, with 4 months being the most commonly used time point (65.2%). Other criteria, including computed tomography imaging to assess bone union (4.3%), clinical examination or decision (8.7%), strength (13.0%), pain (21.7%), and range of motion (17.4%), were less commonly reported. The mean score for quality of RTP criteria was 2.5 (range, 1–4) (Table 5).

Table 5.

RTP criteria.

Criteria	n (%)
Overall	23 (100.0)
Time	23 (100.0)
Imaging	1 (4.3)
Clinical exam/decision	2 (8.7)
Strength	3 (13.0)
Pain	5 (21.7)
Full ROM	4 (17.4)

ROM, range of motion.

Discussion

The most important finding from the current study was that there were high rates of RTP following operative management of anterior shoulder instability in overhead athletes. Second, there was a drop off in the rate of athletes that were able to RTP at their previous competitive level. Third, there was a high variability in the RTP outcomes. Fourth, there was a low rate of recurrent instability after operative management in this population (Table 3). Finally, even though this systematic review provides important insights regarding RTP outcomes following shoulder instability surgery, it also highlights the lack of literature on overhead athletes following anterior shoulder instability surgery.

Table 3.

Recurrent instability.

Outcome	Studies	Percentage (N)
Bankart recurrence	9	5.8% (23/396)
Latarjet recurrence	7	4.4% (17/389)
Remplissage recurrence	1	11.1% (1/9)

RTP is often an athlete's primary concern with anterior shoulder instability. Indeed, Hurley et al.³⁹ found that the biggest predictor of satisfaction at 5-year post-surgical intervention was the ability to RTP. Overall, we found high rates of return to sports irrespective of surgical technique ranging from 70% to 86% with mean times of RTP of 5 to 7 months. We hypothesized low rates of RTP due to possible loss of external rotation after surgical management. However, our findings suggest that overhead athletes are still able to RTP at high rates indicating that loss of motion may not be clinically significant for all overhead athletes. Moreover, RTP to pre-injury levels rates were 71% for arthroscopic Bankart repair and 77% for Latarjet procedure. This is consistent with previous reports, in a systematic review Hurley et al.⁴⁰ analyzed RTP outcomes following Latarjet procedure finding an overall RTP rate of 90% and a return to the same level of play of 81% in overhead athletes with a mean time to return to sports of 6 months. These findings suggest that not all athletes may be able to RTP at their pre-injury level or at all; therefore, patient expectations should be set when they are having their pre-operative counseling.

Moreover, we found a wide variation in RTP and return to same level rates following shoulder instability surgery. Several factors have been shown to influence the ability to RTS following shoulder instability surgery. First, it is still unclear how and when to clear an athlete to safely return to sports among studies. Indeed, previous studies have emphasized the necessity of specific criteria for the RTP. Ciccoti et al.⁴¹ systematically evaluated the criteria for RTS after surgical stabilization of anterior shoulder instability, identifying 13 different combinations of criteria for returning to sports, which highlights the lack of consensus among experts regarding this topic. Therefore, further validation of criteria in overhead athletes may thus be useful to optimize outcomes in these patients.

Second, psychological factors have been shown to play an important role in return to sports following shoulder instability surgery.^42–44 Indeed, Rossi et al.⁴² and Hurley et al.^45,46 evaluated athletes who failed to RTP after the Latarjet procedure and arthroscopic Bankart repair, finding that psychological readiness to RTP was predictive of an athlete’s ability to return to sports and return to the same level of play.

Third, the type of sport, type of athlete, and position of play may have a significant impact on RTP outcomes. In our analysis of sports-specific RTP, the percentage of athletes who were able to RTP at the same level ranged from 50% to 100%, the lowest being handball and the greatest being volleyball, weight training, and judo; although only one patient participated in judo. These findings are consistent with Rossi et al.⁴² finding a lower rate of return to pre-injury level in contact sports that posed a high demand on the shoulder due to repetitive trauma from contact with another competitor or the floor (martial arts) as opposed to a higher rate of return to pre-injury level in sports that did not require as great of a demand on the shoulder. There are also differences in RTP based upon position of play. For instance, Park et al.¹⁸ analyzed RTP outcomes in elite professional baseball players finding high rates RTP and levels of play of 82% and 80%, respectively. However, these values varied significantly among positions pitchers, catchers, and field positions, with pitchers showing lower rates of RTP and a higher rehabilitation time period. Similarly, Lu et al.⁴⁷ analyzed national Basketball Association players who sustained a shoulder instability event, showing that 100% of athletes RTP after shoulder instability surgery. The purpose of this observation is to emphasize the importance of clearly distinguishing amateur and professional athletes and playing positions before undergoing surgery to provide them with specific and appropriate counseling.

We also considered if outcomes differed between patients undergoing primary surgery as compared to those undergoing revisions. Although several of the studies included both groups, only two studies^28,30 compared outcomes between these two patient populations. Neither of which found a statistically significant difference in rate of RTP nor time to RTP between patients receiving primary or revision surgery.

Moreover, one of the main challenges in returning overhead athletes to play is restoration of range of motion necessary to perform the sport-specific tasks, which may itself be impacted by the initial instability event. Following this, operative intervention may further cause a restriction in range of motion. While a randomized controlled trial found arthroscopic Bankart repair resulted in worse abducted external range of motion than non-operative management, this is the most anatomic procedure and may result in improved motion compared to the Latarjet procedure and Remplissage. There is a concern in performing a Latarjet procedure as it is non-anatomic and may limit range of motion or have negative implications for throwing mechanics in this population.⁴⁸ Furthermore, performing a subscapularis tenotomy as opposed to a subscapularis split approach may result in worse range of motion and strength, and is thus inadvisable in this group.⁴⁹ Finally, with the Remplissage procedure, the infill with the infraspinatus has been shown to result in loss of external rotation which can impact throwing. However, this can be minimized by placing the anchor in the safe zone at least 1 cm lateral and no greater than 3 cm distal to the acromion, and avoiding over medialization.⁵⁰ Therefore, future biomechanical and clinical studies are needed to ascertain how the various operative techniques impact throwing motions or the sport-specific overhead abilities.

Limitations

This study has some limitations. Most of the studies in the analysis were retrospective, and thus all the limitations of these studies apply. Additionally, due to lack of controls it was not possible to perform a meta-analysis of the outcomes and compare rates of RTP among the various procedures. Additionally, due to report inconsistencies in the included studies, it was not possible to analyze potential risk factors that may account for inability to RTP. Finally, majority of the studies did not provide sports-specific data; thus, our analysis of sports-specific RTP was limited.

Conclusion

Overall, there were high rates of RTP following operative management of anterior shoulder instability in overhead athletes. Further studies evaluating RTP outcomes while accounting for sources of variation such as RTP criteria, type of sport, type of athlete, and type of surgery are still needed.

Footnotes

Author contributorship

KL and MB independently conducted the title and abstract and full-text review. They also were responsible for data collection and drafted the manuscript. Any disagreements were arbitrated by EH, who also created the study idea, participated in its design, and assisted in drafting the manuscript. JL, IP, SF, OA, and CK critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Not applicable.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed consent

Not applicable.

ORCID iDs

Eoghan T Hurley

Kiera Lunn

Ignacio Pasqualini

References

Varacallo

Musto

Mair

. Anterior shoulder instability. Treasure Island (FL), StatPearls. 2023.

Abdul-Rassoul

Galvin

Curry

, et al. Return to sport after surgical treatment for anterior shoulder instability: a systematic review. Am J Sports Med 2019; 47: 1507–1515.

Owens

Agel

Mountcastle

, et al. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med 2009; 37: 1750–1754.

Brophy

Marx

. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 2009; 25: 298–304.

Galvin

Ernat

Waterman

, et al. The epidemiology and natural history of anterior shoulder instability. Curr Rev Musculoskelet Med 2017; 10: 411–424.

Zaremski

Galloza

Sepulveda

, et al. Recurrence and return to play after shoulder instability events in young and adolescent athletes: a systematic review and meta-analysis. Br J Sports Med 2017; 51: 177–184.

Hurley

Manjunath

Bloom

, et al. Arthroscopic Bankart repair versus conservative management for first-time traumatic anterior shoulder instability: a systematic review and meta-analysis. Arthroscopy 2020; 36: 2526–2532.

Harada

Iwahori

Kajita

, et al. Return to sports after arthroscopic Bankart repair on the dominant shoulder in overhead athletes. J Orthop Sci 2022; 27: 1240–1245.

Memon

Kay

Cadet

, et al. Return to sport following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg 2018; 27: 1342–1347.

10.

Polio

Brolin

. Remplissage for anterior shoulder instability: history, indications, and outcomes. Orthop Clin North Am 2022; 53: 327–338.

11.

Cerciello

Corona

Morris

, et al. Early outcomes and perioperative complications of the arthroscopic Latarjet procedure: systematic review and meta-analysis. Am J Sports Med 2019; 47: 2232–2241.

12.

Hurley

Matache

Wong

, et al. Anterior shoulder instability Part I-Diagnosis, nonoperative management, and Bankart repair-an international consensus statement. Arthroscopy 2022; 38: 214–223.e7.

13.

Hurley

Matache

Wong

, et al. Anterior shoulder instability Part II-Latarjet, remplissage, and glenoid bone-grafting, an international consensus statement. Arthroscopy 2022; 38: 224–233.e6.

14.

Group*. OLoEW. The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine.

15.

Coleman

Khan

Maffulli

, et al. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 2000; 10: 2–11.

16.

Zaman

White

Shi

, et al. Return-to-play guidelines after medial patellofemoral ligament surgery for recurrent patellar instability: a systematic review. Am J Sports Med 2018; 46: 2530–2539.

17.

Clesham

Shannon

. Arthroscopic anterior shoulder stabilisation in overhead sport athletes: 5-year follow-up. Ir J Med Sci 2019; 188: 1233–1237.

18.

Park

Lee

, et al. Return to play after arthroscopic treatment for shoulder instability in elite and professional baseball players. J Shoulder Elbow Surg 2019; 28: 77–81.

19.

Saper

Courson

Milchteim

, et al. Successful outcomes and return to sport after arthroscopic Bankart repair in National Collegiate Athletic Association and National Football League Football Players. Clin J Sport Med 2022; 32: e288–e292.

20.

Pavlik

Csepai

Hidas

, et al. Sports ability after Bankart procedure in professional athletes. Knee Surg Sports Traumatol Arthrosc 1996; 4: 116–120.

21.

Ide

Maeda

Takagi

. Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 2004; 32: 1899–1905.

22.

Neviaser

Benke

Neviaser

. Mid-term to long-term outcome of the open Bankart repair for recurrent traumatic anterior dislocation of the shoulder. J Shoulder Elbow Surg 2017; 26: 1943–1947.

23.

Feng

Chen

, et al. Patient outcomes and fear of returning to sports after arthroscopic Bankart repair with remplissage. Orthop J Sports Med 2021; 9: 23259671211001775.

24.

Gerometta

Rosso

Klouche

, et al. Arthroscopic Bankart shoulder stabilization in athletes: return to sports and functional outcomes. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1877–1883.

25.

Davey

Hurley

Mullett

. Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability. JSES Int 2022; 6: 259–263.

26.

Pavlik

Tatrai

, et al. Outcomes after arthroscopic anterior shoulder stabilization in professional handball players. Orthop J Sports Med 2021; 9: 23259671211011614.

27.

Rossi

Tanoira

Gorodischer

, et al. High variability in functional outcomes and recurrences between contact sports after arthroscopic Bankart repair: a comparative study of 351 patients with a minimum 3-year follow-up. Arthrosc Sports Med Rehabil 2020; 2: e575–e581.

28.

Gowd

Liu

Polce

, et al. Return to sport following Latarjet glenoid reconstruction for anterior shoulder instability. J Shoulder Elbow Surg 2021; 30: 2549–2559.

29.

Bohu

Abadie

van Rooij

, et al. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2606–2615.

30.

Buckup

Sternberg

Smolen

, et al. Functional outcome and return to sports after the arthroscopic Latarjet procedure in young and physically active patients. Arch Orthop Trauma Surg 2020; 140: 1487–1494.

31.

Beranger

Klouche

Bauer

, et al. Anterior shoulder stabilization by Bristow-Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up. Eur J Orthop Surg Traumatol 2016; 26: 277–282.

32.

Perret

Warby

Brais

, et al. Return to professional Australian rules football after surgery for traumatic anterior shoulder instability. Am J Sports Med 2021; 49: 3066–3075.

33.

Ranalletta

Rossi

Bertona

, et al. Modified Latarjet procedure without capsulolabral repair for the treatment of failed previous operative stabilizations in athletes. Arthroscopy 2018; 34: 1421–1427.

34.

Lima

EBS

Oses

de Godoy

, et al. Evaluation of Latarjet procedure in female athletes: a 3-year follow-up prospective cohort study. JSES Int 2022; 6: 343–348.

35.

Rossi

Tanoira

Gorodischer

, et al. Similar results in return to sports, recurrences, and healing rates between the classic and congruent-arc Latarjet for athletes with recurrent glenohumeral instability and a failed stabilization. Arthroscopy 2020; 36: 2367–2376.

36.

Garcia

Liu

, et al. Outcomes of the remplissage procedure and its effects on return to sports: average 5-year follow-up. Am J Sports Med 2016; 44: 1124–1130.

37.

Boileau

O'Shea

Vargas

, et al. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg 2012; 94: 618–626.

38.

Cavalier

Johnston

Tran

, et al. Glenoid erosion is a risk factor for recurrent instability after Hill-Sachs remplissage. Bone Joint J 2021; 103-B: 718–724.

39.

Hurley

Davey

Mojica

, et al. Evaluation of factors associated with successful 5-year outcomes following arthroscopic Bankart repair in athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30: 2092–2098.

40.

Hurley

Montgomery

Jamal

, et al. Return to play after the Latarjet procedure for anterior shoulder instability: a systematic review. Am J Sports Med 2019; 47: 3002–3008.

41.

Ciccotti

Syed

Hoffman

, et al. Return to play criteria following surgical stabilization for traumatic anterior shoulder instability: a systematic review. Arthroscopy 2018; 34: 903–913.

42.

Rossi

Pasqualini

Brandariz

, et al. Relationship of the SIRSI score to return to sports after surgical stabilization of glenohumeral instability. Am J Sports Med 2022; 50: 3318–3325.

43.

Pasqualini

Rossi

Brandariz

, et al. The Short, 5-Item Shoulder Instability-Return to Sport after Injury (SIRSI) score performs as well as the longer version in predicting psychological readiness to return to sport. Arthroscopy 2023; 39: 1131–1138.e1.

44.

Matache

Hurley

Wong

, et al. Anterior shoulder instability Part III-revision surgery, rehabilitation and return to play, and clinical follow-up, an international consensus statement. Arthroscopy 2022; 38: 234–242.e6.

45.

Hurley

Davey

Montgomery

, et al. Analysis of athletes who did not return to play after open Latarjet. Orthop J Sports Med 2022; 10: 23259671211071082.

46.

Hurley

Davey

Mojica

, et al. Analysis of patients unable to return to play following arthroscopic Bankart repair. Surgeon 2022; 20: e158–e162.

47.

Okoroha

Patel

, et al. Return to play and performance after shoulder instability in National Basketball Association athletes. J Shoulder Elbow Surg 2020; 29: 50–57.

48.

Sinha

Kar

Naik

, et al. Decreased motion with normal strength after Latarjet procedure has minimal impact on return to activity. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2579–2586.

49.

Davey

Hurley

, et al. Subscapularis management during open Latarjet procedure: does subscapularis split versus tenotomy matter? A systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31: 2169–2175.

50.

Garcia

Degen

Liu

, et al. The “safe zone” technique improves suture placement and accuracy during arthroscopic remplissage. Orthopedics 2017; 40: e598–e603.

Return to play following operative management of anterior shoulder instability in overhead athletes—A systematic review

Abstract

Background

Methods

Results

Discussion

Keywords

Introduction

Methods

Study selection

Search strategy

Eligibility criteria

Data extraction and analysis

Statistics

Results

Literature search

Study characteristics and patient demographics

Arthroscopic Bankart repair

Open Latarjet procedure

Remplissage procedure

Sports-specific return to play

Return to play criteria

Discussion

Limitations

Conclusion

Footnotes

Author contributorship

Declaration of conflicting interests

Ethical approval

Funding

Informed consent

ORCID iDs

References