Abstract
Objectives:
There is a paucity of literature on return to sport functional testing following arthroscopic labral repair for shoulder instability leading to uncertainty of when it is safe to return to sport. Currently, the most commonly used evaluation metrics are time after surgery and less commonly range of motion and strength of operative extremity. There is currently no validated return to sport testing protocol after arthroscopic labral repair. The aim of this study was to compare elements of a proposed return to sport battery for those undergoing arthroscopic Bankart repair between those able to return to play and those who were not able to by 6 months.
Methods:
All patients who participated in athletics who underwent arthroscopic labral repair for shoulder instability from June 2021 to December 2022 with a fellowship trained orthopedic surgeon were eligible to participate. Study protocol was to undergo functional testing at 4 months post operatively and every 2 months thereafter until cleared for athletics. Functional testing included Closed Kinetic Chain Upper Extremity Stability Test (CKCUES), Posterior Shoulder Endurance Test (PSET), Strength via handheld dynamometry at various range of motion positions. The Athletic Shoulder Test (ASH) has two components- peak force in I, T, Y position (PEAK), and rate of force development in I, T, Y position (RATE). Absolute value as well as limb symmetry index (LSI) were compared. For each test, passing was determined to be greater than 90% symmetry with contralateral extremity. Tests that had a greater than 20% difference in pass rates between the not return to play group (NRTP) and the return to play (RTP) groups were considered to be predictive.
Results:
Overall, 22 patients with at least 6 months of follow up, completed functional testing battery, and cleared to return to play were included. Mean age was 19.8 years (range 11-44 years), with 12 males and 10 females, and the mean follow up was 11 months (6-24 months). Seventeen returned to play (RTP) at mean 6.3 months (range 4.5-23.1), five did not to return (NRTP). Mean SANE score was higher in RTP vs NRTP, 61 (range 25-95) vs 86.7 (60-100), p=0.03). Those that returned to sport met a mean of 6.25 of the 12 criteria at 4 months compared to 4.20 of those that did not return to sport (p-value = .22).
At 4 months, RTP group passed several tests at higher rates than NRTP group - CKCUES (78% vs 0%), PEAK (62.5% vs 20%), RATE (50% vs 0%), and Shoulder Flexion strength (88.9% vs 50%). Other strength measurements were not significantly different between groups.
Conclusions:
CKCUES and ASH (PEAK and RATE) performance testing criteria were significantly higher at 4 months in patients who are able to eventually be cleared to return to sport compared to those that are not able to. Traditional strength testing did not demonstrate differences between groups.
Therefore, we recommend that CKCUES testing and ASH testing with force plates should be incorporated in functional testing as early as 4 months.