Criteria-based return to sport testing is associated with lower recurrence rates following arthroscopic Bankart repair

The verdict

After shoulder stabilization surgery (arthroscopic Bankart repair), does passing an objective return-to-sport test before going back to sports lower the chance the shoulder dislocates again?

Athletes cleared to return to sport using an objective criteria-based testing protocol had a much lower re-dislocation rate (5%) than those cleared simply by time since surgery (22%). This comes from a single small retrospective study with historical controls, so it suggests but does not prove the benefit.

SupportsRead paper

Primary study72 ParticipantsLimited evidence

Key points

Recurrent instability was 5% (2 of 36) in the tested group vs 22% (8 of 36) in the time-based control group.
Athletes who skipped testing had a 4.85 times higher likelihood of recurrence.
At 6 months, 83.8% of tested athletes failed at least one test component and were not yet ready to return.
Testing covered isokinetic and isometric strength plus functional tasks, with a goal of 90% of the uninjured side.
Both groups were demographically similar in age, sex, hand dominance, and contact-sport participation.

How it was conducted

Design: Retrospective case-control study with minimum 1-year follow-up; Level III evidence
Participants: 36 high school and collegiate athletes who had primary arthroscopic anterior labral (Bankart) repair from 2016 to 2018 and completed testing
Control group: 36 historical patients with arthroscopic Bankart repair from 2014 to 2015 cleared by physical exam and time (usually 5-6 months), no testing
Intervention: Criteria-based return-to-sport testing at 6 months: isokinetic and isometric internal and external rotation, endurance test, closed kinetic chain (CKCUES) test, and unilateral seated shot put, goal 90% of the contralateral side
Primary outcome: Recurrence, defined as dislocation or subluxation symptoms requiring revision surgery
Exclusions: Glenoid bone loss >13.5%, joint hyperlaxity (Beighton score 4 or more), off-track Hill-Sachs lesions, rotator cuff tear needing repair, or prior shoulder surgery

What they found

Recurrence was 5% (2 of 36) in the testing group vs 22% (8 of 36) in the control group; odds ratio 4.85; P = .04.
Time from surgery to recurrence did not differ between groups (12 months vs 13.6 months, P = .43).
Only 6 of 36 (16.6%) tested athletes passed fully and returned at 6 months; 28 of 36 (77.7%) returned at 7 months after more rehab; 2 of 36 (5.55%) returned at 8 months.
Only 6 of 32 (16.2%) passed all isokinetic tests at 6 months.
Functional pass rates were 26 of 35 (70.3%) for the CKCUE test and 32 of 34 (86.5%) for the shot put test.
Groups did not differ in age (P = .15), male sex 83% vs 64% (P = .11), dominant-side involvement 52% vs 60% (P = .56), or contact-sport participation (P = .78).

Limitations

Retrospective design that compares against historical controls treated in an earlier era.
Small sample (36 per group) and few recurrence events, so estimates are imprecise.
Rehabilitation compliance could not be determined.
Patient-reported outcomes and rates of return to pre-injury play levels were not available.

Why it matters

For patients: If you have had a Bankart repair, passing an objective strength and function test before returning to sport may lower your chance of dislocating again, even if it means waiting a bit longer.
For clinicians: Consider using criteria-based return-to-sport testing rather than time alone to clear athletes after arthroscopic Bankart repair, especially for higher-risk sports.
For readers: This single small retrospective study links objective return-to-sport testing to far fewer recurrences, a promising signal that needs confirmation in larger prospective trials.

Source

doi:10.1016/j.jse.2021.03.141

Read the original paper

Clinically assessing this area? See the shoulder special tests.