Ill-defined Return-to-Sport Criteria and Inconsistent Unsuccessful Return Rates Caused by Various Reasons Not Necessarily Related to Treatment After Superior Labral Treatments: A Systematic Review.

Igor J Shirinskiy Cain Rutgers Inger N Sierevelt Simone Priester-Vink David Ring Michel Pj van den Bekerom Lukas Pe Verweij

Arthroscopy

Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands.

Published: October 2024

The systematic review aimed to identify criteria for determining return to sport (RTS) following treatments for superior labral pathophysiology, analyze how many patients fail to return to sport, and evaluate reasons for not returning.
A review across 5 databases included 45 studies with 1857 patients, revealing that the majority of studies did not provide RTS criteria and showed significant variability in the rates of patients unable to return to sport (nRTS) or return to pre-injury levels (nRTPL).
Reasons for not returning to sport involved a mix of physical issues (like pain and instability), psychological concerns (such as fear of re-injury), personal factors (like lifestyle changes), and other injuries.

Purpose: To determine (1) which criteria are used to determine return to sport (RTS), (2) the number of patients who are unable to RTS after any superior labral pathophysiology treatment, and (3) which reasons are reported for not returning.

Methods: A systematic review was performed across 5 databases, including studies that report rates for RTS after any treatment of superior labral pathophysiology. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Definitions for no return to sport (nRTS) were extracted as reported in the studies. The ranges of nRTS and no return to preinjury level (nRTPL) were summarized. Reasons for nRTS and nRTPL were categorized using a predefined coding scheme.

Results: Among 45 studies with level of evidence ranging from II to IV, 1,857 patients were involved in sports, 78% (n = 1453) of whom underwent superior labral reattachment, 21% (n = 381) biceps tenodesis, and 9.4% (n = 175) nonoperative treatment. None of the studies provided criteria for RTS, and 2 studies provided criteria for return to preinjury level. The ranges of nRTS and nRTPL varied after superior labral reattachment (0-60%, n = 206; 0-89%, n = 424, respectively), biceps tenodesis (0-25%, n = 43; 3, 8%-48%, n = 78), and nonoperative treatment (11%-75%, n = 62; 18%-100%, n = 78). Reasons for nRTS and nRTPL were related to physical sensations (pain, feeling of instability, discomfort, weakness, lack of motion), psychological factors (fear of reinjury, lack of confidence), personal factors (lifestyle change, social reasons), and injury at another site.

Conclusions: Criteria for determining successful RTS and return to preinjury level after superior labral pathophysiology treatment were not reported by most studies. The nRTS and nRTPL rates varied greatly within and between treatments. The reasons for this unsuccessful return were diverse and related to physical sensations, psychological factors, personal factors, and injury unrelated to treatment.

Level Of Evidence: Level IV, Systematic review of Level II-IV studies.

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http://dx.doi.org/10.1016/j.arthro.2024.09.053	DOI Listing

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