27. OVERTIME: Return to Play Following Bankart Repair

We’re excited to be in the studio today recording this episode on returning to play after arthroscopic stabilization for anterior shoulder instability. Now, we did a whole episode on shoulder instability back in March of 2021 with Dr. Mark Price – shoulder surgeon at Massachusetts General Hospital and team physician for the New England Patriots.

We discussed a lot on that two-part episode, including anterior and posterior instability, nonoperative and surgical treatment, and different surgical approaches including arthroscopic versus open Bankart repair and bone block procedures. It was a great discussion, and we definitely recommend checking it out if you haven’t listened to it already.

But today we’re narrowing our focus to post-op rehab and return to play testing after arthroscopic anterior shoulder stabilization. We’ve spoken about return to play testing a lot on previous episodes. We even did an entire episode with Dr. Robin West – team physician for the Washington Nationals and the Washington Commanders – dedicated to this very topic: returning athletes to play after various orthopedic injuries. In that episode we highlighted that there is often little to no data to guide safe return to sport after an orthopedic injury, particularly those treated surgically.

That is also case for athletes who undergo surgery for anterior shoulder instability. On today’s episode, we’re going to review an article titled “Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability” published in the December 2021 issue of Sports Health. In this case series, Dr. Brian Busconi and colleagues at UMass evaluated 62 athletes who underwent arthroscopic Bankart repair and were subsequently cleared to return to sports using both functional and psychological testing.

Before we dive into the results of this paper, it is worthwhile to review the traditional methods of clearing athletes after Bankart repair as there is currently no validated return to sport assessment for this particular surgery. Ciccotti and colleagues performed a systematic review of 58 studies assessing return to play criteria in a 2018 article published in Arthroscopy. Unsurprisingly, the most common criterion used to clear an athlete after arthroscopic Bankart repair was time. 75% of studies used time from surgery as the sole criterion, with the most commonly used time point being 6 months post-op. 19% used strength and 14% used range of motion. Only 1 of the studies evaluated proprioceptive control as a metric for guiding return to play.