1Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
2Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
3Department of Orthopaedic and Traumatology, Gatam Institute Eka Hospital, BSD, Indonesia
*Corresponding author: Erica Kholinne,
Gatam Institute, Eka Hospital, Faculty of Medicine, Universitas Trisakti, Jl.
Kyai Tapa No.1, Jakarta 11440, Indonesia, E-mail:
erica@trisakti.ac.id
• Received: February 19, 2024 • Revised: April 7, 2024 • Accepted: April 11, 2024
This is an Open-Access article distributed under the terms of the
Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits
unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
A Bankart lesion is a tear of the labrum, the ring of cartilage that encircles
the shoulder joint socket, that can occur when the shoulder is dislocated. This
injury frequently affects young athletes and is associated with shoulder
instability. This review was performed to provide an overview of anterior
shoulder instability, with an emphasis on rehabilitation and the return to
sports following arthroscopic Bankart repair. We searched the Google Scholar and
PubMed academic databases through February 18th, 2024, utilizing keywords
including “arthroscopic Bankart repair” and “return to
sports”. Our findings indicate that athletes who undergo arthroscopic
Bankart repair exhibit higher rates of returning to sports compared to those who
receive other anterior shoulder stabilization procedures. Several factors are
considered when determining readiness to return to athletics, including time
elapsed since surgery, type of sport, strength, range of motion, pain, and
proprioception. Surgeons typically advise athletes to wait approximately 6
months after surgery before resuming sports activities. They also recommend that
athletes regain at least 80% of the strength of the uninjured shoulder or
achieve strength levels comparable to those prior to the injury. Additionally,
patients are expected to attain a full range of motion without pain, which
should be symmetrical to the uninjured side, and demonstrate improved
proprioception in the shoulder. The sport in which an athlete participates can
also influence the timeline for return. Those involved in overhead sports, like
baseball or tennis, often experience lower success rates in returning to their
sport compared to athletes from other disciplines.
An efficiently functioning glenohumeral joint depends on the integrity and
coordinated interaction of both static and dynamic components. The structures
essential for maintaining normal shoulder function are particularly susceptible
to injury and dislocation. Such dislocations frequently involve the glenoid
labrum, bony rim, ligaments, capsule, and humeral head [1]. The incidence of anterior shoulder instability ranges
from eight to 17 dislocations per 1,000 person-years. Anterior shoulder
dislocation rates are notably high among young athletes, particularly in contact
sports such as football and rugby [1–5]. Anterior shoulder
instability has multiple causes; however, the capsulolabral complex and Bankart
lesion are commonly observed in young patients. A Bankart lesion is
characterized by an anterior and inferior detachment of the labrum from the
glenoid, along with capsuloligamentous injury below the equator of the glenoid
[6]. Arthroscopic techniques for
anterior shoulder stabilization have advanced considerably over the past two
decades [7]. The outcomes of arthroscopic
Bankart repair (ABR) are comparable to those of open repair in terms of
recurrence rates, range of motion (ROM), and complications [8–11]. Recent studies have indicated that athletes undergoing ABR
exhibit a higher rate of return to sport (RTS) compared to those treated with
other anterior shoulder stabilization methods [12]. However, the rate at which athletes experience RTS following
ABR varies widely among individual studies [13].
Objectives
This review was conducted to summarize anterior shoulder instability, focusing on
rehabilitation and RTS following an ABR procedure.
Methods
Ethics statement
The present study was a review based on a literature search; consequently,
neither institutional review board approval nor informed consent was
necessary.
Study design
This study was a narrative review based on a search of academic databases.
Setting
The study involved a literature search of the Google Scholar and PubMed databases
through February 18th, 2024. Keywords and terms like “arthroscopy Bankart
repair” and “return to sports” were employed. The inclusion
criteria specified that articles must be written in English and assess the
relationship between ABR and RTS.
Results
The search yielded 11 relevant studies that satisfied the inclusion criteria (Table 1). These articles covered the timeframe
from surgery to the resumption of athletic activities. Most studies suggest that
athletes typically experience RTS approximately 6 months after surgery.
6.6±2.7 months (range, 3–18
months) for return to sport, 9.3±4.0 months (range,
6–24 months) for competitions, and 10.6±4.3 months
(range, 8–24 months) for complete return
3 months for specific training, 6 months
for overhead and high-contact sports
No., number; ABR, arthroscopic Bankart repair.
Discussion
Bankart lesion
A Bankart lesion is characterized by an anterior and inferior detachment of the
labrum from the glenoid, accompanied by an injury to the capsuloligamentous
structures below the equator of the glenoid (Fig.
1). This type of lesion commonly results from a traumatic anterior
glenohumeral dislocation and is particularly prevalent among younger individuals
[14]. Additionally, a traumatic
anterior glenohumeral dislocation can lead to an avulsion fracture of the
anterior glenoid rim, which is termed a bony Bankart lesion [15–17]. The extent of bone loss is a crucial determinant in the
likelihood of recurrent glenohumeral instability following stabilization surgery
[18].
Fig. 1.
Lesions of the shoulder. (A) Labral tear, (B) Bankart lesion.
Mechanism of injury
Shoulder instability manifests through the disruption of the dynamic and static
stabilizing elements of the glenohumeral joint, which can result in dislocation,
subluxation, or a sensation of apprehension accompanied by pain. The stability
of the shoulder is maintained by the glenoid labrum, the glenohumeral ligament
complex, negative intra-articular pressure, and articular conformity.
Furthermore, the rotator cuff and scapular stabilizers represent key dynamic
contributors to shoulder restraint [1].
Anterior dislocation is the most common type of shoulder dislocation, accounting
for approximately 97% of these injuries [19]. Anterior dislocation typically occurs when an individual falls
with the arm abducted and externally rotated, causing the posterosuperior aspect
of the humeral head to impact the anteroinferior aspect of the glenoid rim. This
can result in damage to the humeral head, the glenoid labrum, or both (Fig. 2). Additionally, an indentation may
develop on the humeral head due to a compression fracture, occurring when the
humeral head is forced against the anterior glenoid rim during dislocation
[20]. Rotator cuff injuries can arise
in more than 50% of elderly patients [21].
Fig. 2.
Mechanism of injury in anterior shoulder dislocation resulting in (A)
rotator cuff tear and (B) subluxed humerus.
Risk factors and recurrence rate of redislocation
Patients with a history of shoulder dislocation face an increased risk of
recurrent dislocation. This often occurs due to inadequate tissue healing,
laxity, and high levels of activity. Moreover, patients who have sustained
rotator cuff tears or glenoid fractures are at a heightened risk of recurrent
dislocation [19]. Another critical factor
is glenoid bone loss exceeding 20%, which significantly contributes to recurrent
anterior shoulder instability [22].
Regarding the recurrence rate of instability after ABR, research indicates a
higher occurrence among younger patients [7]. In one study, patients aged 22 years or younger experienced a
recurrence rate after ABR of 13.3%, whereas older patients exhibited a rate of
6.3% [23]. Similarly, another study
reported a recurrence rate of 51% among contact athletes aged 18 years or
younger, compared to a 12% recurrence rate in a group of 25-year-old athletes
[24]. Moreover, their findings
indicated that the risk of recurrence among adolescent athletes was 2.2 times
greater in athletes younger than 16 years old compared to those older than 16
years. However, the recurrence rate varies based on the type of sport, with
contact and collision sports—such as rugby and American
football—displaying exceptionally high recurrence rates [6]. In soccer, one study reported that
goalkeepers have a recurrence rate more than eight times higher than field
position players and experience worse functional outcomes. Goalkeepers often
stop high-velocity shots with their hands, dive with outstretched arms, and
forcefully throw balls, all actions that increase their risk of shoulder injury
[25].
In a retrospective study of 271 patients who underwent primary ABR for anterior
shoulder instability, researchers found that off-track Hill-Sachs lesions
(HSL)—those that extend medially beyond the glenoid track—were
associated with a higher risk of anterior engagement and instability compared to
on-track HSL. The rate of surgical revision for patients with off-track HSL was
48% at an average follow-up of 53.5 months, while the rate for those with
on-track HSL was 13% at an average follow-up of 42.3 months [22]. Another study, which included 100
recreational athletes who received ABR and were followed for an average of
12.7±2.1 years, revealed a 19% rate of subjective apprehension and a 19%
rate of redislocation. Additionally, gradual declines were noted in clinical
outcomes and sports activity levels over time. Surgeons are advised to carefully
select candidates for ABR by considering risk factors such as the presence of
off-track lesions, age under 20 years, and participation in contact sports
[26].
The findings regarding follow-up procedures after primary anterior shoulder
dislocation consistently support the use of ABR. Relative to ABR, a
significantly higher recurrence rate of instability was observed after
conservative treatment. Consequently, it is logical to anticipate the need for
additional future procedures in patients initially treated conservatively. A key
consideration is that instability frequently results in symptoms that can
disrupt patients’ engagement in sports activities [27].
Rehabilitation protocol
Postoperative rehabilitation therapy is essential for promoting the recovery of
shoulder motion and strength, enabling patients to resume functional activities
sooner and ultimately resulting in greater patient satisfaction [27–31]. The postoperative rehabilitation guidelines reported in the
literature vary considerably, and broadly accepted guidelines for rehabilitation
following ABR for anterior shoulder instability do not yet exist [31]. Kelley et al. presented a
postoperative rehabilitation protocol for patients who have undergone ABR,
including 2 years of follow-up. The specifics of this rehabilitation protocol
are detailed in Tables 2, 3 [32].
Table 2.
Rehabilitation program goals
Week (phase)
Goal
1 to 4 (immediate postoperative)
- Protect repair - Mitigate
consequences of immobilization - Promote dynamic
stability and proprioception - Reduce pain and
inflammation - Avoid stretching - Avoid active
external rotation, abduction, or extension
5 to 12 (intermediate)
- Gradually restore full ROM -
Preserve repair integrity - Restore muscular strength and
balance - Enhance neuromuscular control
13 to 21 (minimal protection)
- Maintain full ROM - Improve
muscular control, strength, power, and endurance -
Practice core stabilization and conditioning - Weekly
functional testing begins at week 16 - Weekly TSK-11
administration begins at week 16 - Sport-specific
training begins at week 20
22 to 26 (advance to
strengthening)
- Maintain full ROM - Improve
strength, power, and endurance - Advance functional
activities
26 to 32 (return-to-sports)
- Enhance strength, power, and
endurance - Pass all functional assessments (Table
3) - Maintain mobility
ROM, range of motion; TSK-11, Tampa Scale of
Kinesiophobia–11.
Table 3.
Functional assessment test
Test
Goal
Pass
a. Overhand band reach
Demonstrate functional rotator cuff
activity throughout multiplanar range of motion while avoiding
trapezius dominance, trunk lean, and pelvic tilt
Maintain stability
b. Closed kinetic chain extremity
stability test (CKCUEST)
Measure speed, agility, and power
21 touches (male) or 23 touches
(female) in 15 seconds
c. Upper extremity Y balance
Using the operative arm as a
stabilizer, test mobility and stability of the extremity and
core; combines scapular stability and functional range of motion
with core stabilization and thoracic rotation
3 consecutive progressions
d. One-arm hop test
Focus on stable core, maximum
assessment of strength, and neuromuscular coordination
5 repetitions
e. Posterior Shoulder Endurance Test
(PSET)
Assess posterior rotator cuff and
deltoid strength
85% of contralateral arm strength
f. Trunk stability push-up
Stabilize spine and hips in sagittal
plane during upper body symmetrical motion
3 repetitions with control
g. Long arm plank ball tap
Assess stability, proprioception, and
endurance
10 bidirectional taps with body
control
h. Plank weight stacking
Using the operative arm as a
stabilizer, assess both proprioception and stability of the core
and scapula
4 repetitions×1 lb
Return to sport after arthroscopic Bankart repair
ABR was identified as having the highest rate of RTS across all age groups,
surpassing other stabilization procedures such as open Bankart repair, open
Latarjet, and arthroscopic Latarjet procedures [6,33]. A cohort study by
Blonna et al. compared 30 participants undergoing ABR with 30 participants
undergoing the open Bristow-Latarjet procedure, resulting in a higher Subjective
Patient Outcome for Return to Sports score in the ARB group [33]. A systematic review of 16 articles
evaluated the RTS rate after various surgical anterior shoulder stabilization
techniques, revealing the highest RTS rate among athletes who underwent ABR
(97.5%). Other procedures examined included open Bankart repair (86.1%), open
Latarjet procedure (83.6%), minimally invasive Latarjet procedure (94.0%), and
ABR with remplissage (95.5%) [12].
Goals for ABR in young athletes include restoring shoulder function and enabling
RTS at pre-injury levels [6]. Shoulder
stabilization for Bankart lesions can be achieved through two methods:
arthroscopic surgery or open surgery. Both treatments involve reattaching the
torn labrum to the glenoid [34]. A review
focusing on the RTS in teenagers following surgical stabilization reported an
overall return rate of 95%, with 77% of patients reaching pre-injury levels of
performance [6]. Various criteria were
used to assess the athletes’ readiness to RTS, such as time elapsed since
surgery, type of sport, strength, ROM, pain, and proprioception [35–37]. The type of sport played was linked to outcomes such as RTS
failure or complete RTS.
Time from surgery
The most common criterion for return to play (RTP) was the time elapsed since
surgery, indicating a minimum duration between the surgical procedure and
the athlete’s capability to RTP [36]. A retrospective study of 50 teenage athletes who underwent
ABR revealed that the average time for RTS was 6.6±2.7 months, with a
range of 3 to 18 months. The time to return to competitive play averaged
9.3±4.0 months (range, 6 to 24 months), while achieving a complete
return to pre-injury levels took 10.6±4.3 months (range, 8 to 24
months) [6]. A systematic review
encompassing 58 studies reported that the timeframe for RTS post-surgery
varied from 1.5 to 12 months, with a return after 6 months being the most
cited duration [37]. Another
systematic review, which included 34 studies, found that patients were
typically allowed to RTS after a mean of 5.7 months (range, 1.9 to 32
months) following surgery [13]. More
recently, a survey study involving 317 surgeons from the United States and
Europe indicated that the most frequently recommended time for athletes to
resume sports was 4 months after surgery. However, most of these surgeons
advised waiting an additional period, most often 2 months, before granting
athletes clearance to RTS [38].
Type of sports
The type of shoulder sport played can influence the likelihood of RTS. Allain
et al. categorized sports that place strain on the shoulder into four
distinct groups, as shown in Table 4
[39].
Table 4.
Types of sports involving shoulder activity
Group
Shoulder sport
G1
Non-collision/non-overhead
G2
High-impact/collision
G3
Overhead
G4
Martial arts
A study by Ide et al. reported that overhead athletes exhibited the lowest
rate of complete RTS at 68%, compared to contact athletes and
non-contact/non-overhead athletes, who had respective return rates of 86%
and 100% [40]. Another study
suggested that athletes should only return to overhead sports after 7 months
post-surgery, and they should wait until 10 months after surgery before
returning to competitive sports. Additionally, it is expected that athletes
who participate in overhead sports will fully recover their external
rotation capacity following ABR. Failure to achieve this recovery could
negatively affect sports-related outcomes [41]. Gibson et al. found that ABR, combined with an accelerated
rehabilitation program, allows professional football players to RTP
relatively quickly, with an average time of 11 weeks [42].
Strength
Strength is a challenging parameter to measure objectively due to the
influence of various factors. A total of 25 studies have incorporated muscle
strength within RTS criteria, including achievement of complete strength
restoration, pre-injury strength levels, at least 80% of the strength of the
contralateral side, strength comparable to the contralateral side, symmetric
strength in abduction and external rotation as determined by manual testing,
grade 5 strength in all intrinsic and extrinsic shoulder muscles, and
strength that equal to or exceeding baseline values [36]. A retrospective study assessed strength recovery
post-surgery using isokinetic and isometric devices to provide an objective
evaluation. However, the findings in the literature are inconsistent, and
functional goals were more frequently achieved than strength criteria [43]. A systematic review investigated
the strength criteria for RTS. However, the results were inconsistent, and
the studies did not uniformly assess strength with the same type of device
[37].
Range of motion
The assessment of shoulder ROM involves evaluating both active and passive
movements to ensure that the athlete demonstrates symmetrical, full, and
sport-specific ROM without experiencing pain or apprehension [36,44].
Pain
Another important factor for RTS is the assessment of pain following ABR.
Pain is considered a criterion for RTS, but it always appears in conjunction
with other criteria. In this context, pain has been defined as the presence
of “non-painful ROM” and being “pain-free”
during physical examination or participation in sports. Here, key
distinctions must be made. For the general population, a complete absence of
pain is not a prerequisite. However, for athletes who aim to return to their
sports activities and achieve pre-injury performance levels, being pain-free
is essential [37,45].
Proprioception
To date, few studies have included shoulder proprioception as a criterion for
RTP. Tambe et al. noted an improvement in shoulder proprioception as an RTP
criterion, yet the study did not detail the specific assessment modality
employed [46].
Rate of return to sport
The rate of RTS at pre-injury levels varies widely according to the studies
available, with figures ranging from 31% to 100% [13,37,47]. Memon et al. assessed the RTS in 1,866
patients following ABR. Their study found that 82% of competitive athletes
accomplished RTS, and 88% of those returned to their pre-injury levels [13]. Abdul et al. examined RTS rates after
shoulder stabilization surgery and reported a 97.5% RTS rate, with an average
time of 5.9 months post-ABR [12]. Harada
et al. observed high RTS rates in a cohort of 50 young athletes, with nearly all
participants resuming sports; 96% returned to competitive play, and 76% fully
regained their pre-injury performance levels without any complaints [6]. A systematic review that included 11
studies with 392 adolescent athletes who underwent ABR revealed a 79.8% return
rate to sports at pre-injury levels [48].
In the sport of soccer, the RTS rate at the same level was significantly lower
for goalkeepers compared to field players [25].
Reason for failing to return to sport
Athletes who experience injuries often face negative psychological responses,
including depression, anxiety, irritability, and a lack of confidence. These
psychological reactions can affect a patient’s decision to RTS, even
after ABR [49]. A retrospective study
evaluated patients who underwent ABR and did not RTS over a 24-month follow-up
period. The study reported that 51.9% of patients harbored a persistent fear of
re-injury, 25.0% believed their injury signified the natural conclusion of their
athletic career, 15.4% felt that their lifestyle had changed, 11.5% experienced
persistent pain, and 7.7% were unable to RTS due to other injuries [2]. In research by Tjong et al. involving 25
patients, several reasons were identified for not returning to sport after ABR,
including fear of re-injury, a shift in priorities, mood disturbances, social
support, and a lack of motivation [49].
Plath et al. reported that among athletes who did not RTS after ABR, the primary
reasons were non–shoulder-related factors, followed by concerns about
potential re-injury [50]. A recent study
underscored kinesiophobia—fear of movement—as a prevalent factor
affecting patients’ psychological readiness to RTS. Psychological
interventions, such as cognitive-behavioral therapy and mindfulness, have been
proposed to potentially improve RTS rates in these patients [51].
Conclusion
ABR results in a high percentage of athletes returning to athletic activities,
leading to the development of various criteria to support the RTP. Most surgeons
advise athletes to wait 6 months after surgery before resuming sports, to regain
at least 80% of the strength in the contralateral limb or a level of strength
comparable to that prior to the injury, to achieve a full or symmetrical ROM
without pain, and to demonstrate improved shoulder proprioception. However, the
type of sport also influences the rate of RTS, with overhead sports displaying
the lowest return rates. While many athletes successfully return to their
previous level of competition, some may experience adverse psychological
responses during the process.
Authors' contributions
Project administration: Utami SW
Conceptualization: Mitchel
Methodology & data curation: Pratiwi SR, Kholinne E
No potential conflict of interest relevant to this article was reported.
Funding
Not applicable.
Data availability
Not applicable.
Acknowledgments
Not applicable.
Supplementary materials
Not applicable.
References
1. Galvin JW, Ernat JJ, Waterman BR, Stadecker MJ, Parada SA. The epidemiology and natural history of anterior shoulder
instability. Curr Rev Musculoskelet Med 2017;10(4):411-424.
2. Hurley ET, Davey MS, Mojica ES, Montgomery C, Gaafar M, Jazrawi LM, et al. Analysis of patients unable to return to play following
arthroscopic Bankart repair. Surgeon 2022;20(4):e158-e162.
3. Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the
United States Military Academy. Am J Sports Med 2007;35(7):1168-1173.
6. Harada Y, Iwahori Y, Kajita Y, Takahashi R, Yokoya S, Sumimoto Y, et al. Return to sports after arthroscopic Bankart repair in teenage
athletes: a retrospective cohort study. BMC Musculoskelet Disord 2023;24(1):64
9. Hobby J, Griffin D, Dunbar M, Boileau P. Is arthroscopic surgery for stabilisation of chronic shoulder
instability as effective as open surgery? A systematic review and
meta-analysis of 62 studies including 3044 arthroscopic
operations. J Bone Joint Surg Br 2007;89-B(9):1188-1196.
10. Ng C, Bialocerkowski A, Hinman R. Effectiveness of arthroscopic versus open surgical stabilisation
for the management of traumatic anterior glenohumeral
instability. Int J Evid Based Healthc 2007;5(2):182-207.
12. Abdul-Rassoul H, Galvin JW, Curry EJ, Simon J, Li X. Return to sport after surgical treatment for anterior shoulder
instability: a systematic review: response. Am J Sports Med 2019;47(3):NP24-NP27.
13. Memon M, Kay J, Cadet ER, Shahsavar S, Simunovic N, Ayeni OR. Return to sport following arthroscopic Bankart repair: a
systematic review. J Shoulder Elb Surg 2018;27(7):1342-1347.
16. Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, et al. Midterm results of the bony Bankart bridge technique for the
treatment of bony Bankart lesions. Am J Sports Med 2019;47(1):158-164.
17. Millett PJ, Horan MP, Martetschläger F. The “bony Bankart bridge” technique for restoration
of anterior shoulder stability. Am J Sports Med 2013;41(3):608-614.
19. Abrams R, Akbarnia H. Shoulder dislocations overview [Internet]; Treasure Island (FL): StatPearls; c2023 [cited 2024 Jan 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459125/
20. Pak T, Kim AM. Anterior glenohumeral joint dislocation [Internet]; Treasure Island (FL): StatPearls; c2023 [cited 2024 Jan 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557862/
21. Cunningham NJ. Techniques for reduction of anteroinferior shoulder
dislocation. Emerg Med Australas 2005;17(5-6):463-471.
22. Schwihla I, Wieser K, Grubhofer F, Zimmermann SM. Long-term recurrence rate in anterior shoulder instability after
Bankart repair based on the on- and off-track concept. J Shoulder Elb Surg 2023;32(2):269-275.
23. Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing factors for recurrent shoulder dislocation after
arthroscopic treatment. J Bone Joint Surg 2009;91(11):2537-2542.
24. Torrance E, Clarke CJ, Monga P, Funk L, Walton MJ. Recurrence after arthroscopic labral repair for traumatic
anterior instability in adolescent rugby and contact
athletes. Am J Sports Med 2018;46(12):2969-2974.
25. Pasqualini I, Rossi LA, Brandariz R, Tanoira I, Fuentes N, Denard PJ, et al. Effect of playing position on return to sport, functional
outcomes, and recurrence after arthroscopic Bankart repair in soccer
players. Orthop J Sports Med 2022;10(11):23259671221138106
26. Kim JS, Kim SC, Park JH, Kim HG, Kim DY, Lee SM, et al. Long-term effectiveness and outcome-determining factors of
arthroscopic Bankart repair for recreational sports population: an
assessment of 100 patients with a mean follow-up of 12.7
years. Am J Sports Med 2024;52(3):594-602.
27. Hu B, Hong J, Zhu H, Yan S, Wu H. Arthroscopic Bankart repair versus conservative treatment for
first-time traumatic anterior shoulder dislocation: a systematic review and
meta-analysis. Eur J Med Res 2023;28(1):260
29. McIsaac W, Lalani A, Silveira A, Chepeha J, Luciak-Corea C, Beaupre L. Rehabilitation after arthroscopic Bankart repair: a systematic
scoping review identifying important evidence gaps. Physiotherapy 2022;114:68-76.
30. Matache BA, Hurley ET, Wong I, Itoi E, Strauss EJ, Delaney RA, et al. Anterior shoulder instability part III—revision surgery,
rehabilitation and return to play, and clinical follow-up—an
international consensus statement. Arthroscopy J Arthrosc Rel Surg 2022;38(2):234-242.E6.
31. Kim K, Saper MG. Postoperative management following arthroscopic Bankart repair in
adolescents and young adults: a systematic review. Arthrosc Sports Med Rehabil 2020;2(6):E839-E845.
32. Kelley TD, Clegg S, Rodenhouse P, Hinz J, Busconi BD. Functional rehabilitation and return to play after arthroscopic
surgical stabilization for anterior shoulder instability. Sports Health 2022;14(5):733-739.
33. Blonna D, Bellato E, Caranzano F, Assom M, Rossi R, Castoldi F. Arthroscopic Bankart repair versus open Bristow-Latarjet for
shoulder instability: a matched-pair multicenter study focused on return to
sport. Am J Sports Med 2016;44(12):3198-3205.
34. Sedeek SM, Tey IK, Tan AHC. Arthroscopic Bankart repair for traumatic anterior shoulder
instability with the use of suture anchors. Singapore Med J 2008;49(9):676-681.
35. Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors that influence the return to sport after arthroscopic
Bankart repair for glenohumeral instability. Open Access J Sports Med 2022;13:35-40.
36. Griffith R, Fretes N, Bolia IK, Murray IR, Meyer J, Weber AE, et al. Return-to-sport criteria after upper extremity surgery in
athletes: a scoping review, part 1: rotator cuff and shoulder stabilization
procedures. Orthop J Sports Med 2021;9(8):23259671211021827
37. Ciccotti MC, Syed U, Hoffman R, Abboud JA, Ciccotti MG, Freedman KB. Return to play criteria following surgical stabilization for
traumatic anterior shoulder instability: a systematic review. Arthroscopy 2018;34(3):903-913.
38. Hurley ET, Matache BA, Colasanti CA, Mojica ES, Manjunath AK, Campbell KA, et al. Return to play criteria among shoulder surgeons following
shoulder stabilization. J Shoulder Elb Surg 2021;30(6):E317-E321.
39. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of
anterior instability of the shoulder. J Bone Joint Surg 1998;80(6):841-852.
40. Ide J, Maeda S, Takagi K. Arthroscopic Bankart repair using suture anchors in athletes:
patient selection and postoperative sports activity. Am J Sports Med 2004;32(8):1899-1905.
41. Buckup J, Welsch F, Gramlich Y, Hoffmann R, Roessler PP, Schüttler KF, et al. Back to sports after arthroscopic revision Bankart
repair. Orthop J Sports Med 2018;6(2):2325967118755452
42. Gibson J, Kerss J, Morgan C, Brownson P. Accelerated rehabilitation after arthroscopic Bankart repair in
professional footballers. Shoulder Elb 2016;8(4):279-286.
43. Wilson KW, Popchak A, Li RT, Kane G, Lin A. Return to sport testing at 6 months after arthroscopic shoulder
stabilization reveals residual strength and functional
deficits. J Shoulder Elb Surg 2020;29(7):S107-S114.
44. Wilk KE, Bagwell MS, Davies GJ, Arrigo CA. Return to sport participation criteria following shoulder injury:
a clinical commentary. Int J Sports Phys Ther 2020;15(4):624-642.
45. Bravi M, Fossati C, Giombini A, Macaluso A, Lazzoli JK, Santacaterina F, et al. Criteria for return-to-play (RTP) after rotator cuff surgery: a
systematic review of literature. J Clin Med 2022;11(8):2244
48. Kasik CS, Rosen MR, Saper MG, Zondervan RL. High rate of return to sport in adolescent athletes following
anterior shoulder stabilisation: a systematic review. J ISAKOS Joint Disord Orthop Sports Med 2019;4(1):33-40.
49. Tjong VK, Devitt BM, Lucas Murnaghan M, Ogilvie-Harris DJ, Theodoropoulos JS. A qualitative investigation of return to sport after arthroscopic
Bankart repair: beyond stability. Am J Sports Med 2015;43(8):2005-2011.
51. Owusu-Ansah GE, Anudu EE, Ross PP, Ierulli VK, Mulcahey MK. Psychological readiness to return to sport after shoulder
instability. JBJS Rev 2023;11(9):e23.00022.
6.6±2.7 months (range, 3–18
months) for return to sport, 9.3±4.0 months (range,
6–24 months) for competitions, and 10.6±4.3 months
(range, 8–24 months) for complete return
3 months for specific training, 6 months
for overhead and high-contact sports
No., number; ABR, arthroscopic Bankart repair.
Rehabilitation program goals
Week (phase)
Goal
1 to 4 (immediate postoperative)
- Protect repair - Mitigate
consequences of immobilization - Promote dynamic
stability and proprioception - Reduce pain and
inflammation - Avoid stretching - Avoid active
external rotation, abduction, or extension
5 to 12 (intermediate)
- Gradually restore full ROM -
Preserve repair integrity - Restore muscular strength and
balance - Enhance neuromuscular control
13 to 21 (minimal protection)
- Maintain full ROM - Improve
muscular control, strength, power, and endurance -
Practice core stabilization and conditioning - Weekly
functional testing begins at week 16 - Weekly TSK-11
administration begins at week 16 - Sport-specific
training begins at week 20
22 to 26 (advance to
strengthening)
- Maintain full ROM - Improve
strength, power, and endurance - Advance functional
activities
26 to 32 (return-to-sports)
- Enhance strength, power, and
endurance - Pass all functional assessments (Table
3) - Maintain mobility
ROM, range of motion; TSK-11, Tampa Scale of
Kinesiophobia–11.
Functional assessment test
Test
Goal
Pass
a. Overhand band reach
Demonstrate functional rotator cuff
activity throughout multiplanar range of motion while avoiding
trapezius dominance, trunk lean, and pelvic tilt
Maintain stability
b. Closed kinetic chain extremity
stability test (CKCUEST)
Measure speed, agility, and power
21 touches (male) or 23 touches
(female) in 15 seconds
c. Upper extremity Y balance
Using the operative arm as a
stabilizer, test mobility and stability of the extremity and
core; combines scapular stability and functional range of motion
with core stabilization and thoracic rotation
3 consecutive progressions
d. One-arm hop test
Focus on stable core, maximum
assessment of strength, and neuromuscular coordination
5 repetitions
e. Posterior Shoulder Endurance Test
(PSET)
Assess posterior rotator cuff and
deltoid strength
85% of contralateral arm strength
f. Trunk stability push-up
Stabilize spine and hips in sagittal
plane during upper body symmetrical motion
3 repetitions with control
g. Long arm plank ball tap
Assess stability, proprioception, and
endurance
10 bidirectional taps with body
control
h. Plank weight stacking
Using the operative arm as a
stabilizer, assess both proprioception and stability of the core
and scapula
4 repetitions×1 lb
Types of sports involving shoulder activity
Group
Shoulder sport
G1
Non-collision/non-overhead
G2
High-impact/collision
G3
Overhead
G4
Martial arts
Table 1.
Characteristics of the included studies
No., number; ABR, arthroscopic Bankart repair.
Table 2.
Rehabilitation program goals
ROM, range of motion; TSK-11, Tampa Scale of
Kinesiophobia–11.
Table 3.
Functional assessment test
Table 4.
Types of sports involving shoulder activity
