Return to Sport Following Arthroscopic Anterior Shoulder Stabilization: High Outcome Scores Despite Moderate Rate of Return to Play

OBJECTIVES: The purpose of this study was to determine the capacity to return to sport and other patient-rated outcomes following arthroscopic shoulder stabilization in a case series comparing upper extremity/contact (UE) and lower extremity (LE) athletes. METHODS: Patients who underwent arthroscopic anterior shoulder stabilization by the senior author between November 2006 and November 2010 were contacted for follow up on their return to play and outcomes assessment. Outcomes included a questionnaire that had the Single Assessment Numeric Evaluation (SANE), ASES Shoulder Score, Marx Shoulder Activity Scale, and Western Ontario Shoulder Instability Index (WOSI). RESULTS: The cohort consisted of 48 patients involved in active sports. They identified themselves as participating in a sport around the time of their injury that primarily involved either the upper extremity (n = 35) or lower extremity (n = 13). Contact athletes were grouped with the upper extremity athletes. Upper extremity and contact sports included football, basketball, ice hockey, rock climbing, baseball, volleyball, and weightlifting. Lower extremity sports included running, skiing, snowboarding, mountain biking, and soccer. Average time to follow-up was 37 months (range, 19-79 months) in the UE group and 41 months (range, 18-76 months) in the LE group (p = 0.57). Average age at the time of surgery was 26 years (range, 16-42 years) in the UE group and 29 years (range, 18-45 years) in the LE group (p = 0.33). Twenty-three patients (23/35, 66%) in the UE group and 10 patients (10/13, 77%) in the LE group were able to return to their sport by the time of follow-up (p = 0.39). Average time to return to sport was 6.2 months (range, 3-12 months) in the UE/C group and 7.9 months (range, 3-18 months) in the LE group (p = 0.28). Of those patients able to return to their sport, 16 patients (16/23, 70%) in the UE group and 5 patients (5/10, 50%) in the LE group were able to return to their pre-injury activity level (p = 0.18). The average Marx Activity Scale was 11.9 and 11.5 in the UE and LE groups, respectively (p = 0.72), while the average SANE score was 85 and 87 in the UE and LE groups, respectively (p = 0.53). The average ASES score was 89 in the UE group and 94 in the LE group (p = 0.12). The WOSI score was 23% versus 26% in the UE and LE groups, respectively (p = 0.62). Patients were able to indicate reasons for their inability to return, many had more than one: eight patients did not return secondary to loss of strength, six due to pain, five had a fear of reinjury, 3 cited loss of speed as a reason, and 3 felt a sense of instability. Six patients did not return due to a loss of interest in their sport, or development of a new sport interest. CONCLUSION: There is no significant difference between upper and lower extremity athletes in terms of return to sport, time to return to sport, or other functional outcomes in this cohort. There may be a trend towards greater return to pre-injury activity level in upper extremity athletes, however further evaluation on a larger sample size is necessary to determine this. Despite high scores on the shoulder outcome measures, the athlete’s rate of return to their sport was only moderate.