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.

Abstract

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. 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. 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. 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 IV, Systematic review of Level II-IV studies.