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.

Purpose: The aims of this systematic review were to determine (1) which criteria are used to determine return to sport (RTS), (2) the number of patients that are unable to RTS following 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 following any treatment of superior labral pathophysiology. Study quality was assessed using the MINORS criteria. Definitions for nRTS were extracted as reported in the studies. The ranges of no return to sport (nRTS) and no return to pre-injury 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, 1857 patients were involved in sports, 78% (n=1453) of whom underwent superior labral reattachment, 21% (n=381) biceps tenodesis, and 9.4% (n=175) non-operative treatment. None of the studies provided criteria for RTS and two studies provided criteria for return to pre-injury level (RTPL). The ranges of nRTS and nRTPL varied following 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.

Conclusion: Criteria for determining successful RTS and RTPL following superior labral pathophysiology treatment were not reported by the majority of 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.