Arthroscopic Management of Recurrent Shoulder Instability in Overhead Athletes: Functional Outcomes and Return-to-Play Analysis

Abstract

Recurrent shoulder instability poses a significant challenge for overhead athletes, often leading to prolonged downtime and career-threatening complications. This study evaluates the functional outcomes and return-to-play (RTP) rates following arthroscopic Bankart repair in overhead athletes with recurrent anterior shoulder instability. A retrospective cohort analysis was conducted on 52 overhead athletes (mean age 24.3 ± 4.7 years; 78% male) who underwent primary arthroscopic stabilization between 2018 and 2023 at a single sports medicine center. Inclusion criteria included a history of at least two dislocations, participation in overhead sports (e.g., baseball, tennis, swimming), and minimum 24-month follow-up. Surgical technique involved standard arthroscopic Bankart repair with suture anchors, supplemented by capsulorrhaphy in 28% of cases. Postoperative rehabilitation followed a phased protocol emphasizing progressive strengthening and sport-specific drills. Primary outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and Western Ontario Shoulder Instability Index (WOSI). RTP was defined as return to competitive play, with levels categorized as same, reduced, or none. Secondary measures included recurrence rates, complications, and time to RTP. At a mean follow-up of 32.4 ± 8.1 months, significant improvements were observed in ASES (pre: 52.1 ± 12.3; post: 88.7 ± 9.4; p<0.001), Rowe (pre: 48.6 ± 11.2; post: 92.3 ± 7.8; p<0.001), and WOSI (pre: 1420 ± 320; post: 320 ± 180; p<0.001) scores. Overall RTP rate was 84.6% (44/52), with 67.3% (35/52) returning to pre-injury level. Mean time to RTP was 6.2 ± 2.1 months. Recurrent instability occurred in 7.7% (4/52), all requiring revision surgery. Complications included stiffness (5.8%) and infection (1.9%). Subgroup analysis revealed higher RTP in younger athletes (<25 years: 90% vs. ≥25: 75%; p=0.04) and lower recurrence in non-contact sports (p=0.03). Arthroscopic management provides excellent functional restoration and high RTP rates in overhead athletes, though careful patient selection and rehabilitation are crucial to minimize recurrence.

Keywords: Recurrent shoulder, return-to-play (RTP), Arthroscopic