We’ve all been there—you’re working with a high-level athlete after a Bankart repair or Laterjet, they’re at the 6-month mark, their ROM looks great, and they’re itching to get back on the field. The surgeon gives the green light, but you can’t help but wonder:
Are they actually ready?
In the world of ACL rehab, we have strict batteries of tests, symmetry indexes, and psychological readiness scales. But when it comes to the shoulder, the literature has been surprisingly quiet on what “ready” actually looks like. A new scoping review just dropped in IJSPT that digs into the return-to-sport rates for over 2,000 competitive athletes, and the results are a massive wake-up call for sports physical therapists.
The study looked at the difference between soft tissue repairs and bony augmentations, but more importantly, it looked at how we are making the decision to clear these athletes. Is it based on strength? Function? Or just a date on the calendar?
On this week’s episode of the podcast, I’m diving deep into this research to discuss the current success rates of shoulder stabilizations and, more importantly, the 10 criteria surgeons are using to clear athletes. Some of what they found might surprise you—and it might change the way you progress your next shoulder patient. Check out this week’s episode to learn more!
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 388: Outcomes and Return to Sport Testing After Bankart and Laterjet Shoulder Stabilization Surgery
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Show Notes
• Eval and Treatment of the Shoulder Online Course
• Return to Competitive Sport After Anterior Shoulder Stabilization: A Scoping Review of Current Outcomes and Clearance Decision-Making Criteria
Transcript
Mike Reinold:
Welcome back, everybody, to the latest episode of the Ask Mike Reinold Show. We are here with another journal article review episode for you. I have Anthony Videtto, Brendan Gates, Dave Tilley, Lenny Macrina, Diwesh Poudyal here answering, not answering, but reviewing a journal article here. Kind of some new stuff we’re trying. Let us know if you like the feedback on this new format.
But today we have an article from the International Journal of Sports Physical Therapy, 2025. The Return to Competitive Sport After Anterior Shoulder Stabilization: A Scoping Review of Current Outcomes and Clearance Decision-Making Criteria. Great concept for an article. I like this. IJSPT just continues to produce such good, clinically relevant stuff. I just love this stuff. I love this. Return to competition, shoulder stabilization, decision-making. We need this. We talk about this with ACL all the time. It’s exciting to see an article on this for shoulder surgery.
So, Brendan Gates, for the review, what do you got for us? How was the article?
Brendan Gates:
Yeah, it was a good article. I liked it. I found it very interesting. I’m excited to talk about it. I think good segue, talking about the ACL background. I think we’ll talk about that a little at the end, but let’s get into it. So the purpose of the study was twofold. First, they wanted to look at return to sport and recurrent instability rates in competitive athletes that were undergoing anterior shoulder stabilization surgeries, and they looked primarily at Bankart and Laterjet procedures. Importantly, they differentiated return to sport in this study. They were talking about return to sport of previous level or pre-injury level, not just back to sport in any capacity.
The second thing they set out to do was to describe how return to sport decisions are being made, and they wanted to look at the timeframes and the criteria used for clearance after these procedures. They thought this was important because right now, or I guess before they published this in 2025, there was a wide amount of variability in the return to sport and instability rates, and there was no standardized approach to clearing athletes after the surgery. So, as you mentioned, this was a scoping review. The authors conducted a systematic literature search across several databases, and they were looking to find articles that were within the last 10 years that analyzed return to sport of pre-injury levels and recurrent instability rates with at least a two-year follow-up in competitive athletes after anterior shoulder stabilization.
So they focused on competitive athletes because they thought too many of the previous papers that were coming out included recreational athletes, and they thought that this was underestimating the true return to sport outcomes in these higher-level populations. The ages that they looked at in these studies ranged from 16 to 40. One thing to note, this was 93% male subjects, for what it’s worth. But in this study, they included 29 papers that they looked at. There were 2,187 athletes, and there were 2,237 shoulders that they looked at. And like we said earlier, most of the surgeries fell into two categories. They had the Bankart repair, so the soft tissue stabilization. They had 1,467 subjects, and they had the Laterjet procedure, which had 770 subjects. Like we said, they looked at rates of return to sport of pre-injury level, rates of recurrent instability, time to return to sport, and then the criteria used for clearance decisions.
So what did they find? Overall… So, they had hypothesized that the return to sport of pre-injury levels were going to be somewhere between 65 to 75% based on the previous literature, and the recurrent instability rates were going to be somewhere between 10 to 20%. And they found that overall, 82.3% of these competitive athletes returned to their prior or pre-injury level of sport. So, better than they had anticipated. If we break it down by procedure, the Bankart repair had a return to sport of previous level of 79.7% and a recurrent instability rate of 9.2%, so lower than their anticipated 10 to 20. And then the Laterjet had slightly better numbers at 87.4 return to sport of previous level, and the recurrent instability was all the way down to 3.1%. So, the outcomes were generally pretty good. The Laterjet did tend to have a higher return to previous level of sport rate and a lower recurrent instability rate. They also had a smaller sample size than the Bankart.
The next thing they looked at was the time to return to sport, and this varied drastically. So it varied from 11 weeks to 8.4 months, but they did say that high 60% of the studies cleared athletes around five to six months. And then they looked at clearance criteria as well. The two most common criteria that they reported were strength and range of motion, and they were a little bit vague. So they didn’t specify if it was all handheld dynamometry or if it was more manual muscle testing or what, but at least 45% of the studies included some assessment of strength and range of motion to help their decisions of getting someone back to their sport. Very few of the studies used some sort of objective testing battery, so using psychological readiness assessments, functional performance measures, and those that did were very varied, and they were not standardized. So, clinical implications: I think overall, in general, competitive athletes seem to do pretty well after anterior shoulder stabilization. 82% returning to the previous level is higher than some of the previous literature, and that’s a pretty good number in my book.
The procedure choice may matter. They found that the Laterjet procedure did have those slightly better outcomes and lower recurrent instability rates, especially for a high-risk athlete who is dislocating quite a bit, maybe has some bone loss of the glenoid. But again, this was in general, and the sports that were included, we can talk about a little bit more, but this was not specific to something like an overhead thrower, baseball player, javelin, so I’m sure we’ll talk about that. They found that the return to sport decisions are poorly standardized. Most clinicians are still relying on time since surgery, which you can’t replace tissue healing, but then strength and range of motion were the other two that they looked at, but they didn’t really do much else. They kind of just felt it out and sent them off. This paper suggests that, like ACL rehab, there should be some sort of criteria-based testing in addition to strength, range of motion, and time since surgery.
So the framework that they suggested was, yes, look at the strength and the range of motion testing, use the handheld dynamometer, be very objective with that, but then maybe start to add in some functional testing. They mentioned ideas about the athletic shoulder test, the closed kinetic chain, upper extremity stability test, the upper quarter Y-balance test. And then there’s some other ones out there, the seated shot-put, the FTPI, the ball drop… There’s quite a few out there. They suggested using the SIRSI or the TSK-11 for psychological readiness, similar to how we use the ACL-RSI. And then they said there needs to be some sort of exposure to sport-specific demands. So for a baseball player, introducing an interval throwing program or a graded exposure to contact for maybe a football player.
I know we have our own battery of tests for clearance that we use at Champion. I’m sure the listeners are excited to hear about that, but I’ll open it up to you guys. Excited to hear your thoughts on this paper.
Mike Reinold:
Love it. Great overview, Brendan. That was awesome. Cool article, right? I mean, man, I love seeing the success. I mean, 80 to 87% depending on the procedure. I love seeing the Laterjet not only return more, but have a lower recurrence rate too. That’s actually pretty cool to see. So I like seeing that. I don’t know, what’d you guys think about the outcomes, the timeframes? I’d be kind of curious about your thoughts on the timeframes. I want to meet that guy that came back at 11 weeks, to be honest with you. I’d be curious what he’s up to. But yeah, Dave, what do you think?
Dave Tilley:
Yeah, I can jump in first because my thoughts are around the… It’s obviously something I think this study is explaining what many of us clinicians feel, like the stress of the return to sport lacks criteria. But in my mind, I was thinking so much around ACL. You can’t say, is a procedure “successful”? They get back to a high-level and they don’t have instability, only based all along the procedure itself. Think about ACL. If we have someone who has ACL, LAT, and a meniscus, so much of their rehab is going to be based upon, yes, the surgery goes well, the surgical technique, the early range of motion stuff and all that, but a lot of their success is like the 12, 16, 20, 24 strengthening program and a lot of the work that goes in between.
And so I was thinking actually about Diwesh and the strength coaches, about how a lot of our “success” with ACL is like we have this very in-depth, hardcore strengthening, agility, speed change direction program that we put people through well after the surgery is “stable” at three months, and maybe like the tunnels are here. And I thought about this too. It’s like, yes, you can have a Bankart. Yes, you can have a really good Laterjet go well, but if you took that person and just said like, “All right, we’re going to wait it out, do some basic dumbbell stuff, and then let’s see how it goes when you go back to…”
And to Brendan’s point, not even a QB, javelin thrower, an overhead athlete… I think you can’t always just pin like, oh, it was successful or not based on this huge range in PT criteria for like how they were… Were they strength training? Were they doing landmine pressing and pulling and pushing? Were they doing a throwing program? So that’s what was in my mind, is like, yes, the surgery might be great at a bone level or dynamic stabilizer, restore passive stability, but there’s a huge range in who’s going to be rehabbed in a very successful way. And those who are just like wait it out, do dumbbells, we’ll strength test you. One of them was like 80% of other side, close to normal strength. I think that’s a huge problem. It’s like there’s no lack of standardization of like, okay, one person does knee extensions with ACLs for 10 weeks, one person’s doing a five-month strength conditioning program before they get their testing done. I think that matters huge.
Mike Reinold:
Yeah. And that whole 80% LSI, I feel like that’s, I don’t know, I guess it’s important in the leg too. I was going to say it’s even more important in the upper body, but me, I think it’s important in both. 80% LSI is a failure in my mind. It seems like you did a bad job if you hit 80% LSI. But yeah, I thought it was crazy. I mean, at Champion, obviously, I think time, range of motion, and strength are just so obvious. Brendan brought that up. They’re so obvious. You need those, especially with an anterior stabilization procedure. Range of motion’s key. If you didn’t get your motion back and you don’t have the range of motion to hit the unique demands for your sport, then obviously you shouldn’t be cleared. So I like those. I like how they said to use a handheld dynamometer, which we use here at Champion.
But let’s talk about some of the functional tests because there’s a lot of functional tests out there, and people throw these functional tests out all the time. They say do these few tests, but I don’t know how much we really like a lot of these tests. So I guess the question is, of all the tests that they kind of recommended, what are your thoughts on them? Do you have any that you think you either are trying or you want to try more? Because I would say in the past, to me, I’ve always thought my athletes are ready when their range and strength are back, and they’ve gone through a rehab progression where I’ve seen them do a lot of dynamic activities. I know that they’re going to be successful when they get back to the sport because I saw it with the rehab process. And while that’s, I think, appropriate, it’s also not quantifiable, and I think that’s the thing.
So, of these tests, what do you guys think? Has anybody tried any of these? Where are we at, and what kind of test do you think we want to use? Who wants to start? Brendan, maybe?
Brendan Gates:
Yeah, I can start. I was doing quite a bit of research on these a couple of months ago, and there’s some interesting data coming out about the athletic shoulder test, and you can use the force plates to quantify the strength in those three positions. They kind of look at 180, 135, and 90 pushing straight down to the force plates, and they’re coming out with some norms, and they’re coming out with some data about improved outcomes with better test scores on the athletic shoulder. I haven’t used it a ton clinically other than just playing around with it, but certainly something I’m interested in. I think for me at this point, I just am not so sure how the numbers from that are going to dictate the rehab plan that I make. I’m still going to do ISTs and Ys. I’m still going to do a lot of the cuff strengthening, obviously, and then slowly get them into a graded program in the gym.
I don’t want to waste time, so I feel like I need to do a little bit more research on it before I find it valuable to keep in my kind of battery of tests. Some of the others, though, I think outside of the baseball players, I know there’s a Kevin Wilk paper that goes through kind of a battery of criteria of functional performance measures, and he talks about the FDPI, the ball drop test, some of the 90-90 dribbles, and things like that. So those are interesting. Outside of the baseball players, there’s some that I think are more valuable. So I had a wrestler who had an anterior dislocation Bankart repair, and we did quite a bit of the closed kinetic chain stuff, and we used that in his rehab. So we had planks with shoulder taps that mimic the demands of the closed kinetic chain, upper extremity stability test.
I know it’s for posterior instability, but the one-arm hop test… I don’t know if you guys have seen that one. It’s pretty aggressive. You pretty much do a one-handed pushup position. You jump on and off of a step. I had a hard time showing it to this kid, but I use that more as an exercise or almost like a heavy impact plyo towards the end stage of his rehab. And yes, it’s for posterior instability technically, but I think with the demands of his sport, we used it as like a small scale kind of exposure to that position. So I don’t know, there’s a lot out there. I think a lot are interesting. I personally don’t use a ton in a battery where like, okay, you got to hit this, this, this, and this before I let you go back to your sport. But I like a lot of the parts of the tests.
So anyway, that’s my thoughts.
Mike Reinold:
You know what? The way you describe all those, when you go through all those tests, and you read all these tests, what they are essentially looking at is they’re almost looking at capacity, and I’m not even sure how specific that capacity is to some of the things that we’re looking for in our athletes. But, for example, like the drop ball test, if you have low capacity on that, like in your 50% of the other side, then yeah, you’re probably not ready because you just haven’t built the capacity. I like that. Things like the closed connect chain tests or maybe the ASH test, talk about that quickly like that. It’s like, yeah, I mean, if you had a shoulder dislocation, you’re coming back from surgery, can you produce force the same side to side? I think that’s great. I don’t know. I mean, I’ve still found it very rare that I’ve wanted to do an ASH test on somebody, and I do work with a lot of overhead athletes that I certainly don’t feel the need to do an ASH test for.
Looking at the literature, it’s reliable. I like it. And there’s studies showing it’s valid, meaning that it’s consistent to shoulder strength testing. So you know what that made me say when I read that article is, great, I’ll just continue to shoulder strength test and not do the ASH test. That’s kind of like what I did for my overhead athletes. Now, I have a rugby player right now, a female rugby player. We actually started her rehab progression now to prepare her to pass the closed kinetic chain upper extremity test. And all honestly, we’re starting exercises to say like, “All right, we’re going to actually do that.” We’re going to do an ASH test on her because I want to see her exert force side to side that’s similar. So I think that’s going to go well. I think actually too, it’s going to be almost like that apprehension that you may have when you’re not ready as well.
So I think there’s some benefits of those things. I just don’t think they’re magic. Like, man, if you don’t pass this test, you’re not going to do well. Or you have to pass this test in… I don’t know. I don’t know. Those are kind of my thoughts on the upper extremity stuff. But I don’t know, what do you guys think? I mean, somebody else jump in on your thoughts on all this testing with upper extremity. I know we’ve been dabbling with them for years, but what do you guys think?
Diwesh Poudyal:
The one that kept coming to my head was also the ASH test, and especially looking at the paper, how it mentions the instability rate and the return to sport rate is way lower for your overhead athletes, like your pitchers. So, I think maybe something a little bit more in that specific position with arm extended out away from the body, maybe even closer to overhead, and maybe testing in that 180 position that Brendan mentioned for the ASH test, or maybe even the 135. I think that’s maybe a viable test. And I think the other thing that maybe we can start looking at is the rate of force development from that test. The nice thing about force plates is that they are super sensitive for time measures.
So instead of just testing for max peak force in those overhead positions or at that quarter position, maybe look at RFD because we’re probably going to get a pretty good idea of just general strength from your isometric dynamometery test, but maybe we get a little bit more of like RFD testing and the capacity, like you mentioned, Mike, of like, can you do this movement with a lot of force and really fast? Because that’s likely the demand that we’re going to be seeing when it comes back to getting ready to throw or throwing well to be able to return back to the previous level.
Mike Reinold:
Yeah, it makes a lot of sense.
Diwesh Poudyal:
So I think ASH tests are worth messing with.
Mike Reinold:
I mean, with the rate of force development on a contact kind of athlete, it makes sense to try those things. I think it’s worth playing with here because I think if they’re truly not ready, you’re going to see a side to side difference for sure. But I don’t know. The reason why the rates are so low in overhead athletes has nothing to do with their ability to do an ASH test. It has to do with… They probably shouldn’t have had the surgery, but that’s a whole other conversation that has nothing to do with that. You’re not going to get back to throwing if you have a Laterjet. It’s not happening.
But I don’t know. Dave, in your gymnasts, what’s been your experience with some of this testing? Because I know obviously I would feel a lot better if my gymnast passed some tests. So what’s your experience in that?
Dave Tilley:
Yeah, I think it’s similar to what you were saying, is a lot of those studies look at strength versus the progression and rehab and how they do well. And maybe it’s my fault. Maybe I should be much more regimented and give a standard criteria. But the challenging thing is that there is no normative data, or what do I know is good? What are some of the tests and measures? We have LSI, we have torque, we have all sorts of ranges that we know are good for lower extremity stuff. So if I do an ASH, or how far should this med ball toss go? For a 14-year-old female gymnast or an 18-year-old gymnast who had whatever, a Bankart repair, what’s good? Is it like, okay, that’s just far? Is it close? Is it far? The ASH test and stuff like that. Symmetry, of course, but is there a rate of force development thing?
I don’t know what I’m really looking for. And I think, again, maybe it’s a half user error on me that I haven’t dug in enough to know normative data for my population, but just having a set of tests is one thing, but how do you know passing versus good versus bad? I know with lower extremity stuff, I can talk to Diwesh about a squat jump, a kind of move and jump, a 10-hop test, a single leg depth drop, and look at very specific metrics on the force plate for good versus bad eccentric breaking RFD. But does that matter for an ASH test that if I push in this millisecond faster? I think it’s a little bit more murky for me to use them. We’re making big decisions based on these tests sometimes. So I’m clearing somebody to play or not, and many people have a scholarship waiting on my decision to say when they’re going back. And so I need some concrete data before I start suggesting someone’s ready or not.
Mike Reinold:
Well said.
Brendan Gates:
I will say, yeah, we don’t need to keep this going longer than it has to, but VALD actually put out some interesting data on RFD and peak force for baseball players for the ASH test. I just linked it in the chat. I have no idea how that works with this format, but it’s there. So if you’re interested more, there are some norms that you can tie to, and I’m happy to talk about them more. We can let people go find them on their own, but there is a little bit out there. And then I did find a paper, too, previously talking about NCAA athletes who were healthy, doing both the upper quarter Y-balance test and then the upper extremity stability test. And so there are some norms out there, but like you said, how are we to know that those are super accurate? It’s definitely something we need to look more at.
Mike Reinold:
I think it goes back down to the psychological readiness and that thing. You pass these tests when they can perform them, I think, with confidence. And even an ASH test, which you think we’re probably trying to get a number or a rate of force development number versus the closed kinetic chain upper extremity where you’re… I guess you’re getting numbers of taps, but theoretically it’s the performance of it. I think you do that, and you’re going to know the person’s going to know I’m ready. It feels good. It feels similar side to side. They’re confident in their ability to perform the test. I don’t know. I guess that’s my optimism in some of these tests, is it’s very apparent to the person.
Lenny Macrina:
Lower extremity has always been sexier, for lack of a word, in doing research. So I think maybe we get this data in the next five or 10 years, now that we recognize we need more data, but lower extremity ACL rehab, ACL research, normative data has always been, at least in my 20-plus-year career… It’s the better research to do. You know what I mean? Or it’s just more prevalent. I don’t want to say better. It’s just more prevalent in general. So maybe we get this data out of the way of force plate data. We recognize we need it, so somebody will do it. It’s just going to take a long time.
Diwesh Poudyal:
It seems like a good challenge.
Mike Reinold:
Yeah.
Diwesh Poudyal:
All these resources have been spent on lower body, but maybe it’s time to step up our game for figuring out some of these testing parameters for the upper body, but I don’t know.
Mike Reinold:
I still think the lower body, we’re doing jumps, we’re doing hops…
Lenny Macrina:
And it’s different, correct. Yeah.
Mike Reinold:
That makes sense, right?
Lenny Macrina:
Yeah, it’s different.
Mike Reinold:
I mean, I’ve never had a rugby athlete get on the field, lie on their stomach, and push real hard into the ground. You know what I mean? Or go into a tall plank and tap their shoulders in the middle of a game. It’s just like… I’m being blunt. I’m not saying these things aren’t necessary or anything like that. It’s just, I think that’s the reason why they’re still not popular, is they don’t feel specific enough to a lot of people.
Dave Tilley:
Jumping is jumping.
Mike Reinold:
Yeah. I mean, you’re never going to deny a jump is a jump, and that’s what you need to get back to a sport. And if you jump poorly, it’s probably not going to go well, but like, these tests I think are just different. So sometimes we come up with a test to just come up with a test to say we did something. But that being said, I think, more than anything else, does this challenge the person to feel more comfortable with their ability to perform? And I think that’ll show. If you do poorly at these tests, the person’s not comfortable. So I think that’s the big take home for me.
Cool. Awesome. Thank you, Brendan. Great job with the review. Another great article from IJSBT. Again, good success rates. I think it’s awesome. And I think it spurred the conversation. How can we do a better job with objective testing? How could we do a better job with functional testing? And then we should be doing some psychological readiness in these athletes. I think we’re crazy not to. Might as well. I mean, so let’s be a little bit more dynamic with what we do with our athletes, but awesome.
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