AAOS Now

Published 9/1/2016

High RTP Rates After Shoulder Surgery

Level of play similar before and after instability surgery
Study data presented at the 2016 American Orthopaedic Society for Sports Medicine annual meeting indicate that return to play (RTP) rates are high for intercollegiate football players following shoulder stabilization surgery.

Football athletes from seven programs in the Pacific-12, Southeastern Conference, and Atlantic Coast Conference participated in the IRB-approved study. In all, 153 athletes (177 shoulder injuries) who were active on their team's rosters during the 2004–2013 football seasons and had required surgical treatment for shoulder instability met the inclusion criteria. The researchers collected the following data for each athlete:

  • direction of instability
  • type of surgery
  • RTP time
  • quality and level of play before and after surgery

The researchers analyzed the data to determine overall RTP rates and to see whether variables, such as depth chart position and scholarships, influenced RTP.

Most of the surgical interventions were isolated arthroscopic stabilization procedures. Overall, 85.4 percent of athletes who underwent arthroscopic surgery without concomitant procedures returned to play. Researchers found no statistical difference in RTP rates, regardless of the procedure—posterior labral repair, anterior labral repair, or combined labral repair (Table 1). They found that athletes who underwent surgery played in more games after surgery than before (49.9 percent of games before surgery to 71.5 percent after surgery).

With respect to depth chart position, 93.3 percent of starting players, 95.4 percent of utility players, and 75.7 percent of rarely used players returned to play. Among the 45 starting players, 93 percent returned to play, with 91 percent returning to the same level of play following surgery. Players with less game time also returned to play at the same or higher level after surgery. 

"We found no significant statistical difference in RTP rates between the various types of shoulder instability surgeries. However, athletes who were starters were more likely to return to play than less-utilized players," said the study's lead author R. Judd Robins, MD, of the U.S. Air Force Academy Sports Medicine Service. "Having a scholarship also seemed to significantly correlate to an individual's returning to play following surgery.

"Our findings suggest that the majority of football athletes who have some form of shoulder instability repair are able to return to the sport and progress as players in their respective football programs," said Dr. Robins. 

Dr. Robins' coauthors of "Return to Play after Shoulder Instability Surgery in NCAA Division I Intercollegiate Football Athletes" are Jimmy Hoshang Daruwalla, MD; Seth C. Gamradt, MD; James E. Tibone, MD; Jeffrey M. Tuman, MD; Jason L. Dragoo, MD; Matthew A. Javernick, MD; Eric C. McCarty, MD; Eric M. Yochem; Robert E. Hancock, MD; Jennifer H. Miley; Alexis E. Pilato, MD; Jeffrey A. Guy, MD; Stephanie A. Boden; John W. Xerogeanes, MD; and Patrick E. Greis, MD.

The authors' disclosure information can be accessed at www.aaos.org/disclosure