Outcomes and Return to Sport Testing After Bankart and Laterjet Shoulder Stabilization Surgery - #AMR388

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 see full show notes and more, head to: https://mikereinold.com/outcomes-and-return-to-sport-testing-after-bankart-and-laterjet-shoulder-stabilization-surgery/

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Transcript

Intro and Free Course Invite

SPEAKER_04 0:48

On this episode of the Ask Mike Reinhold Show, we do a journal article review looking at the success rate of Bancart and Latter J procedures and what we can do to improve our return to sport testing. The Ask Mike Reinhold Show. Helping people feel better, move better, perform better. Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training. If you want to learn how to get started optimizing and enhancing performance, this is the course for you. Head to micrunnell.com/slash performance to sign up today. Back everybody to the latest episode of the Ask Mike Reynolds Show. We are here with another journal article review episode for you. I have Anthony Vedetto, Brendan Gates, Dave Tilly, Lenny McCrina, DeWesh Podell here answering, uh not answering, but reviewing a journal article here. Kind of some new stuff we're trying. Let us know if you'd 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. And you know, IJSPT just continues to produce such good clinically relevant stuff. I just love this stuff. Um, but I love this. I love not you know, return to competition, shoulder stabilization, decision making. We need this, right? We talk about this with ACL

Why Shoulder Return To Sport Matters

SPEAKER_04 2:25

all the time. It's it's exciting to see an article on this for um for for shoulder surgery. So, Brendan Gates for the review, what do you got for us? How was the article?

SPEAKER_00 2:35

Yeah, it was a good article. I liked it. I found it very interesting. I'm excited to talk about it. I think uh good segue talking about the ACL background. I think we'll talk about that a little at the end. Um, but let's get into it. So the purpose of the study was twofold. Uh, 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 bank art and ladder J procedures. Um, importantly, they differentiated that return to sport in this study. They were talking about return to sport uh of previous level or pre-injury level, not just back to sport in any uh capacity. Um the second thing they set out to do was to describe how return to sport decision uh decisions are being made, and they wanted to look at the time frames and the criteria used for clearance after these procedures. Um 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 the instability rates, and there was no standardized approach to clearing athletes

Study Setup and Who Was Included

SPEAKER_00 3:35

after these surgeries. So, as you mentioned, is this was a scoping review. Um, 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 uh after these anterior shoulder stabilizations. So they focused on competitive athletes because they thought too many of the previous papers that were coming out were including recreational athletes, and they thought that this was underestimating the true return to sport uh outcomes in these higher level populations. Um, the ages that they looked at in these studies ranged from 16 to 40. Uh, one thing to note, this was 93% male subjects, um, for what it's worth. But in the study they, or excuse me, in this study, they included 29 papers that they looked at. There was 2,187 athletes, uh, 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 bank art repair, so the soft tissue stabilization. They had a hundred or excuse me, 1,467 subjects, and they had the latter J procedure, which had 770 subjects. Um, 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 uh clearance decisions. So what did they find? Overall, so they had hypothesized that the return to sport of pre-injury levels were gonna be somewhere between 65 to 75 percent based on the previous literature, and then the uh recurrent instability rates are gonna be somewhere between 10 to 20 percent. Uh and they found that overall, 82.3 percent of these competitive athletes returned to their prior or pre-injury level of sport, so better than they had anticipated. Um, if we break it down by procedure, the bank art repair had a return to sport of previous uh level of 79.7 percent and a recurrent instability rate of 9.2%, so lower than their anticipated 10 to 20. And then the latter J had uh slightly better numbers at 87.4 return to sport of previous level, and the recurrent instability was all the way down to 3.1%. Um so the outcomes were generally

Return Rates and Reinjury Numbers

SPEAKER_00 5:46

pretty good. Um the latter J did tend to have a higher return to uh previous level of sport rate and a lower recurrent instability rate. They also had a smaller sample size than the bank art. Um the next thing they looked at was the time to return to sport, and uh this varied drastically. So it varied from 11 weeks to 8.4 months. Okay. Uh but they did say high 60% of the studies cleared athletes around five to six months. Um and then they looked at clearance criteria as well. The two most common criteria 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. Um very few of the studies used some sort of objective testing battery, so using psychological readiness assessments, functional performance measures, uh, and those that did were very, uh, very varied and they were not standardized. So clinical implications, uh I think overall, in general, uh 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 uh these that's a pretty good number in my book. Um the procedure choice, you know, may matter. Um they found that the latter J procedure did have those slightly better outcomes and lower recurrent instability rates, uh, especially for a high-risk athlete who is um dislocating quite a bit, maybe has some bone loss, bone loss of the glenoid. Um, but again, this was in general, and the uh the sports that were included we can talk about a little bit more, but this was not specific to something like an overhead thrower, you know, baseball player, javelin. So I'm sure we'll talk about that. Um they found that, yeah, the return to sport decisions are poorly standardized. You know, most clinicians are still relying on time since surgery, which you can't replace tissue healing, right? But then strength and range of motion were the other two that they looked at. But they didn't really do much else. Um they kind of just felt it out and sent them off. Uh 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. Um, so the framework that they uh suggested was yes, look at the strength and the range of motion testing, you know, use the handheld dynamometer, you know, be very objective with that. But then maybe start to add in some functional testing. You know, they mentioned ideas of the athletic shoulder test, um, the closed kinetic chain upper extremity stability test, uh, the upper quarter Y balance test, and then uh, you know, there's some other ones out there, the seated shot put, the FTPI, you know, the ball drop, there's quite a few out there. Um they suggested using the Circe or the TSK 11 for psychological readiness,

The Big Gap in Clearance Criteria

SPEAKER_00 8:22

similar to how we use like the ACL RSI. And then they said there needs to be some sort of exposure to sports-specific demands, you know, so for a baseball player introducing an interval throwing program or uh you know a graded exposure to contact for maybe a football player. Um I know we have our own you know battery of tests for clearance that we use at Champion. I'm sure the listeners are excited to hear about that, but uh, I'll open it up to you guys. Uh excited to hear your thoughts on this paper.

SPEAKER_04 8:47

Love a great overview, Brendan. That was awesome. Uh cool article, right? I mean, man, that's uh I I love seeing the the success, right? I mean, 80 to 87 percent, depending on the procedure. Um, I love seeing the Ladder J not only return more, but have a lower recurrence rate too. That's actually um pretty cool to see. So I'd like seeing that. Um, I don't know. What do you guys think about um you know the outcomes, the time frames? I'd be kind of you know curious your thoughts on the time frames. I really I want to meet that guy that came back in 11 weeks, to be honest with you. I'd be curious what what he's up to. But uh yeah, Dave, what do you think?

SPEAKER_05 9:19

Yeah, I can jump in first because my thoughts are around like the it's obviously something I think like this study is explaining what many of us clinicians feel like the stress of like the return to sport lack of criteria. But in my mind, I was thinking so much around like ACL, right? Like you can't say it's a procedure successful quote unquote, like they get back to a high-level level and they don't have instability only based all along the procedure itself, right? Think about ACL. If we have someone who has like ACL, LET, and a meniscus, like so much of their rehab is gonna be based upon yes, the surgery goes well, the surgical technique, the early range of motion stuff, and all that, but like a lot of their success is like the 12, 16, 20,

Rehab Quality Drives Outcomes Too

SPEAKER_05 9:55

24 strengthening program and a lot of the work that goes in between. And so I I was thinking actually about duacing the strength coaches about like how a lot of our quote unquote success with ACL is like we have this very in-depth hardcore strengthening, agility, speed change of direction program that we put people through well after the surgery is quote unquote 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 bank cart, yes, you can have a really good um ladder J go well. But if you took that person and just said, like, all right, we're gonna wait it out, do some basic dumbbell stuff, and then like let's see how it goes when you go back to, and to Brennan's point, not even a QB uh 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 uh 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 a dynamic stabilizer, you know, restore passive stability, but like there's a huge range in who's gonna be rehabbed in a very s 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. Like 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.

SPEAKER_04 11:44

Yeah, and that whole 80% LSI, I feel like that's you know, I don't know, I guess it's important in the leg too. I was gonna say it's even more important in the upper body, but me I I think it's important in both. You know, 80% LSI is a failure in my mind. Like that's uh, you know, that's that's it's it seems like you did a bad job if you uh if you hit uh 80% LSI. But um yeah, I I I thought it was crazy. I mean, there at Champion, obviously, you know, I I think time, range of motion, and strength are just so obvious, right? Brendan brought that up, right? Those are they're so obvious. You need those, especially with an anterior stabilization procedure. Range of motion is like key. Like 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, right? I like how they said, you know, 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 just they say, like, 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 that they kind of um recommended, what are your thoughts on them? Do you have any that you you think like you either are trying or you want to try more? Because you know, I I would say in the past, like to me, I've always thought my athletes are ready when their range and strength is back and they've gone through a rehab progression where I've seen them do a lot of dynamic activities. Like I know that they're gonna be successful when they get back to the sport because I saw it, you know, with their rehab process, right? And while that's I think appropriate, yeah, 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? Does anybody, you know, where where are we at and what kind of test do you think we want to use? Who wants to start? Brendan, maybe?

SPEAKER_00 13:26

Yeah, I can start. Um I was doing quite a bit of research on these a couple months ago. Um, and there's some interesting data uh coming out about the athletic shoulder test, and uh you can use the force plates to quantify the strength in those three positions. So they kind of look at like 180, 135, and 90 pushing straight down to the force plates. Um and they're coming out with some norms and they're coming out with uh some data about you know improved outcomes with better test scores on the athletic shoulder. Um I haven't used it a ton clinically, other than just playing around with it, but certainly something I'm interested in. Um I think for me, you know, I at this point, I just

Which Functional Tests Are Worth It

SPEAKER_00 14:02

am not so sure how the numbers from that are gonna dictate the rehab plan that I make. Um, you know, I'm still gonna do I's, T's, and Y's. I'm still gonna do a lot of the cuff strengthening, obviously, and then slowly get them into a graded uh program in the gym. So I don't want to waste time. Uh, 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. Um of the others, though, I think uh, you know, outside of the baseball players, I know there's a Kevin Wilkes paper that goes through kind of a battery of criteria of uh functional performance measures, and he talks about the FDPI, the ball drop test, some of the 90-90 dribbles and things like that. Um those are interesting. Uh outside of the baseball players, you know, um there's some that I think are more valuable. So I had a wrestler who had an anterior uh dislocation, bank art repair, um, and we did quite a bit of like the closed kinetic chain stuff, and we use that in his rehabs with like planks with shoulder taps that mimics kind of the demands of the closed kinetic chain um upper extremity stability test. Um, you know, I even I know it's for posterior instability, but the one-arm hop test, I don't know if you guys have seen that one. Uh it's pretty aggressive. You like pretty much do a one-handed push-up position, you jump on and off of a step. Like I had a hard time showing it to this kid. Um, but I use that more as like uh an exercise or almost like a heavy impact plyo um 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 um 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 like a battery where like, okay, you got to hit this, this, this, and this before I let you go back to your sport. Um, but I like a lot of the parts of the tests. So anyway, that's my thoughts.

SPEAKER_04 15:42

Yeah you know what, like the way you describe all those, right? When you go through all those tests and you read all these tests, what what are they 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 you know, for example, like you know, the drop ball test, right? Like if you're if you have low capacity on that, like and you're 50% of the other side, then yeah, you're you're you're probably not ready because you just haven't built the capacity. I like that. Um, things like you know, the you know, the closed connected chain tests or uh maybe the ash test, you know, 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. Um, I don't know. I mean, I'm still I I've still found it very rare that I've wanted to do an ash test on somebody. Um, you know, and you know, I do work with a lot of overhead athletes that I certainly don't feel the need to do an ash test for. Um looking at the literature, it's it's reliable. I like it. It's in there's studies showing it's valid, meaning that like 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. Right. 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. In all honesty, like we were starting exercises to say, like, all right, we'll we're gonna actually do that and we're gonna do ash tests on her because I want to see her uh exert force side to side that's similar. Um, so you know, I I think that's gonna go well. I think actually, too, it's gonna be like 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, right? Like, man, if you don't pass this test, you're not gonna do well. Or you have to pass this test, like in I I don't know. I just I don't know. Those those are kind of my thoughts on the upper extremity stuff. But um, I don't know. What do you guys think? I mean, somebody else jump in on on your thoughts on all these testing with the upper extremity. I know we've been dabbling with them for years, but what do you guys think?

SPEAKER_02 17:46

The one the one that kept coming to my head was also the hash test. Um, especially kind of looking at the paper, how it mentions um the the instability rate and uh the return score rate is way lower for your overhead athletes like your pitchers. Um I think maybe something a little bit more in that specific position with the arm rate extended out away from the body, maybe even closer to overhead, maybe testing in that 180 position that run dimension for the extra sensor, maybe even 130 to highlight. Um I think that's maybe available test. And I think the other thing that maybe we can start looking at is maybe the the rate of force in the element of force rates is that they are super sensitive towards measures instead of just testing for matrix for in those origin positions or you know kind of like order positions. Maybe look at RD, because we we're probably gonna get a pretty good idea of general training from your isometric and a monitoring test. But maybe we get a little bit more of like R and D testing and like capacity, like you mentioned, like of like can you do this movement with a lot of force and really fast? That's likely the demand that we're gonna be seeing when it comes back to you know getting ready to throw or throwing well to be able to you know return back to their previous level. So I think I think AshTh is worth mentioning with the U.S.

SPEAKER_04 18:59

I mean with the rate of force development on a contact like kind of athlete, it makes sense like you know, to try those things. I think it's worth kind of you know playing with here. Because I think if they're truly not ready, you're gonna see a side-to-side difference for sure. You know, but you know,

Rate Of Force and Overhead Reality

SPEAKER_04 19:12

I don't know. The reason why the rates are so low in overhead athletes has nothing to do with their ability to to do an ash test. It has to do as they probably shouldn't have had this surgery, but that's a whole nother conversation that that has nothing to do with that. Like you're not gonna get back to throwing if you have a a ladder. It's not happening. Um, but I don't know, Dave, in your gymnast, what's been your experience with like some of these testing? Because I know obviously um I would feel a lot better if my gymnast passed some tests, right? So what what's your experience in that?

SPEAKER_05 19:42

Yeah, I think it's similar to what you were saying, is like a lot of those studies look at like strength versus the progression and rehab and like how they do well. And and maybe it's my fault, maybe you know, I should be much more regimented and give a standard criteria. But the challenging thing is that there is no like normative data or like what do I know is good? You know, like what are some of the tests and measures? You know, we have LSI, we have torque, we have all sorts of ranges that we know are good for like lower extremity stuff. So if I do an ash or like how far should this med ball toss go? Like for a 14-year-old female gymnast or an 18-year-old gymnast who had whatever a bank art repair, like what's good? Is it like, okay, like that's just like far? Is it close? Is it far? The ash test and stuff like that. Symmetry, of course, like, but is there a rate of force development thing? Is there a 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 like normative data for my population, but just having a set of tests is one thing. But like, how do you know passing versus good versus bad? I know with lower extremity stuff, I can talk to Duesh about a squat jump, a counter moving 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, right? But like, does that matter for an Ash test that if I push in this millisecond faster, I think it's like a little bit more murky for me to like use them. We're making big decisions

Missing Norms and High Stakes Decisions

SPEAKER_05 21:00

based on these tests sometimes. So I'm 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.

SPEAKER_04 21:12

Well said.

SPEAKER_00 21:15

I will say uh yeah, I don't need to, you know, we don't need to keep this going longer than it has to, but uh Vauld actually put out some interesting data on RFD and peak force for baseball players for the uh ash test. Uh I just linked it in the chat. I have no idea how that works with this format, but um, it's there, you know. So I I if you're interested more of that, there is some norms that you can tie to um and happy to talk about them more or you know, we can let people go find them on their own. Um but there is a little bit out there, and then I did find a paper too previously talking about NCAA athletes uh who were healthy doing both the upper quarter Y balance test and then the uh upper extremity stability test. And so there are some norms out there, but like you said, you know, how how are we to know that those are super accurate? Um definitely something we need to look more at.

SPEAKER_04 22:02

I think it goes back down to like the psychological readiness and that thing. You you pass these tests when they can perform them, I think, with confidence, right? And you know, even even an ash test, which you think, you know, we're probably trying to get a number right or a rate of force development number versus like you know the closed connection upper extremity where you're you know you're I guess you're getting numbers of taps, but like theoretically it's performance of it. Um I I think you're just gonna you you do that and you're gonna know the person's gonna know like I'm ready. You know, that feels good, it feels similar side to side. They're confident in their ability to perform the test. Like, I don't know. I guess I get that's my optimism in in some of these tests is it's very, very apparent to the person, right?

SPEAKER_01 22:41

Lower extremity has always been uh uh sexier for lack of a lack of a word in in doing research. So um so I think maybe we get this data in the next five or ten 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 twenty plus year career, as is it's it's the better research to do. You know what I mean? So like or it's just more prevalent. I don't want to say better, it's just more prevalent uh in general. So maybe we get this data now that we have force plate data, we recognize we need it, so somebody will do. Do it, it's just gonna take a long time.

SPEAKER_03 23:18

Seems like a good challenge, right? Yeah, 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.

SPEAKER_04 23:29

I still think though, lower body, like you're we're we're doing jumps, we're doing hope. And it's different stuff. Yeah, that makes sense, right? I mean, I'm never flying, I've never had a rugby athlete get on the field, lie on their stomach, and push real hard into the ground. Right. You know, it's like it's just you know you know what I mean, or or or go into a tall plank and tap their shoulders in the middle of a game. Like it's just like you know, like I'm I'm just I'm being blunt, you know, like I'm 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're they they don't feel specific enough to a lot of people. Jumping is jumping. Yeah, I mean you're never never gonna deny like 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 gonna 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 you know, that being said, I think more than anything else, is does this challenge the person to feel more comfortable with their ability to perform? And I think that I think that'll show if you do poorly at these tests, the person's not comfortable, right? So I I I think that's the big take-home for me. So cool. Awesome. Thank you, Brendan. Great job with the review. Uh, another great article from IJSBT. Again, good success rates. I think it's awesome. And I think, you know, it spurred the conversation. How can we do a better job with objective testing? How can we do a better job with like functional testing? And then, you know, we should be doing some psychological readiness in these athletes. I think we're we're crazy Nazi, right? Might as well. I mean, so you know, let's be a little bit more dynamic of what we do with our athletes. But awesome. Uh, if you uh like these articles, please let us know. We want to hear about these journal article reviews. Send us some comments on social media, let us know, and be sure to subscribe so you can get episodes in the future. Thank you.