Management of Shoulder Instability in the Overhead Athletes

Return to Sport After Shoulder Injuries in Mixed Martial Arts: Implications on Longevity and Performance

Background/Objectives: Mixed martial arts (MMA) is a combat sport which heavily involves upper limb strength, mobility, and stability. Shoulder injuries, given their impact on striking and grappling, may significantly hinder performance and career longevity. However, their specific effects on competitive outcomes remain poorly defined. This study evaluates return-to-sport rates, fight performance, and long-term success in professional MMA athletes following shoulder injuries. Methods: A retrospective cohort study was conducted using publicly available databases to identify professional MMA fighters from the UFC, Bellator, and Strikeforce who sustained shoulder injuries requiring withdrawal from scheduled bouts. Fighter demographics, injury characteristics, and treatment approaches were recorded. Performance metrics-including winning percentage, takedown (TD), knockdown (KD), and significant strike (SS) rates-were compared before and after injury. Independent t-tests were used, and significance was set at p < 0.05. Results: A total of 27 fighters with 34 documented shoulder injuries were included. The most common injury was a torn labrum (41.2%), with 76.5% requiring surgical intervention. Aggregate winning rates significantly declined from 81.96% pre-injury to 54.7% post-injury (p < 0.001). Aggregate KD rates also dropped significantly (p < 0.001), while TD rates trended downward without reaching statistical significance. SS rates remained stable, suggesting potential compensatory mechanisms. Injury recurrence was observed in 22.2% of cases. Conclusions: Shoulder injuries in MMA are associated with a substantial decline in competitive success, particularly in knockout capability, emphasizing the critical role of shoulder integrity in fight performance. The high recurrence rate suggests the need for optimized rehabilitation protocols and stricter return-to-sport guidelines to enhance fighter longevity.

Editorial Commentary: The Shoulder Instability-Return to Sports After Injury Scale Is More Than Just a Psychological Readiness Tool-It Is a Potential Predictive Model for Outcomes and Recurrence

The Shoulder Instability-Return to Sports After Injury (SIRSI) scale is a useful psychological readiness tool to determine whether athletes are prepared to return to sport. Although questions remain on the optimal timing of survey administration based on the type of procedure (i.e., arthroscopic Bankart repair vs Latarjet procedure) and external factors contributing to psychological readiness, its current use begs the question of what other applications may be appropriate. The SIRSI scale has recently been able to effectively predict patient-reported and clinical outcomes, such as postoperative instability recurrence. However, it also may have added value as a serial screening tool for determining a safe return to preinjury activity rather than just serving as a harbinger of further negative outcomes after shoulder stabilization. Increasingly, we must recognize the fundamental limitations in our current rehabilitation pathways and sometimes myopic, 1-dimensional return-to-play criteria (e.g., range of motion or isokinetic testing) in facilitating a safe return to competition. We must transition to a more regimented, criteria-based return-to-play battery that incorporates optimized psychological readiness. As such, the SIRSI scale, like its anterior cruciate ligament counterpart, could become the standard of care in determining confidence in returning to sport and ultimately serve as a benchmark of surgical success.