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Maggini E, Tedah Djemetio MD, Husband I, Paganelli L, Saccomanno MF, Milano G. Criteria, Timing, and Factors Associated With Return to Competitive Sport After Rotator Cuff Surgery. Sports Med Arthrosc Rev 2024; 32:22-32. [PMID: 38695500 DOI: 10.1097/jsa.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Rotator cuff pathology in competitive athletes is common and may produce chronic symptoms and joint disability, impairing sports participation and leading to premature retirement. Athletes are a high-functioning patient population with unique characteristics. Decision-making for return to sport is a complex and multifactorial process. Literature is sparse and does not provide precise guidelines to assist physicians to make the right decision. This review aimed to highlight factors affecting outcome, timing, and criteria for return to competitive sport after rotator cuff surgery to help physicians to clearly counsel athletes and make high-quality decisions for return to sport.
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Affiliation(s)
- Emanuele Maggini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Mac Donald Tedah Djemetio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Isabella Husband
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Luca Paganelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
| | - Maristella F Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Shim SS, Confino JE, Vance DD. Common Orthopaedic Injuries in CrossFit Athletes. J Am Acad Orthop Surg 2023; 31:557-564. [PMID: 37155727 DOI: 10.5435/jaaos-d-22-01219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/01/2023] [Indexed: 05/10/2023] Open
Abstract
CrossFit is a high-intensity exercise program that has gained popularity over the past few decades. CrossFit combines movements from Olympic weight lifting, gymnastics, powerlifting, and high-intensity interval training. As CrossFit continues to expand, knowledge of the associated orthopaedic injuries to aid providers in diagnosis, treatment, and prevention will be increasingly important. The most common CrossFit injuries occur in the shoulder (25% of all injuries), spine (14%), and knee (13%). Male athletes are markedly more likely to experience injuries than female athletes, and injuries occur markedly less when there is supervised coaching of the athletes. The most common causes of injury in CrossFit include improper form and exacerbation of a prior injury. The purpose of this article was to review the literature to aid clinicians in identifying and treating common orthopaedic injuries in CrossFit athletes. Understanding the injury patterns, treatment, and prevention options is important for a successful recovery and return to sport.
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Affiliation(s)
- Stephanie S Shim
- From the Department of Orthopedics, Columbia University at Mount Sinai Medical Center, Miami Beach, FL (Shim and Vance), and the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY (Confino)
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Khan AZ, Stoll KE, Erickson BJ. Rehabilitation and Return to Work and Sport After Rotator Cuff. Clin Sports Med 2023; 42:175-184. [DOI: 10.1016/j.csm.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nicolay RW, Moore LK, DeSena TD, Dines JS. Upper Extremity Injuries in CrossFit Athletes-a Review of the Current Literature. Curr Rev Musculoskelet Med 2022; 15:402-410. [PMID: 35867271 DOI: 10.1007/s12178-022-09781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Cross-discipline fitness, or CrossFit, has exploded in popularity during the last two decades. During this time, there have been a high volume of patients presenting to clinicians with a wide range of associated injuries. Given the high intensity, high repetition, and competitive nature of CrossFit training and competition, athletes are vulnerable to injury, particularly upper extremity injury. The rate of injury to the shoulder, elbow, and wrist in CrossFit is higher when compared to traditional weight-training and more comparable to elite-level gymnastics and Olympic-style lifting. Due to the growing popularity of CrossFit-style exercise and the relatively high rate of injury among its participants, clinicians are likely to encounter these athletes. The purpose of this review is to familiarize clinicians with CrossFit and the associated injuries they will likely encounter. RECENT FINDINGS The medical literature focusing on CrossFit has demonstrated exponential growth, with the first article published in 2012 and 59 articles published in 2020. Although the body of literature is growing, there are no high-level studies focusing on CrossFit. The literature mainly consists of level IV and V studies, primarily consisting of case reports and case series. Recent studies have proven that CrossFit athletes are vulnerable to high rates of upper extremity injury and a few studies have identified risk factors for injury. Future high-level research is required to study modifiable risk factors, diagnostic criteria, and treatment options for these high-risk athletes in order to improve the safety of their sport. The CrossFit body of research is limited to level IV and V studies; however, the literature is clear, CrossFit athletes face a high rate of upper extremity injury. For this reason, clinicians must be familiar with CrossFit and its associated pathology. The goal of this review is to familiarize clinicians with CrossFit and the associated pathologies they will likely encounter.
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Affiliation(s)
- Richard W Nicolay
- Hospital for Special Surgery, 429 E. 75th St., New York, NY, 10021, USA.
| | - Laura K Moore
- Hospital for Special Surgery, 429 E. 75th St., New York, NY, 10021, USA
| | - Tyler D DeSena
- New York University, 50 W. 4th St, New York, NY, 10012, USA
| | - Joshua S Dines
- Hospital for Special Surgery, 429 E. 75th St., New York, NY, 10021, USA
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da Silva LG, Ferrer RM, de Souza JR, Gracitelli MEC, Secchi LLB. Rehabilitation After Surgical Treatment of Pectoralis Major Rupture in a CrossFit® Practitioner: A Case Report. Int J Sports Phys Ther 2022; 17:724-731. [PMID: 35693859 PMCID: PMC9159717 DOI: 10.26603/001c.35720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose The upper limbs are frequently injured during CrossFit® practice, and in some cases, surgical repair is recommended. The purpose of this case report was to describe the rehabilitation process performed after the surgical repair of a pectoralis major rupture in a CrossFit® practitioner. Design Case report. Case Description The subject was a 26-year-old man, with 1.75m and 69kg, who practiced CrossFit® for five years and sustained the injury during the execution of the ring dip. The rehabilitation protocol was of 16 weeks duration. Passive modalities and exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements were performed. Shoulder range of motion was assessed through goniometry, and muscle strength was assessed through isometric dynamometry. Outcomes At week seven the subject had full range of motion, and at week fourteen achieved limb symmetry (Limb Symmetry Index - 84.78 - Abduction; 97.58 - Adduction; 86.15 - Internal Rotation; 85.06 - External Rotation) in muscle strength. The subject returned to his previous level of athletic activities. Conclusions: A 16-week protocol performed with exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements was abe to promote the return to sport at the pre-injury level in a CrossFit® practitioner.
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Affiliation(s)
- Lucas Gomes da Silva
- Physical Therapy Department, Centro Universitário Sudoeste Paulista (UNIFSP) - Campus Itapetininga - Itapetininga - Brazil
| | - Rafael Marques Ferrer
- Brazilian National Society of Sports Physical Therapy (SONAFE-Brazil) - São Paulo - Brazil
| | - José Roberto de Souza
- Sciences and Technologies in Health Post-Graduation Program, University of Brasília (UNB)
| | - Mauro E C Gracitelli
- Institute of Orthopedics and Traumatology, School of Medicine,, University of São Paulo - São Paulo - Brazil
| | - Leonardo Luiz Barretti Secchi
- Physical Therapy Department, Federal University of São Carlos (UFSCar) - Post-Graduate Program in Physical Therapy - Laboratory of Analysis and Intervention of the Shoulder Complex - São Carlos - Brazil., Federal University of São Carlos (UFSCar)
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Bravi M, Fossati C, Giombini A, Macaluso A, Lazzoli JK, Santacaterina F, Bressi F, Vorini F, Campi S, Papalia R, Pigozzi F. Criteria for Return-to-Play (RTP) after Rotator Cuff Surgery: A Systematic Review of Literature. J Clin Med 2022; 11:jcm11082244. [PMID: 35456339 PMCID: PMC9024603 DOI: 10.3390/jcm11082244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review of the literature aimed to highlight which criteria are described in the literature to define when a patient, after rotator cuff repair (RCR), is ready for return-to-play (RTP), which includes return to unrestricted activities, return to work, leisure, and sport activities. An online systematic search on the US National Library of Medicine (PubMed/MEDLINE), SCOPUS, Web of Science (WOS), and the Cochrane Database of Systematic Reviews, was performed with no data limit until December 2021. A total of 24 studies that reported at least one criterion after RCR were included. Nine criteria were identified and among these, the most reported criterion was the time from surgery, which was used by 78% of the studies; time from surgery was used as the only criterion by 54% of the studies, and in combination with other criteria, in 24% of the studies. Strength and ROM were the most reported criteria after time (25%). These results are in line with a previous systematic review that aimed to identify RTP criteria after surgical shoulder stabilization and with a recent scoping review that investigated RTP criteria among athletes after RCR and anterior shoulder stabilization. Compared to this latest scoping review, our study adds the methodological strength of being conducted according to the Prisma guidelines; furthermore, our study included both athletes and non-athletes to provide a comprehensive view of the criteria used after RCR; moreover, ten additional recent manuscripts were examined with respect to the scoping review.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
- Correspondence:
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
| | - José Kawazoe Lazzoli
- Biomedical Institute, Medical School, Fluminense Federal University, Niterói 24220-008, Brazil;
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico, 00128 Rome, Italy; (M.B.); (F.S.); (F.B.)
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, 00128 Rome, Italy; (F.V.); (S.C.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.G.); (A.M.); (F.P.)
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Goyette BN, Hudnall MT, Halpern JA. Testosterone Use in the Perioperative Setting. Curr Sex Health Rep. [DOI: 10.1007/s11930-021-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carbone S, Castagna V, Passaretti D, Candela V, Cerciello S, Delli Sante E, Gumina S. Supraspinatus repair and biceps tenodesis in competitive CrossFit athletes allow for a 100% of return to sport. Knee Surg Sports Traumatol Arthrosc 2021; 29:3929-3935. [PMID: 33159531 DOI: 10.1007/s00167-020-06345-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/20/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The shoulder is the most commonly injured body part in CrossFit training. The aim of this study is to report the clinical and MRI results of an arthroscopic repair of supraspinatus tear associated with SLAP lesion in competitive CrossFit athletes. METHODS Competitive CrossFit athletes affected by a full-thickness supraspinatus tear associated with SLAP lesion secondary to training injury were prospectively enrolled in the study. Clinical diagnosis was confirmed with MRI (> 1.5 T). Functional evaluation was done using the Constant Score (CS) and ASES score (ASES). All lesions were treated with single-row repair and biceps tenodesis. Minimum follow-up (clinical, MRI) was 24 months. RESULTS Nineteen patients were available at the final follow-up. The average age was 43-year-old (range 28-52, SD 8), 12 were males and 7 females. Pre-operative CS and ASES were 67 (range 61-77, SD 7) and 71 (range 62-79, SD 5), respectively. At the 24-month follow-up, 19/19 athletes resumed intensive training and 17/19 returned to competitions. CS and ASES rose to 90 (p = 0.039) and 93 (p = 0.04), respectively. At the final follow-up, MRI indicated complete healing of the tendon in 15 (79%) cases and 4 (21%) cases with type II Sugaya repair integrity. Two of the patients of the latter group did not return to their usual training level and showed type II (Kibler) scapular dyskinesis. CONCLUSIONS Arthroscopic repair of the supraspinatus tendon associated with biceps tenodesis led to a 100% of return-to-CrossFit training and 90% rate of individuals resuming competitions at 24 months of follow-up. MRI showed 15 (79%) cases of complete healing and 4 (21%) cases with type II Sugaya repair integrity; biceps tenodesis clinically failed only in 1 case and the athlete complained of a decrease in the competitions scores and opted to discontinue CrossFit competitions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefano Carbone
- Clinica San Feliciano, Via Giulio Pittarelli 114, 00166, Rome, Italy.
| | | | | | | | | | | | - Stefano Gumina
- Sapienza University of Rome, Polo Pontino, Latina, Italy
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Torres-Banduc MA, Jerez-Mayorga D, Moran J, Keogh JWL, Ramírez-Campillo R. Isokinetic force-power profile of the shoulder joint in males participating in CrossFit training and competing at different levels. PeerJ 2021; 9:e11643. [PMID: 34616590 PMCID: PMC8451436 DOI: 10.7717/peerj.11643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background As participants who engage in CrossFit training and competition perform a large volume of high intensity overhead activities, injuries to the shoulder are one of the most common in this sport. Previous research in other sports has indicated that the isokinetic force power profile of the shoulder joint (IPSJ) rotator muscles may assist in the prediction of shoulder injury. Aim Therefore, the objective of this study was to determine the IPSJ in males engaged in CrossFit training at different competitive levels. Methods In a cross-sectional study design, participants (age, 24.1 ± 2.7 years) classified as ‘beginner’ (n = 6), ‘intermediate’ (n = 7) or ‘advanced’ (n = 9) provided informed consent to participate in this study. The IPSJ assessment involved rotational and diagonal movements, including internal and external shoulder rotator muscles, at both 180°.s−1 and 300°.s−1. The variables analysed were peak torque/body mass (%), mean power (W) and the external/internal peak torque/body mass ratio (%). A Kruskal–Wallis test was used to compare the IPSJ of the three groups, with Dunn’s test used for post-hoc analysis. The alpha level was set at p < 0.05. Results The IPSJ showed greater torque and power values in those who competed at the advanced level as compared to those at a lower competitive level (i.e. intermediate, beginner). This was observed mainly for the internal rotation and internal diagonal movements at both 180°.s−1 and 300°.s−1. However, such differences between competitive levels were, in general, absent for the external rotation and external diagonal movements. Moreover, the participants from the advanced competitive level exhibited an imbalance of peak torque between the muscles responsible for the external–internal rotational and external-internal diagonal movements of the shoulder (i.e. peak torque external/internal ratio <66%), particularly in the dominant shoulder. Conclusion These findings suggest greater development of the shoulder internal rotators and a higher probability of shoulder injury in CrossFit athletes at the advanced competitive level. Based on these results, participants engaged in CrossFit training and competition may wish to increase the volume of training for the shoulder external rotator muscles to complement the large increases in shoulder internal rotator strength that occur as a part of their regular training regimes.
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Affiliation(s)
- Maximiliano A Torres-Banduc
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Las Americas, Viña del Mar, Chile.,Escuela de Ciencias de la Salud, Universidad de Viña del Mar, Viña del Mar, Chile.,Department Physical Education and Sports. Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Daniel Jerez-Mayorga
- Facultad de Ciencias de la Rehabilitación, Universidad Andres Bello, Santiago, Chile
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, United Kingdom
| | - Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia.,Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Griffith R, Fretes N, Bolia IK, Murray IR, Meyer J, Weber AE, Gamradt SC, Petrigliano FA. Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 1: Rotator Cuff and Shoulder Stabilization Procedures. Orthop J Sports Med 2021; 9:23259671211021827. [PMID: 34395687 PMCID: PMC8358521 DOI: 10.1177/23259671211021827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Standardized criteria are lacking to guide patient return to sport (RTS) after rotator cuff surgery (RCS) or shoulder stabilization surgery (SSS). Purpose: To describe RTS criteria used after RCS and SSS in athletic populations. Study Design: Scoping review; Level of evidence, 4. Methods: This scoping review was based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. A total of 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced search) and the gray literature were searched for English-language studies that reported at least 1 RTS criterion in athletes after shoulder surgery. Studies were assigned to the RCS or SSS subgroup based on the primary procedure performed. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. Results: Included were 52 studies and 2706 athletes (2206 male, 500 female, with a mean age of 28.8 ± 1.8 years). The RCS group consisted of 14 studies and the SSS group consisted of 38 studies. Time from surgery was the most common RTS criterion reported overall (37/52 studies; 71%) as well as within the RCS (93%) and SSS (63%) subgroups. Muscle strength (25/52 studies; 48%) and range of motion (23/52; 44%) were used by almost half of the included articles. RTS criteria reported less often were absence of pain, successful completion of sport-specific or position-specific test, proprioception, radiographic evaluation, patient-surgeon agreement, minimum time required to participate in pain-free throwing, and satisfactory scapulothoracic mechanics. All studies used 1 to 3 of the above RTS criteria; however, the definition of each criterion differed among the included articles. Conclusion: Time from surgery was the most commonly reported RTS criterion after RCS or SSS in athletes, whereas muscle strength and range of motion were used by almost half of the articles. There was high heterogeneity in the definition of each RTS criterion used among the included studies, which also used different combinations of 1 to 3 RTS criteria. These results suggest the need to better define quantitative and qualitative RTS criteria in athletes undergoing rotator cuff and shoulder stabilization procedures in order to safely return athletes to sport.
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Affiliation(s)
- Rebecca Griffith
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nickolas Fretes
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Iain R Murray
- Department of Orthopaedic Sports Medicine, Stanford University, Redwood City, California, USA
| | - John Meyer
- Meyer Institute of Sport, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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