Definitions of Return to Play After Shoulder Surgery in Competitive Athletes Are Nonspecific and Unstandardized: A Systematic Review
Year: 2026
Type: review
Study design: Systematic Review
Abstract: PURPOSE: To characterize return to play (RTP) definitions in shoulder surgery literature involving competitive athletes and evaluate their quality. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, Embase, and the Cochrane Library. Studies reporting RTP after shoulder surgery in competitive athletes were included. Definitions were classified as complete, partial, or minimal. Complete definitions referenced both the preinjury competitive level and an objective participation threshold. Partial definitions included only one of these elements, whereas minimal definitions lacked both and used vague terminology (e.g., "returned to sport"). RTP reporting terminology and RTP clearance criteria were also recorded for each study. RESULTS: Overall, 130 studies with 6983 patients were included. RTP definitions were classified as complete in 27.7% of studies, partial in 51.5%, and minimal in 20.8%. Single-sport studies more frequently reported complete definitions than multisport studies (39.5% vs 10.9%, P = .003). Successful RTP was explicitly defined in 15.4% of studies. The most common definition was RTP at the preinjury level (n = 46; 35.4%), and the most common complete definition was return for at least 1 game/match at the preinjury level. Time was the most frequently cited clearance criterion (n = 67; 51.5%) and was the only cited criterion in 34 studies (26.2%). Most studies (74.6%) had a level of evidence of IV. CONCLUSIONS: Studies on competitive athletes undergoing shoulder surgery often use vague and incomplete definitions for RTP, with the most common definition being return to sport at the preinjury level. Studies are also characterized by a low level of evidence. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.
DOI: 10.1002/arj.70576
Institutions: Augusta University, Duke University, Duke Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7213771837