Rehabilitation Protocol Variability Following Arthroscopic Bankart Repair and Remplissage for Management of Anterior Shoulder Instability: A Systematic Review.
Juan B Villarreal-Espinosa, Michael M Reinold, Mohammad Khak and 4 others
PMID 39371186WHAT IT FOUND
Protocols after arthroscopic Bankart plus remplissage varied widely.
Sling use, immobilization length, motion restrictions, therapy start, strengthening, and return-to-sport criteria differed across included studies.
Key findings
01Most included studies used a simple sling, and reported immobilization times from three to six weeks.
02Range of motion restrictions varied, with four-to-eight-week external rotation restriction the most reported, and active-assisted or active motion starting from two to twelve weeks.
03Most studies gave a time to return to sport, but only 11 studies used objective criteria such as strength, range of motion, pain, or stability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Most included studies were Level III or IV evidence, with only three studies at Level I or II. The data were too heterogeneous for quantitative synthesis, so the review describes practice patterns rather than comparing outcomes. Some included studies did not clearly state the physical therapy protocol, and terminology varied, such as whether a shoulder immobilizer meant a sling. Patients had combined arthroscopic Bankart repair plus remplissage, and some could have had SLAP or long head of biceps repair, so the review cannot separate the contribution of any one surgical component. Soft-tissue injury magnitude was not consistently reported, which may affect early versus delayed motion decisions. Only 11 studies used objective return-to-sport criteria, and no study accounted for psychological readiness.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not read the authors' suggested protocol as tested evidence. The review describes variation across studies, and the proposed protocol was not subjected to rigorous study.