For athletes recovering from a shoulder dislocation, arthroscopic Bankart repair is often the preferred surgical solution to restore stability. While many rehabilitation programs end with “return-to-play” testing, these assessments may not tell the whole story. Understanding the limitations of these tests is essential for reducing the risk of re-injury and ensuring a truly successful return to competition.
What Return-to-Play Testing Measures
Return-to-play (RTP) testing is designed to evaluate whether an athlete has regained enough strength, range of motion, and functional capacity to safely resume sport. Common assessments include:
- Isokinetic strength testing
- Functional movement patterns
- Sport-specific drills
- Balance and coordination measures
These metrics provide useful benchmarks, but they often focus on measurable performance rather than the underlying tissue healing and joint stability needed for long-term shoulder health.
The Healing Timeline vs. Functional Readiness
One of the biggest challenges with RTP testing is that functional performance can improve faster than biological healing. After Bankart repair, the labrum and surrounding soft tissues require months to fully integrate with the bone and regain tensile strength. An athlete might “pass” functional tests at 4–6 months but still have immature tissue healing, leaving them vulnerable to another dislocation under high load or contact.
Strength and Symmetry Aren’t the Whole Picture
Many RTP protocols emphasize achieving muscle strength symmetry between the injured and uninjured shoulders. While important, equal strength doesn’t necessarily mean the joint is stable in dynamic, unpredictable game situations. Neuromuscular control, proprioception, and the ability to react to sudden changes in movement are harder to quantify but play a critical role in preventing re-injury.
Sport Demands Vary Widely
A quarterback, a swimmer, and a rugby player all stress their shoulders in different ways. Standard RTP tests may not account for the unique biomechanical loads of a specific sport. Without sport-specific progression and testing, an athlete might be cleared to return too early for the demands of their position or discipline.
Bridging the Gap with Comprehensive Evaluation
For safer return-to-play decisions after Bankart repair, a more holistic approach is needed. This includes:
- Advanced imaging to confirm tissue healing status
- Neuromuscular assessments to measure proprioception and reaction time
- Gradual sport-specific training to simulate real game forces
- Collaboration between surgeon, physical therapist, and athletic trainer for individualized clearance
By integrating these elements, athletes gain a better chance of returning at full capacity without compromising the surgical repair.
Making Informed Decisions for Long-Term Shoulder Health
Passing a standard RTP test doesn’t guarantee readiness for the unpredictable forces of competition. Athletes, coaches, and medical professionals should view RTP results as just one piece of the puzzle. Combining these metrics with thorough clinical evaluation and sport-specific progression offers the best protection against re-injury.
If you’re recovering from a Bankart repair or considering surgical options for shoulder instability, comprehensive guidance can make all the difference. For expert assessment and individualized recovery planning, book an appointment with Dr. Hill, experienced shoulder surgeon, today.
AUTHOR: Brian W. Hill, M.D., is a board-certified shoulder surgeon at Palm Beach Orthopedic Institute. He is an expert in advanced reconstructive and arthroscopic techniques and serves as an assistant team physician for the Washington Nationals and their affiliates. Dr. Hill treats shoulder injuries and arthritis with a focus on patient-centered care and clear communication.
