Abstract
Background:
Psychological readiness is increasingly recognized as a determinant of successful return to sport (RTS) after shoulder stabilization surgery. The Shoulder Instability-Return to Sport after Injury (SIRSI) score is a validated tool to assess psychological recovery, yet its prognostic value at intermediate postoperative milestones remains unclear.
Hypothesis:
To evaluate whether 6-month SIRSI scores predict 1-year patient-reported outcome measures (PROMs) and RTS in adolescent athletes after shoulder stabilization surgery. We hypothesized that higher 6-month SIRSI scores would be associated with improved 1-year PROMs and RTS rates.
Methods:
Our study retrospectively identified patients aged 14-18 years who underwent surgical shoulder stabilization at a single institution between August 2022 and August 2023, with follow-up at 6 months and equal to or greater than 1 year. Psychological readiness was assessed with SIRSI score; PROMs included American Shoulder and Elbow Surgeons (ASES) Assessment form, the Tegner Activity Scale (Tegner), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and the Pediatric/Adolescent Shoulder Survey (PASS) were collected. Associations between 6-month SIRSI scores and 1-year PROMs and RTS were analyzed.
Results:
Twenty-three athletes (mean age 16.7 ± 1.1 years, 65.2% male, 69.6% dominant-arm surgery) who underwent shoulder stabilization surgery. The cohort included patients participating in a diverse range of sports, with the most common being football (26.1%), soccer (13.0%, and basketball (8.7%). Six-month SIRSI scores demonstrated moderate positive correlations with 1-year ASES (ρ = 0.42) and Tegner scores (ρ = 0.51). Athletes who returned to their primary sport had higher median 6-month SIRSI scores of 78.3 compared to 46.7 in those who did not (p = 0.006). Improvements were observed across all PROMs from 6 months to 1 year. The overall return-to-sport rate was 73.9%, with 23.5% returning to a higher level of play, 58.8% to same level of play, and 11.8% to lower level of play.
Conclusion:
Six-month SIRSI scores are associated with 1-year functional outcomes and RTS success in adolescent athletes following shoulder stabilization surgery. Incorporating SIRSI into routine six-month assessment would enable identification of athletes whose psychological readiness lags in post-operative recovery milestones such as time from surgery, detecting those at risk for delayed RTS or re-injury. Future research should aim to stratify by surgical technique and sex to better understand individualized recovery patterns and explore interventions that target psychological as well as physical readiness.