Rehabilitation and Return to Sport After Anterior Shoulder Stabilization

Abstract

Rehabilitation after anterior shoulder stabilization is a critical yet variably standardized determinant of outcome, and broadly accepted protocols remain lacking. The postoperative protocol is organized into 4 phases linked to a timeline. Phase 1 (0‐6 weeks) protects the repair with sling use for 4 weeks followed by weaning, passive‐ and active‐assisted motion within staged limits, and early scapular control. Phase 2 (7‐10‐12 weeks) discontinues the sling, restores full staged motion including external rotation at 45° of abduction, and begins rotator cuff and scapular strengthening while avoiding push‐ups, bench press, throwing, and overhead loading. Phase 3 (10‐12 weeks to 4‐6 months) normalizes motion, strength, and power; introduces push‐up, pull‐up, and running progressions; and begins functional testing. Phase 4 (4‐6 months and beyond) advances sport‐specific training and a graded return to weight training while avoiding high‐risk lifts. Although the overall framework mirrors standard Bankart rehabilitation, the posterior‐based nature of remplissage warrants early protection of internal rotation range of motion and a more conservative progression of external rotation strengthening, with delayed return of full motion and tolerance to manual resistance. Return to sport is criterion‐based rather than time‐based, requiring restored strength, motion, and proprioception; resolution of apprehension and pain; sport‐specific skills; and psychological readiness, with objective test batteries guiding graded sport exposure. Open‐ and closed‐chain testing add‐ons are introduced only after adequate performance on the core battery and are selected according to the mechanism of injury and sport‐specific demands, with closed‐chain assessment emphasized for collision and contact athletes and open‐chain assessment for overhead and throwing athletes. Collision and overhead athletes warrant additional caution, and no validated minimum time point for return currently exists.