Return to Sport After Surgery for Adolescent Idiopathic Scoliosis: From Time-Based Clearance to Sport-Specific Readiness

Return to sport (RTS) is an important outcome after surgery for adolescent idiopathic scoliosis (AIS), yet postoperative clearance remains largely time-based and reported outcomes vary according to procedure, population, endpoint, and treating-center policy. This critical review integrates direct postoperative RTS cohorts with biomechanical, rehabilitation, psychological, safety, and clinical-guidance evidence. Most available data concern adolescents treated with posterior spinal fusion and rely on self-reported participation. Resumption of physical activity or sport is common within the first postoperative year, but return to the same discipline, previous competitive level, and objectively verified performance is less consistently demonstrated. Evidence for anterior fusion is sparse, whereas vertebral body tethering is supported by smaller, selected cohorts and should be interpreted separately. Associations between RTS and distal fusion level or construct characteristics remain inconsistent, and biomechanical studies suggest redistribution rather than normalization of movement. Reported sport-related complications are uncommon, but existing cohorts are too small and lack exposure denominators to quantify rare events. No universal safe date or validated AIS-specific readiness battery currently exists. The proposed Multidimensional Scoliosis Return-to-Sport Framework therefore uses elapsed time as safety context while integrating clinical recovery, physical and psychological readiness, graded sport-specific exposure, and distinct return outcomes. The framework is evidence-informed and requires prospective validation.