Critical evidence synthesis on rehabilitation following arthroscopic shoulder stabilisation surgery for traumatic anterior instability: consensus recommendations for clinical practice and research - commissioned by the British Elbow & Shoulder Society.

Abstract

Arthroscopic shoulder stabilisation surgery (ASSS) is a common procedure for treating anterior shoulder instability. Postoperative rehabilitation remains a crucial, but under-researched, aspect of patient recovery. Despite its importance, no comprehensive rehabilitation guideline based on robust clinical trials has emerged, leaving a gap in evidence-based practice. To address this, the British Elbow & Shoulder Society appointed the Allied Health Professional Clinical Guideline Group to review current practices and establish clinical guidance on rehabilitation. This evidence synthesis aims to provide a critical synthesis and discussion on rehabilitation following ASSS. The intended outcome is to highlight areas of uncertainty and make recommendations for clinical practice and further research. The development of this evidence synthesis followed a rigorous five-stage process: (1) systematic literature review, (2) UK national practice survey, (3) expert consensus (Delphi) study, (4) updated literature search and review and (5) synthesis of the previous four stages. Stages 1–3 have been published previously. This evidence synthesis comprised stages 4 and 5. 10 key domains for postoperative rehabilitation from immediate postsurgery to return to normal function, including sports, were identified. This paper synthesises current knowledge and provides a platform for recommendations in clinical practice and future research. In particular, early shoulder movement was recommended during the ‘immobilisation period’, but confined to shoulder elevation up to 90°, anterior to the scapular plane, with neutral external rotation. Further high-quality primary research is needed to address uncertainties and expand the evidence base, thereby informing and challenging clinical practice.