Defining Return To Performance As A Postoperative Outcome In Orthopedic Surgery

PURPOSE: Return to sport (RTS) is a frequently used orthopedic outcome that assesses intervention success for athletes. Although inconsistently reported, return to performance (RTP) adds depth to RTS reporting, assessing the quality of sports resumption and potentially guiding clinical management post-injury. This systematic review aims to synthesize reporting on postoperative performance outcomes in orthopedic literature. METHODS: Medline, PubMed Central, Embase, and Web of Science databases were searched for studies through July 2024. Inclusion criteria comprised studies analyzing performance measures for athletes post-orthopedic surgery; exclusions included those without a performance metric or outside orthopedic focus. Abstracts were screened in Covidence by multiple independent researchers for eligibility, with a third researcher resolving conflicts. Full-text articles were reviewed for relevant sport, joint, and surgery data. Primary outcomes included definitions of RTP and specific statistics or questionnaires. RESULTS: We analyzed 175 studies across 11 sports. Baseball (20.00%), basketball (14.29%), and American football (13.14%) were the most studied sports, with 49 articles (28.00%) covering multiple sports. The knee (33.14%), shoulder (14.29%), and elbow (10.86%) were the most commonly examined joints. ACL reconstruction (25.71%), UCL reconstruction (8.00%), and hip arthroscopy (5.14%) were the primary surgeries studied. Objective measures, such as isolated in-game statistics, were used in 128 articles (73.14%), while 39 articles (22.29%) used subjective measures or questionnaires to define RTP. Eight studies (4.57%) employed both. CONCLUSIONS: This review highlights considerable variability in RTS and RTP reporting, with limited consensus on RTP definitions. RTP was frequently assessed with isolated in-game statistics (69.71%), in-office assessments, or subjective questionnaires (22.29%), with a small fraction (4.57%) using both. In-game statistics, however, are often inaccessible beyond professional sports, and patient questionnaires lack standardization in outpatient settings for assessing RTP. Standardizing RTP definitions could help surgeons provide athletes with more accurate expectations for postoperative outcomes.