Defining Return to Sport: A Systematic Review

Category: Sports Introduction/Purpose: Return to sport (RTS) commonly serves as a measure for assessment of clinical outcomes in orthopaedic sports medicine surgery. Unfortunately, while RTS is commonly utilized in research for this purpose, currently, there is no widely accepted or standardized definition for when an athlete has officially returned to his or her sport. The purpose of this study was to conduct a systematic review to evaluate and report the differences in specific definitions of return to sport (RTS) utilized in the orthopaedic surgery literature. Methods: A systematic review was performed using PubMed, Embase and Cochrane databases per PRISMA guidelines. Search terms consisted of variations of 'RTS' combined with variations of 'orthopedic surgery' and 'define' to capture as many relevant articles as possible. The definition of return to sport was recorded and analyzed. Results: 718 articles were identified in the initial search, 29 of which met eligibility criteria, providing a clear definition of RTS. Of the 29 studies included, 20 (69.0%) defined RTS as an athlete competing in a game or other competitive play, and these definitions are further broken down in Table 1. Three (10.3%) defined this as the athlete competing in a game or other competitive play, but with an explicitly stated competition-level modifier of the athlete returning to their pre-injury level of competition. Two articles (6.9%) included returning to training or practice and the remaining four articles (13.8%) used terminology other than the standard RTS. Conclusion: There is variability in the definition of RTS used in the literature. Most studies refer to the athlete competing in a game or other competitive play. Other variants include returning to practice/training and explicitly defined competition levels and objectives. Future studies should aim to standardize the definition of RTS to facilitate more precise assessment of outcome following sports medicine surgery. Using terminology that describes components of the recovery and rehabilitation process, such as 'return to participation' and 'return to performance' in addition to RTS will allow us to better understand the athlete's recovery and associated level of competition or performance.