Getting Them Back in the Game: When Can Athletes with Adolescent Idiopathic Scoliosis Safely Return to Sports? A Mixed Effects Study of the Pediatric Orthopaedic Association of North America

Background: Despite the relative frequency of posterior spinal fusion and instrumentation (PSF) for adolescent idiopathic scoliosis (AIS), there are limited guidelines for postoperative return to sports. Few studies explore factors influencing treating surgeons’ recommendations.

Methods: A survey presenting several clinical vignettes of patients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis was distributed to 1,496 Pediatric Orthopaedic Society of North America (POSNA) members. Out of the 57 returned surveys, 170 met the inclusion criteria. Mixed effects models were created to assess the effects of surgeon and hypothetical patient characteristics on return to jogging, noncontact, contact, and collision sports.

Results: Estimated marginal mean time to return to sporting activities increased for more physically demanding sports (jogging: 4.1 months, 95% confidence interval [CI]: 3.8-4.3; noncontact: 4.6 months, 95% CI: 4.3-4.9; contact 6.8 95% CI: 6.4-7.1; collision: 9.8 95% CI: 9.2-10.4). Hypothetical patient characteristics (gender, age, obesity, skeletal maturity, levels fused, and fusions ending in thoracic versus lumbar spine) were not associated with changes in return to sport recommendations for jogging, noncontact, contact, or collision activities.

Surgeon volume, experience, fellowship type, and practice setting all affected return to all activities (p < 0.05). Surgeons with prior complications from return to sport delayed return to collision activities (9.4 months, 95% CI: 8.4-10.3) versus surgeons without complications (7.2 months, 95% CI: 5.7-8.7, p<0.001).

Conclusion: Surgeons currently allow earlier return to high-intensity sports after PSF for AIS compared to previous studies. Protocol trends vary based on physician-related factors such as years in practice, case volume, fellowship training, practice type, and prior experience with complications. Patient-related factors were not found to impact return to sport protocols. This survey provides a portrait of current practice trends and serves as a foundation for future investigation.