The impact of kinesiophobia on rehabilitation and return to sport following arthroscopic Bankart repair for glenohumeral instability: a minimum 1-year follow-up

Abstract

Background

Anterior glenohumeral instability is a common issue, particularly among young and active individuals. Arthroscopic Bankart repair is an effective surgical method for achieving long-term shoulder stability. However, despite favorable biomechanical outcomes, return to sport rates vary widely. Psychological factors, especially kinesiophobia, may play a decisive role in this variability.

Purpose

The aim of this study was to evaluate the impact of postoperative kinesiophobia on clinical outcomes, functional scores, and return to sport following arthroscopic Bankart repair.

Methods

A retrospective review was conducted on 73 patients who underwent arthroscopic Bankart repair between December 2019 and June 2024. All patients had a minimum follow-up of 12 months. The Tampa Scale for Kinesiophobia (TSK), Western Ontario Shoulder Instability Index (WOSI), and American Shoulder and Elbow Surgeons Shoulder Score (ASES) were utilized for assessments. Patients were stratified based on their TSK scores, and the relationships between kinesiophobia levels, functional outcomes, and return-to-sport rates were analyzed statistically.

Results

The mean patient age was 28 years (range, 15–47 years), with a mean follow-up period of 22 months (range, 12–50 months). Patients with high TSK scores demonstrated significantly worse WOSI and ASES outcomes (p < 0.001), indicating poorer shoulder-related quality of life and diminished shoulder function. Elevated levels of kinesiophobia were also associated with reduced rates of high-level return to sport. A strong positive correlation was observed between preoperative and postoperative TSK scores (r = 0.611), suggesting persistence of kinesiophobia over time. Despite achieving surgical stability, fear of reinjury emerged as a significant barrier to returning to sport.

Conclusion

Kinesiophobia is a critical psychological factor that adversely affects functional recovery and return to sport following arthroscopic Bankart repair. Patients with high levels of kinesiophobia demonstrated poorer shoulder function, reduced shoulder-related quality of life, and lower rates of return to high-level sport, despite achieving surgical stability. These findings highlight the importance of incorporating psychological assessment and targeted interventions into postoperative rehabilitation protocols to optimize functional outcomes and facilitate a successful return to sport.

Introduction

Glenohumeral instability predominantly affects young athletes and is recognized as a significant condition that can lead to recurrent dislocations and chronic injuries if not appropriately managed [1–3]. The treatment approach for shoulder dislocations varies depending on patient-specific anatomical factors such as age, the frequency of dislocations, and the extent of bony and soft tissue damage [4, 5]. While conservative management aims to alleviate pain and provide temporary stabilization, it is often associated with high recurrence rates and delayed return to sport due to persistent instability [6–8].

Both open and arthroscopic Bankart repair techniques have been shown to effectively restore shoulder stability and function. Return to sport rates following surgical stabilization have been reported to range between 71% and 98%, depending on the type of sport and level of athletic participation [9–11]. However, it is well-documented that even after successful surgical intervention, many patients struggle to return to their pre-injury level of sport, despite regaining the ability to perform daily activities [12, 13].

Although surgical success rates are high, postoperative rehabilitation duration and the psychological status of the patient play a pivotal role in determining clinical outcomes. Given that return to sport is considered one of the key benchmarks of success in instability surgery, non-surgical factors influencing this process warrant further investigation. Recent studies have highlighted the psychosocial underpinnings of reinjury fear among athletes, emphasizing that psychological responses such as depression, loss of confidence, anxiety, and emotional tension are common following sports-related injuries [14, 15]. Recurrent dislocations or the fear of re-dislocation can lead to self-imposed activity restrictions, further complicating the rehabilitation process. Larsson et al. defined kinesiophobia as the fear of physical movement and activity due to concerns of reinjury, underscoring its potential impact on postoperative recovery [16]. Despite the recognized importance of psychological factors, there is a paucity of literature specifically addressing the role of kinesiophobia following shoulder instability surgeries [11].

The aim of this study is to evaluate the impact of postoperative kinesiophobia on the rehabilitation process and return to sport in patients who underwent arthroscopic Bankart repair for glenohumeral instability. Furthermore, this study seeks to elucidate the influence of elevated kinesiophobia scores on functional recovery and the subjective perception of surgical success. The findings from this research may underscore the necessity of integrating psychological assessments and interventions into return to sport protocols, promoting a holistic approach to postoperative rehabilitation.

Methods

Design and participant

This study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki. Institutional review board (IRB) approval was obtained from our local ethics committee prior to the initiation of the study. All patients were retrospectively reviewed, and informed consent was obtained from each participant.

This retrospective study included a total of 102 patients who underwent arthroscopic Bankart repair for recurrent anterior glenohumeral instability between December 2019 and June 2024. The inclusion criteria were: a history of traumatic, recurrent anterior shoulder dislocations, a minimum postoperative follow-up duration of 12 months, and the availability of complete clinical records. Postoperative outcome assessments (TSK, WOSI, and ASES) were conducted at the final follow-up visit for all patients. All patients included in the analysis completed a minimum postoperative follow-up of 12 months, ensuring consistency and comparability of the assessment time points across the cohort.

Exclusion criteria included: multidirectional or posterior shoulder instability, advanced glenoid bone loss exceeding 20%, previous surgical intervention on the affected shoulder, patients undergoing revision surgery for recurrent instability, concomitant significant shoulder pathologies (e.g., full-thickness rotator cuff tear, SLAP lesions), patients with epilepsy, and those with incomplete follow-up data (Fig. 1).

Fig. 1.

Flow chart of the included patients

Activity level was categorized based on patients’ self-reported participation in physical activity and sports prior to injury. Patients were classified as having a low activity level if they did not participate in regular sports or structured physical activity, a moderate (recreational) activity level if they participated in non-competitive recreational sports, and a high activity level if they were involved in regular competitive or high-demand sports [17, 18].

Sports classification was defined according to the type and intensity of sports participation. Sports were categorized as non-contact, limited-contact, or contact/collision sports, based on commonly used classifications in sports medicine literature. This approach has been widely applied to evaluate return-to-sport outcomes and injury risk in shoulder instability populations [1, 19].

Surgical techniques

All surgical procedures were performed by a single experienced surgeon under general anesthesia with the patient positioned in the beach-chair position. In addition to the standard posterior viewing portal, anteroinferior and anterosuperior working portals were established. The capsulolabral complex was meticulously mobilized from the anterior glenoid rim, and the glenoid edge was debrided using a shaver to prepare the bone bed for repair.

A minimum of two knotted suture anchors were placed on the anterior glenoid rim between the 3 o’clock and 5 o’clock positions, according to the clock-face orientation. The anteroinferior labrum was reattached to the glenoid using simple sliding knots, restoring the capsulolabral complex and reestablishing the tension of the anterior capsule.

In cases where a Hill-Sachs lesion was present and deemed “off-track,” an additional accessory portal was created. The Hill-Sachs lesion was debrided with a burr and microfractured to promote bleeding. Two knotted suture anchors were placed within the defect at intervals of 0.5 to 1 cm. Using a suture passer, the sutures were passed through the posterior capsule and infraspinatus tendon. The defect was then filled using simple knots, completing the Remplissage procedure in conjunction with the Bankart repair.

Postoperative rehabilitation

All patients followed the same standardized rehabilitation protocol. Postoperatively, the affected arm was immobilized in a sling for 2 weeks, with the elbow maintained at 90° of flexion and the shoulder in neutral rotation (0°). During this period, passive shoulder abduction and flexion exercises were initiated. Pendulum exercises and external rotation movements were strictly avoided.

Between the 2nd and 4th postoperative weeks, active flexion and abduction were allowed up to shoulder level. From the 1st to the 2nd month, patients were guided by a physiotherapist to achieve full active flexion and abduction. Complete restoration of range of motion (ROM) was targeted between the 3rd and 5th months.Return to contact sports was permitted after the 6th postoperative month, following confirmation of functional recovery and joint stability. Functional recovery and joint stability were confirmed based on clinical examination, including absence of apprehension, restoration of full or near-full range of motion, shoulder strength comparable to the contralateral side, and satisfactory functional outcome scores (ASES and WOSI) indicating acceptable shoulder function.

Evaluation of measurements

The Tampa Scale for Kinesiophobia (TSK) is a 17-item questionnaire designed to assess fear of movement or reinjury in patients with musculoskeletal disorders. Each item is scored on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Higher total scores indicate greater levels of kinesiophobia, reflecting a pronounced fear or anxiety towards physical activity, whereas lower scores denote minimal fear-avoidance behaviors. The Tampa Scale for Kinesiophobia (TSK) scores were categorized based on previously published cut-off values. Scores ≤ 37 were considered low kinesiophobia, whereas scores > 37 indicated high (elevated) kinesiophobia [20, 21]. Although validated TSK cut-off values specific to shoulder instability are currently lacking, the TSK is a general measure of fear of movement and reinjury and has been widely applied across various musculoskeletal and orthopedic populations, supporting its use for patient stratification in the present study.

The Western Ontario Shoulder Instability Index (WOSI) is a patient-reported outcome measure used to evaluate the functional impact, pain intensity, and quality of life in individuals suffering from shoulder instability. The WOSI consists of 21 questions, with total scores ranging from 0 to 210 points. Higher WOSI scores correspond to more severe shoulder-related impairments and symptoms.

The American Shoulder and Elbow Surgeons Shoulder Score (ASES) is a validated clinical tool designed to assess shoulder function and pain levels through both patient-reported and clinician-assessed components. The score comprises two subscales: pain (50 points) and functional assessment (50 points), yielding a total score out of 100. Lower ASES scores indicate significant shoulder dysfunction, while higher scores reflect pain-free and optimal shoulder performance.

Activity level was categorized based on patients’ self-reported participation in physical activity and sports prior to injury. Patients were classified as having a low activity level if they did not participate in regular sports activities, a hobby level if they participated in recreational sports without competitive demands, and a high activity level if they were involved in regular competitive or high-demand sports. Sports classification was determined based on the type of sport performed prior to injury and its associated physical demands. Sports were categorized as low level (non-contact or low-demand sports), intermediate level (sports involving moderate physical demand or limited contact), and high level (contact or collision sports, or sports with high risk of shoulder instability).

Statistical analysis

The statistical analysis was conducted using SPSS software version 26.0. The distribution of continuous variables was investigated using both statistical (Kolmogorov-Smirnov or Shapiro-Wilk test) and visual (histogram and Q-Q plot) methods. Categorical variables were presented as numbers and percentages, while continuous variables were reported as mean ± standard deviation (SD) or median [minimum-maximum], where appropriate. The comparison of categorical variables was performed using the chi-square test or Fisher’s exact test, depending on the expected frequencies. Bonferroni correction was applied for multiple comparisons to control the type I error rate. For correlation analysis, Spearman’s correlation coefficient was applied for non-normally distributed or categorical variables. Pearson correlation analysis was conducted to examine the relationships between preoperative and postoperative clinical outcome measures, including the Tampa Scale for Kinesiophobia, American Shoulder and Elbow Surgeons Score and Western Ontario Shoulder Instability Index. A p-value < 0.05 was considered statistically significant.

Results

The study population consisted of 73 patients aged between 15 and 47 years. The mean age of the study population was 28.0 ± 6.8 years, 64 of them (87.7%) were male, and 9 of them (12.3%) were female. Among the study cohort, 61.6% had injury on the right side, and 38.4% had injury on the left side. A dominant-side injury occurred in 26 patients (35.6%), whereas 47 patients (64.4%) had a non-dominant-side injury. Before the injury, 30 patients (41.1%) had a low activity level, 38 patients (52.1%) had a high activity level, and five patients (6.8%) engaged in sports as a hobby. Based on their pre-injury sports classification, three patients (4.1%) had a low level, 18 patients (24.7%) were classified as intermediate, and another 52 patients (71.2%) were classified as high. The average number of shoulder dislocations before surgery was 3.3 ± 2.0.

Regarding surgical treatment, 66 patients (90.4%) underwent a Bankart repair, while 7 patients (9.6%) had an additional Remplissage procedure. The average follow-up period after surgery was 22.3 months ± 9.9, ranging from 12 to 50 months (Table 1).

Table 1.

Baseline characteristics of the study population (n = 73)

Variable	n (%) / Mean ± SD [range]
Age, years	28.0 ± 6.8 [15–47]
Sex
• Female	9 (12.3%)
• Male	64 (87.7%)
Injury side
• Right	45 (61.6%)
• Left	28 (38.4%)
Dominant injury
• Dominant	26 (35.6%)
• Non-dominant	47 (64.4%)
Pre injury activity level
• Low	30 (41.1%)
• High	38 (52.1%)
• Hobby	5 (6.8%)
Pre injury sport class
• Low	3 (4.1%)
• Intermediate	18 (24.7%)
• High	52 (71.2%)
Number of dislocations before surgery	3.3 ± 2.0
Surgery type
• Bankart	66 (90.4%)
• Bankart + Remplissage	7 (9.6%)
Post operative activity level
• None	5 (6.8%)
• Low	27 (37.0%)
• High	25 (34.2%)
• Hobby	16 (21.9%)
Post injury sport class
• Low	12 (16.4%)
• Intermediate	41 (56.2%)
• High	20 (27.4%)
Follow-up time, months	22.3 ± 9.9 [12–50]

Table 2 presents a comparison between two groups based on the Tampa Scale for Kinesiophobia (TSK) scores. WOSI scores were categorized into minimal, moderate, severe, and very severe instability according to established severity classifications, with higher scores indicating greater shoulder-related impairment. Western Ontario Shoulder Instability Index (WOSI) was used to assess the severity of shoulder instability symptoms. In the TSK-Low group, 58.2% of patients demonstrated minimal shoulder instability, whereas only 11.1% of patients in the TSK-High group had minimal instability. Moderate instability was observed in 40.0% of patients in the TSK-Low group compared with 61.1% in the TSK-High group. No cases of severe instability were observed in the TSK-Low group, while 22.2% of patients in the TSK-High group experienced severe instability. Very severe instability was present in 1.8% of patients in the TSK-Low group and 5.6% of patients in the TSK-High group. A statistically significant difference was observed between the two groups, indicating that higher levels of kinesiophobia were associated with worse shoulder instability outcomes (p < 0.001).

Table 2.

Comparison of shoulder stability and function according to Tampa Scale for Kinesiophobia (TSK) scores

	TSK-Low (n = 55)	TSK-High (n = 18)	p
Western Ontario Shoulder Instability Index			< 0.001
Minimal	32 (58.2%)	2 (11.1%)
Moderate	22 (40.0%)	11 (61.1%)
Severe	–	4 (22.2%)
Very Severe	1 (1.8%)	1 (5.6%)
American Shoulder and Elbow Surgeons Shoulder Score			< 0.001
Perfect	39 (70.9%)	2 (11.1%)
Good	16 (29.1%)	16 (88.9%)
Medium	–	–
Poor	–	–

TSK groups were defined using previously published cut-off values, with scores < 37 indicating low kinesiophobia and scores ≥ 37 indicating high kinesiophobia. Shoulder instability severity was classified based on Western Ontario Shoulder Instability Index (WOSI) categories as minimal, moderate, severe, and very severe. ASES scores were interpreted according to established functional outcome categories. Values are presented as number (percentage)

Regarding shoulder function assessed by the American Shoulder and Elbow Surgeons (ASES) score, 70.9% of patients in the TSK-Low group achieved a perfect functional score, compared with only 11.1% in the TSK-High group. A good functional outcome was observed in 29.1% of patients in the TSK-Low group and 88.9% of patients in the TSK-High group. No patients in either group demonstrated moderate or poor functional scores. The difference between groups was statistically significant, with high kinesiophobia being associated with inferior functional outcomes (p < 0.001).

As shown in Table 3 clinical scores significantly improved postoperatively, with reduced kinesiophobia and instability and enhanced shoulder function (p < 0.001).

Table 3.

Changes in the clinical scores in the preoperative and postoperative periods

	Preoperative	Postoperative	p
TAMPA Scale	56.9 ± 5.9	30.4 ± 8.5	< 0.001
Western Ontario Shoulder Instability Index	77.9 ± 13.2	33.7 ± 12.5	< 0.001
American Shoulder and Elbow Surgeons Shoulder Score	65.9 ± 7.4	83.5 ± 6.8	< 0.001

Table 4 presents the correlation analysis of TSK with WOSI and ASES shoulder scores. Preoperative TSK scores showed a strong positive correlation with postoperative TSK scores (r = 0.611, p < 0.01), indicating that higher levels of kinesiophobia prior to surgery were associated with higher kinesiophobia after surgery. There was no correlation between preoperative TSK scores and preoperative WOSI and ASES scores. The postoperative TSK score was negatively correlated with the postoperative ASES and positively correlated with the postoperative WOSI (p < 0.05 for both). Furthermore, during the postoperative follow-up period, TSK was found to be positively and moderately correlated with WOSI, while a negative but moderate correlation was observed between TSK and ASES shoulder score (p < 0.001 for both).

Table 4.

Correlation analysis of the Tampa scale for kinesiophobia with shoulder instability and function

	PREOP TSK	PREOP ASES	PREOP WOSI	POSTOP TSK	POSTOP ASES	POSTOP WOSI
PREOP TSK	1	− 0.142	0.137	0.611**	0.040	0.113
PREOP ASES		1	− 0.143	− 0.201	0.534**	− 0.232*
PREOP WOSI			1	0.275*	− 0.184	0.743**
POSTOP TSK				1	− 0.259*	0.259*
POSTOP ASES					1	− 0.260*
POSTOP WOSI						1

*p < 0.05 and **p < 0.01

TSK Tampa Scale for Kinesiophobia, ASES American Shoulder and Elbow Surgeons Score, WOSI Western Ontario Shoulder Instability Index, PREOP Preoperative, POSTOP Postoperative

Discussion

This study yielded three key findings. First, patients who underwent arthroscopic Bankart repair for anterior glenohumeral instability demonstrated significant improvements in clinical and functional outcome scores. Second, despite these improvements, there was a noticeable decline in the rate of return to pre-injury activity levels. Finally, the findings highlight that, beyond effective rehabilitation and surgical success, the patient’s psychological status serves as a critical determinant in the return to sport process.

Our results revealed that, although surgical stabilization was achieved, patients with high levels of kinesiophobia experienced delayed functional recovery and significantly lower return to sport rates. This observation supports the growing body of literature emphasizing the dual influence of biomechanical and psychosocial factors on return to sport outcomes [22–24]. Advances in surgical techniques have enabled more precise anatomical labral reconstructions, preserving remnant tissue and facilitating the functional restoration of the capsulolabral complex [25–27]. Nevertheless, despite reductions in recurrence rates, return to sport outcomes have not reached the desired levels [28]. This discrepancy likely stems from the fact that returning to sport is not solely dependent on biomechanical stability but also intimately tied to the patient’s psychological recovery process [13, 22].

A systematic review by Ardern et al. underscored that physical test outcomes alone are insufficient predictors of return to sport success, with psychological factors such as self-confidence, anxiety, and fear of reinjury playing pivotal roles [13]. Similarly, in our study, patients with elevated preoperative TSK scores exhibited significantly poorer postoperative functional scores, underscoring the influence of psychological barriers on surgical outcomes.

While statistically significant differences were observed between groups in TSK, WOSI, and ASES scores, it is also important to consider the clinical relevance of these findings. Previous studies have suggested that the minimal clinically important difference (MCID) for the ASES score ranges approximately between 6 and 12 points, whereas for the WOSI score, an improvement of approximately 10% of the total score has been considered clinically meaningful [29, 30]. In the present study, the observed between-group differences in both ASES and WOSI scores exceeded these commonly accepted MCID thresholds, indicating that the differences associated with higher levels of kinesiophobia were not only statistically significant but also clinically meaningful.

Although a universally accepted MCID value for the Tampa Scale for Kinesiophobia (TSK) has not been firmly established, higher TSK scores have consistently been associated with poorer functional outcomes, reduced quality of life, and delayed return to sport in musculoskeletal populations [20, 31]. Therefore, the magnitude of the observed differences in TSK scores in this cohort further supports the clinical relevance of kinesiophobia as a meaningful barrier to functional recovery and return to sport following arthroscopic Bankart repair.

Kinesiophobia is a psychological condition characterized by fear-avoidance behaviors resulting from chronic pain and recurrent injuries [32]. Kasik et al. defined kinesiophobia not merely as fear of movement but as a psychosocial barrier directly impacting an individual’s functional capacity and quality of life [33]. This issue becomes particularly critical in the context of return to sport after shoulder instability surgeries. In our cohort, high postoperative TSK scores demonstrated a significant correlation with lower ASES and higher WOSI scores, indicating the detrimental impact of kinesiophobia on functional outcomes. Tjong et al.‘s qualitative analysis also emphasized that biomechanical readiness alone is insufficient for return to sport; a subjective sense of “feeling secure” is essential for a successful return [24]. A lack of this psychological readiness may result in avoidance behaviors, diminished functional performance, or complete withdrawal from sports participation. High levels of kinesiophobia have been increasingly recognized as a significant psychological barrier affecting postoperative rehabilitation and return to sport outcomes. Previous studies have demonstrated that fear of reinjury and avoidance behaviors can persist despite adequate biomechanical stability, leading to delayed functional recovery and reduced rates of return to sport. Ardern et al. emphasized that psychological readiness is a critical determinant of successful return to sport, often outweighing objective physical recovery parameters. Similarly, Tjong et al. highlighted that patients’ subjective perception of shoulder security plays a central role in return to sport decision-making following arthroscopic Bankart repair. Consistent with these findings, our results indicate that elevated kinesiophobia is associated with worse functional outcomes and greater shoulder-related disability, underscoring the importance of addressing psychological factors alongside surgical and rehabilitative interventions [24]. The Tampa Scale for Kinesiophobia (TSK) was selected in this study because it specifically evaluates fear of movement and reinjury, which are central psychological barriers during postoperative rehabilitation. Unlike the SIRSI, which is primarily designed to assess psychological readiness for return to sport, the TSK provides a broader assessment of fear-avoidance behaviors that may influence functional recovery and daily activity participation beyond sport-specific outcomes. Given the aim of this study to investigate the impact of kinesiophobia on overall functional outcomes and rehabilitation following arthroscopic Bankart repair, the use of the TSK was considered appropriate [13, 22].

All patients included in this study had glenoid bone loss of less than 20%, a threshold considered non-critical for surgical failure [27, 34]. The persistently low return to sport rates in these cases suggest that non-surgical factors, rather than technical failures, play a predominant role. Gao et al. reported that while recurrence rates after arthroscopic Bankart repair have decreased over time, variability in return to sport outcomes is largely attributed to psychosocial factors rather than surgical techniques [26]. Thus, achieving surgical stability does not guarantee a successful return to sport; the psychosocial dimensions of rehabilitation must also be meticulously addressed. Our finding of a strong positive correlation between preoperative and postoperative TSK scores (r = 0.611, p < 0.01) underscores that kinesiophobia can persist chronically and necessitates proactive intervention.

Furthermore, we observed that patients with higher TSK scores exhibited significantly lower return to sport rates. Interestingly, recreational athletes demonstrated lower return to sport rates compared to professional athletes. This disparity may be attributed to the social and occupational identity associated with professional sports, which fosters higher motivation for return. In contrast, recreational athletes are more likely to be influenced by fear of reinjury in their decision-making process [23, 35]. The Tampa Scale for Kinesiophobia (TSK) could serve as an effective tool for objectively assessing psychological barriers during the postoperative period [36]. For individuals with high kinesiophobia levels, integrating psychological counseling and cognitive-behavioral therapy (CBT) programs into standardized rehabilitation protocols may enhance return to sport rates [23].

The findings of this study highlight the necessity of assessing and managing psychological factors, alongside biomechanical parameters, during the return to sport process in patients undergoing anterior shoulder instability surgery. Preoperative psychological screenings (e.g., TSK, anxiety scales) and individualized psychoeducation programs for high-risk patients may contribute to more sustainable surgical outcomes. Moreover, multidisciplinary rehabilitation programs involving orthopedic surgeons, physiotherapists, and sports psychologists can facilitate more successful return to sport outcomes [22, 24].

Currently, the literature addressing the impact of kinesiophobia on functional outcomes following shoulder instability surgery remains limited. Specifically, there are no established cutoff values for TSK in the context of shoulder surgery. Future prospective, randomized controlled trials are warranted to evaluate the effectiveness of psychological interventions on return to sport outcomes. Additionally, comprehensive biopsychosocial models should be developed to analyze the interaction between biomechanical and psychological factors in shoulder instability rehabilitation.

Limitations

This study has several limitations. First, due to its retrospective design, the data collection process may have been influenced by factors beyond the researchers’ control, potentially introducing selection and information bias. Second, the Tampa Scale for Kinesiophobia (TSK), which was utilized for assessing kinesiophobia, lacks validated clinical cutoff values specific to shoulder surgery, thereby introducing interpretive ambiguity in the context of this patient population. Third, patients who experienced recurrent dislocations or underwent revision surgery were excluded from the study. This exclusion limits the applicability of the findings to only those patients who underwent primary surgical intervention, thus reducing the generalizability of the results to the broader population. Lastly, the potential impact of psychological interventions, such as psychosocial support or psychotherapy, was not investigated in this study. Consequently, the contributions of these interventions to the rehabilitation process and return to sport outcomes could not be evaluated.

Conclusion

Following arthroscopic Bankart repair, functional recovery is influenced not only by the technical success of the surgical procedure but also by the patient’s psychological status. Patients with high levels of kinesiophobia exhibited reduced shoulder function and delayed return to sport. These findings underscore the necessity of integrating psychological components into rehabilitation protocols. Preoperative psychological screening and early interventions targeting kinesiophobia may enhance patient satisfaction and facilitate a safer and more expedited return to sport.

Authors’ contributions

Concept and Design: N.A., E.Ö., F.E.T.; Supervision: E.D., Y.Ş, ; Data Collection and/or Processing: E.Ö.,Y.Ş.; Analysis and/or Interpretation: F.E.T.,E.D.; Literature Search: N.A.,Y.Ş.; Writing: N.A.; Critical Review: N.A.,E.Ö.,F.E.T.

Funding

None.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Ethics Committee of Erzurum City Hospital (Ethics Committee for Clinical Research; approval date and number: 13 March 2025 — 37163). The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to inclusion in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.