{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:48:39Z","timestamp":1788587319433,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Return to sport (RTS) is an important outcome after surgery for adolescent idiopathic scoliosis (AIS), yet postoperative clearance remains largely time-based and reported outcomes vary according to procedure, population, endpoint, and treating-center policy. This critical review integrates direct postoperative RTS cohorts with biomechanical, rehabilitation, psychological, safety, and clinical-guidance evidence. Most available data concern adolescents treated with posterior spinal fusion and rely on self-reported participation. Resumption of physical activity or sport is common within the first postoperative year, but return to the same discipline, previous competitive level, and objectively verified performance is less consistently demonstrated. Evidence for anterior fusion is sparse, whereas vertebral body tethering is supported by smaller, selected cohorts and should be interpreted separately. Associations between RTS and distal fusion level or construct characteristics remain inconsistent, and biomechanical studies suggest redistribution rather than normalization of movement. Reported sport-related complications are uncommon, but existing cohorts are too small and lack exposure denominators to quantify rare events. No universal safe date or validated AIS-specific readiness battery currently exists. The proposed Multidimensional Scoliosis Return-to-Sport Framework therefore uses elapsed time as safety context while integrating clinical recovery, physical and psychological readiness, graded sport-specific exposure, and distinct return outcomes. The framework is evidence-informed and requires prospective validation.<\/jats:p>","DOI":"10.3390\/jcm15166336","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Return to Sport After Surgery for Adolescent Idiopathic Scoliosis: From Time-Based Clearance to Sport-Specific Readiness"],"prefix":"10.3390","volume":"15","author":[{"given":"Maria Cesarina","family":"May","sequence":"first","affiliation":[{"name":"IRCCS Azienda Ospedaliera Metropolitana, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8517-0057","authenticated-orcid":false,"given":"Carlo","family":"Biz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0825-2707","authenticated-orcid":false,"given":"Luca","family":"Puce","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2578-1133","authenticated-orcid":false,"given":"Andrea","family":"Zanirato","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliera Metropolitana, 16132 Genoa, Italy"},{"name":"Department of Integrated Surgical Diagnostic Sciences (DISC), Orthopedic Clinic, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-9882","authenticated-orcid":false,"given":"Pietro","family":"Ruggieri","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Formica","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliera Metropolitana, 16132 Genoa, Italy"},{"name":"Department of Integrated Surgical Diagnostic Sciences (DISC), Orthopedic Clinic, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/BPO.0b013e31824b285f","article-title":"Return to athletic activity after posterior spinal fusion for adolescent idiopathic scoliosis: Analysis of independent predictors","volume":"32","author":"Fabricant","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1097\/BRS.0000000000000452","article-title":"Timing and predictors of return to short-term functional activity in adolescent idiopathic scoliosis after posterior spinal fusion: A prospective study","volume":"39","author":"Tarrant","year":"2014","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/BRS.0000000000002284","article-title":"When Do Patients Return to Physical Activities and Athletics After Scoliosis Surgery?: A Validated Patient Questionnaire Based Study","volume":"43","author":"Sarwahi","year":"2018","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/s43390-022-00535-3","article-title":"Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: What variables actually have an influence? A retrospective study","volume":"10","author":"Ruffilli","year":"2022","journal-title":"Spine Deform."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s43390-022-00592-8","article-title":"Adolescent athletes return to sports rapidly after posterior spine fusion for idiopathic scoliosis: A prospective cohort study","volume":"11","author":"Tetreault","year":"2023","journal-title":"Spine Deform."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/BRS.0000000000004599","article-title":"High Rates of Successful Return to Competitive Athletics After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Regardless of Distal Fusion Level: A Prospective Cohort Study","volume":"48","author":"Fabricant","year":"2023","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pepke, W., Madathinakam, A., Bruckner, T., Renkawitz, T., Hemmer, S., and Akbar, M. (2023). Return to Sport after Adolescent Idiopathic Scoliosis (AIS) Correction Surgery: A Retrospective Data Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041551"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"419","DOI":"10.4103\/jcvjs.jcvjs_123_24","article-title":"Return to sports activities following posterior scoliosis correction and instrumented fusion for adolescent idiopathic scoliosis and its correlation to Lenke classification","volume":"15","author":"Khaleeq","year":"2024","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s43390-021-00330-6","article-title":"Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: A review of the current literature","volume":"9","author":"Barile","year":"2021","journal-title":"Spine Deform."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tetreault, T.A., and Garg, S. (2023). Return to play following spine surgery. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1176563"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1177\/03635465251390546","article-title":"Return to Sport After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic Review and Clinical Recommendations","volume":"54","author":"Nassar","year":"2026","journal-title":"Am. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e717","DOI":"10.1097\/BPO.0000000000001902","article-title":"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","volume":"41","author":"Ho","year":"2021","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cabrera, G., Falconi, B., Piantoni, L., Remondino, R., Galaretto, E., and Tello, C.A. (2026). Return to sports after surgery in adolescent idiopathic scoliosis. Spine Deform.","DOI":"10.1007\/s43390-025-01257-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s43390-024-01010-x","article-title":"Guidelines for returning to activity after spinal deformity surgery","volume":"13","author":"Turtle","year":"2025","journal-title":"Spine Deform."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tucker, S., Heneghan, N.R., Rushton, A., Gardner, A., Russell, E., and Soundy, A. (2026). International consensus on sports, exercise, and physical activity participation during post-operative interventions for Adolescent Idiopathic Scoliosis: An e-Delphi study. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0322346"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jspd.2018.08.015","article-title":"Spine and Lower Extremity Kinematics Exhibited During Running by Adolescent Idiopathic Scoliosis Patients With Spinal Fusion","volume":"7","author":"Kakar","year":"2019","journal-title":"Spine Deform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00586-018-5741-7","article-title":"Spinal correction surgery improves asymmetrical trunk kinematics during gait in adolescent idiopathic scoliosis with thoracic major curve","volume":"28","author":"Nishida","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s00586-017-5369-z","article-title":"Asymmetrical trunk movement during walking improved to normal range at 3 months after corrective posterior spinal fusion in adolescent idiopathic scoliosis","volume":"27","author":"Schimmel","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3613","DOI":"10.1007\/s00402-021-03956-3","article-title":"Early dynamic changes within the spine following posterior fusion using hybrid instrumentation in adolescents with idiopathic scoliosis: A gait analysis study","volume":"142","author":"Pesenti","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"780","DOI":"10.4184\/asj.2017.11.5.780","article-title":"Bone Mineral Density and Physical Performance of Female Patients 27 Years or Longer after Surgery for Adolescent Idiopathic Scoliosis","volume":"11","author":"Akazawa","year":"2017","journal-title":"Asian Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s43390-022-00487-8","article-title":"Spinal mobility and muscle function in middle-aged patients treated for early onset idiopathic scoliosis: Compared with untreated and treated adolescent onset patients","volume":"10","author":"Romberg","year":"2022","journal-title":"Spine Deform."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10192","DOI":"10.1038\/s41598-021-89674-7","article-title":"Transient fixation of L4 vertebra preserves lumbar motion and function in Lenke Type 5C and 6C scoliosis","volume":"11","author":"Yang","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s43390-024-00849-4","article-title":"Comparable rates of lumbar disc degeneration at long-term following adolescent idiopathic scoliosis spinal fusion extended to L3 or L4: Systematic review and meta-analysis","volume":"12","author":"Ruffilli","year":"2024","journal-title":"Spine Deform."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1123\/jab.2017-0085","article-title":"Intratrunk Coordination During High-Effort Treadmill Running in Individuals With Spinal Fusion for Adolescent Idiopathic Scoliosis","volume":"33","author":"Li","year":"2017","journal-title":"J. Appl. Biomech."},{"key":"ref_25","first-page":"e19362","article-title":"Global Spine Range of Motion in Patients With Adolescent Idiopathic Scoliosis Before and After Corrective Surgery","volume":"13","author":"Mehkri","year":"2021","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"103034","DOI":"10.1016\/j.otsr.2021.103034","article-title":"Performance of Forward Roll Maneuvers Following Corrective Spinal Fusion for Idiopathic Scoliosis Patients","volume":"107","author":"Iida","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/00042752-200203000-00005","article-title":"Sports activity of patients with idiopathic scoliosis at long-term follow-up","volume":"12","author":"Parsch","year":"2002","journal-title":"Clin. J. Sport Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Barone, G., Giudici, F., Manzini, F., Pironti, P., Vigan\u00f2, M., Minoia, L., Archetti, M., Zagra, A., and Scaramuzzo, L. (2024). Adolescent Idiopathic Scoliosis Surgery: Postoperative Functional Outcomes at 32 Years Mean Follow-Up. Children, 11.","DOI":"10.3390\/children11010052"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1007\/s00586-021-06874-5","article-title":"Mid-long-term outcome and degeneration of the remaining unfused lumbar intervertebral disc in adolescent idiopathic scoliosis patients who had posterior spinal fusion surgery","volume":"30","author":"Chiu","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1007\/s00586-021-06768-6","article-title":"Return to sport and daily life activities after vertebral body tethering for AIS: Analysis of the sport activity questionnaire","volume":"30","author":"Baroncini","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1177\/21925682231222887","article-title":"Combined Anterior Thoracic Vertebral Body Tethering and Posterior Lumbar Tethering Results in Quicker Return to Sport and Activity Compared to Posterior Spinal Instrumented Fusion in Patients with Adolescent Idiopathic Scoliosis","volume":"15","author":"Oeding","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s12178-016-9372-5","article-title":"Complications following spine fusion for adolescent idiopathic scoliosis","volume":"9","author":"Murphy","year":"2016","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1111\/os.14175","article-title":"Bilateral Spondylolysis of Lumbar Vertebra Secondary to Long Spinal Fusion for Idiopathic Scoliosis: A Case Report and Review of Literature","volume":"16","author":"Huang","year":"2024","journal-title":"Orthop. Surg."},{"key":"ref_34","first-page":"e76854","article-title":"Lumbar Spondylolysis After Posterior Corrective Fusion for Adolescent Idiopathic Scoliosis: A Report of Two Cases and Literature Review","volume":"17","author":"Nikaido","year":"2025","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1177\/2192568219859573","article-title":"Comparison of Pulmonary Function After Selective Anterior Versus Posterior Fusion for the Correction of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis","volume":"10","author":"Demura","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"\u00c7etinkaya, \u0130., Kuru \u00c7olak, T., Korkmaz, M.F., and Aydo\u011fan, M. (2025). Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial. Healthcare, 13.","DOI":"10.3390\/healthcare13162063"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1302\/2633-1462.69.BJO-2025-0012.R1","article-title":"A Protocol of Accelerated Rehabilitation following surgery for adolescent Idiopathic Scoliosis (PARIS): A feasibility study","volume":"6","author":"Walters","year":"2025","journal-title":"Bone Jt. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/AJP.0000000000000971","article-title":"Risk and Resilience Predictors of Recovery After Spinal Fusion Surgery in Adolescents","volume":"37","author":"Beeckman","year":"2021","journal-title":"Clin. J. Pain"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/AJP.0000000000001200","article-title":"Child and Parent Risk and Resilience Factors as Predictors of Long-term Recovery in Youth Undergoing Spinal Fusion Surgery","volume":"40","author":"Bartels","year":"2024","journal-title":"Clin. J. Pain"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Misterska, E., Tomaszewski, M., Marcinak-St\u0119pak, P., and G\u0142owacki, M. (2026). Pre- and postsurgical anxiety and body perception: The significance of cognitive-behavioral therapy in scoliosis adolescents. BMC Musculoskelet. Disord., 27.","DOI":"10.1186\/s12891-026-09645-9"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s43390-023-00677-y","article-title":"Monitoring the initial recovery after fusion surgery using activity trackers in adolescent idiopathic scoliosis: Going in the lumbar spine decreases the daily step count","volume":"11","author":"Ackermans","year":"2023","journal-title":"Spine Deform."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6336\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:27:54Z","timestamp":1786969674000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":41,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166336"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166336","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]}}}