The Latarjet surgery is a popular treatment option for athletes with recurrent shoulder instability, but can it get them back in the game in six months?
Return to Sport 6 Months After Latarjet Procedure Unlikely
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#shoulderinstabilitySecondary#laterjetprocedure
A new study, “Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study,” published online February 11, 2020 in The American Journal of Sports Medicine, says not in all cases.
In this study, researchers evaluated return of strength and range of motion six months after the Latarjet procedure and analyzed risk factors for failure to achieve return-to-play criteria at six months.
The multicenter study included 65 athletes, 83% played contact sports while 37% played overhead sports. All of the athletes underwent the latarjet procedure for anterior instability, 29% for primary instability and 71% for failed prior stabilization. Strength and range of motion were measured before surgery and again at six months post-op. Return-to-sport criteria included return to baseline strength and less than 20˚side-to-side range of motion deficits in all planes.
According to the data collected, 55% of the athletes failed to meet one or more return-to-sport criteria including persistent weakness (6%) and 20˚or more side-to-side loss of motion. Return-to-sport did not appear to be affected by the differences in approach (subscapularis 57% vs/ tenotomy 47%; p = .49). Risk factors for not meeting criteria to return to sport identified were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odd ration [aoR], 1.61; 95% CI, 1.14-2.43; p = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; p = .01), as well as preoperative side to side range of motion deficits and deficits in external rotation at 90˚of abduction.
The researchers wrote, “A large percentage of athletes fail to achieve full strength and range of motion 6 months after the latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet [range of motion] or strength [return-to-sport criteria].”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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