Summary

A large percentage of athletes do not have full return of strength and range of motion at 6 months following Latarjet procedure.

Abstract

Background

The Latarjet procedure is the becoming increasingly popular for the treatment of young athletes with recurrent instability. Earlier return to play protocols have been trialed with the thought that one is only waiting on bone healing. However, the impact of post-operative range of motion (ROM) and strength must be considered as well. Return to play has traditionally been accepted at 6 months post-operatively, but it is unknown what percentage of athletes achieve full strength and range of motion at that point, and whether there is any difference based upon subscapularis surgical technique.

Purpose

1) To evaluate rates of return of full strength and range of motion at 6 months after Latarjet. 2) To determine whether rates of results vary by subscapularis split versus tenotomy or athlete status (contact or overhead).

Methods

Ten participating sites throughout the United States enrolled patients in a prospective cohort study. Sixty-five athletes met inclusion criteria (mean age 24.5 SD 8.2; 59 male, 6 female) and underwent Latarjet procedure for anterior instability. All participated in either contact sports (83%) and/or overhead sports (37%). The Latarjet procedure was performed with either subscapularis tenotomy (64%) or split (36%). Strength and range of motion were assessed pre-operatively and at 6 months after surgery. Return to play (RTP) passage was defined as full strength as well as less than 20 degrees side-to-side range of motion deficits in all planes. The independent likelihood of strength and motion RTP criteria at 6 months for subscapularis tenotomy vs split was assessed with multivariate logistic regression modeling with adjustment as needed for age, sex, preoperative strength/motion, number of prior dislocations, and participation in contact versus overhead sports.

Results

45% of patients failed to meet one or more return to play criteria: 9% failed for persistent weakness and 39% for = 20 degree side to side loss of motion. All patients with loss of motion had = 20 degree external rotation deficits either with elbow at side (88%) or at 90 degrees abduction (44%). There was no difference in RTP passage at 6 months between subscapularis split versus tenotomy either for strength (p=0.89) or range of motion (p=0.53). Contact athletes had a 53% RTP passage rate while overhead athletes had a 67% passage rate (p=0.17). Pre-operative weakness was not significantly predictive of post-operative weakness (p=0.13), and pre-operative external rotation was not predictive of post-operative ER deficits (p=0.16). No other predictors for failure to meet RTP criteria at 6 months were identified.

Conclusions

A large percentage of athletes do not have full return of strength and range of motion at 6 months following Latarjet procedure.