Is Return To Play At 6 Months After Latarjet Safe? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Abstract

Purpose/Introduction: 1) To evaluate return of strength and range of motion 6 months after Latarjet; 2) to determine risk factors for failure to achieve return to play (RTP) criteria at 6 months. Methods: Ten participating sites throughout the United States enrolled patients in a multicenter prospective cohort study. In this cohort, 65 athletes (83% contact sports, 37% overhead sports) underwent Latarjet procedure for anterior instability (71% as primary procedure for instability, 29% after failure of prior stabilization procedure) (36% subscapularis split; 64% tenotomy) and met inclusion criteria (mean age 24.5 SD 8.2; 59 male, 6 female). Strength and range of motion were assessed pre-operatively and at 6 months after surgery. Consistent with traditional thought, RTP criteria were 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 was assessed with multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, pre-operative strength/motion, percentage bone loss, number of prior dislocations, pre-operative subjective shoulder function (ASES and WOSI%), and participation in contact versus overhead sports. Results: 55% of patients failed to meet one or more return to play criteria: 6% failed for persistent weakness and 51% for ≥ 20° side to side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) (p=0.49) in the univariate analysis. In the multivariate analysis, independent risk factors for failure to achieve either strength or ROM criteria were pre-op ASES scores (per 10 point decrease, adjusted Odds Ratio [aOR] 1.61 CI 1.14, 2.43; p=0.006), WOSI % (per 10% decrease, aOR 0.61 CI 0.38, 0.92; p=0.010, and a pre-operative side to side ROM deficit ≥20° in any plane (aOR 5.01 CI 1.42, 21.5, p=0.01) or deficits in external rotation at 90° abduction (per 10° increased deficit, aOR 1.64 CI 1.06, 2.88, p=0.02). Conclusion: A large percentage of athletes, 55%, fail to return to full, baseline strength and ROM 6-months post-operatively following Latarjet. Greater pre-operative stiffness, and subjective disability are risk factors for failure to meet either ROM or strength RTP criteria. Knowing many athletes return to sport well before 6 months despite not having return of full strength and ROM, return to play criteria following Latarjet should be transitioned away from strict chronological measures and towards sport- and position-specific, functionally based metrics, considering both objective and subjective findings. Disclosure(s): No interests to disclose.