A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

Abstract

Context: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines.

Evidence acquisition: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)-accredited academic orthopaedic surgery programs.

Study design: Descriptive epidemiology study.

Level of evidence: Level 3.

Results: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport-specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks.

Conclusion: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair.

Strength of recommendation taxonomy (sort): Level C.

Keywords: Bankart; Latarjet; rehabilitation; return to sport; shoulder instability.

Figure 1.

CONSORT (Consolidated Standards of Reporting Trials) diagram. ACGME, Accreditation Council for Graduate Medical Education.

Figure 2.

Early range of motion (ROM) exercises. Data labels represent total counts across n = 31, with elbow/hand/wrist exercises representing the most commonly referenced early ROM exercise (n = 26; 84%) and hand-up-spine stretches representing the least common (n = 1; 3%). IR, internal rotation.

Figure 3.

Passive range of motion time line. PIR behind back, buttock, L3, and T12 excluded due to lack of tabulated data across protocols. PER, passive external rotation; PFF, passive forward flexion; PIR, passive internal rotation; PROM, passive range of motion.

Figure 4.

Active range of motion time line. Black dot represents mean, with bar representing 1 SD from the mean in weeks. AROM, active range of motion.

Figure 5.

Resistance exercise and strengthening time line. Black dot: mean of start times; bar representing the range of earliest to latest start times in weeks. ER, external rotation; IR, internal rotation.

Figure 6.

Return-to-sport time line for nonoverhead versus overhead athletes versus all protocols.