Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability in the Athlete - Key Considerations for Rehabilitation

Abstract

The Latarjet procedure with transfer of the coracoid process and its attached conjoint tendon is a well-established surgical technique for the treatment of anterior glenohumeral instability in patients with anteroinferior bone loss and/or high risk for recurrence. Biomechanical and clinical studies have shown excellent results and high rates of return to sports. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through each phase of rehabilitation. Return to sports rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back to sports participation. Therefore, the purpose of this clinical commentary is to provide a rehabilitation protocol for the Latarjet procedure, progressing through clearly defined phases, with guidance for safe and effective return to sport. Recommended criteria are highlighted which allows the clinician to progress the patient through each phase appropriately rather than purely following timeframes from surgery. This progression ensures the patient has completed a thorough rehabilitation program that addresses ROM, strength, power, neuromuscular control and a graded return to play. Level of Evidence: 5.

Keywords: latarjet; movement system; rehabilitation; return to sport; shoulder.

Figure 1.. Deltopectoral approach to a right glenohumeral joint: A subscapularis (SSC) split was performed in the lower third to access the anterior glenoid. The coracoid tip was detached and transferred to the anteroinferior glenoid rim. The attached conjoint tendons are diverted through the subscapularis split.

Figure 2.. Joint position sense exercise: Patient in supine position with closed eyes. First, the uninvolved extremity is actively moved, then the affected extremity is moved to as close to that position as the uninvolved extremity.

Figure 3.. Wall slides to help activate the serratus anterior.

Figure 4.. PNF D2 movement pattern with resistance. The movement pattern is diagonal and spiral in nature and crosses midline.

Figure 5.. Rhythmic stabilization in quadruped position. The right limb is in an overhead, closed chain position.

Figure 6A, 6B.. Push-pull arm cable exercise.

Figure 7.. 90/90 Wall dribble performed as an OKC exercise.

Figure 8.. Plyometric UE jumps at start position (A) and end position (B) on Pilates reformer.