Editorial Commentary: Failure to Return to Sport After the Latarjet Procedure May Be Due to Diverse Causes: Psychological Reasons Are Most Common.

Abstract

The Latarjet procedure is a successful treatment for anterior shoulder instability, with fewer than 5% of patients having redislocations-revision surgery and prior surgery having been shown to be significant risk factors for recurrence. Approximately 90% of athletes return to play after the Latarjet procedure, comparable to arthroscopic Bankart repair. Patients may be physically unable to return to play, which may be due to persistent pain, apprehension, or weakness. Pain may be common after the Latarjet procedure and may be attributable to issues with hardware or graft placement, and it may be best evaluated with computed tomography scans. If screw fixation is not parallel to the joint and too posterior, then it may irritate the suprascapular nerve. Weakness due to nerve injury occurs in fewer than 1% of patients. Graft issues may be difficult to manage if due to nonunion, malunion, malpositioning, or graft fracture. All of these may also contribute to apprehension, as could incomplete rehabilitation or psychological reasons. Psychological reasons for not returning to play are the greatest contributor to athletes being unable to return to play after the Latarjet procedure and may be an area where improvements could be made in early screening and intervention. Improvements in the rehabilitation process could address psychological issues, and perhaps patients with kinesiophobia should be rehabilitated differently from those with concerns over their ability to perform for other reasons, such as retirement from sport. Finally, it is important to report why athletes are not returning to sport.