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Latarjet Procedure

Original Editor - Shreya Pavaskar Top Contributors - Yahya Al-Razi, Ruchita Parikh, Caroline Stone, Shreya Pavaskar, Vidya Acharya, Alexandra Stead, Kim Jackson and Pacifique Dusabeyezu

Introduction

The Latarjet procedure is a surgical procedure designed to treat anterior glenohumeral instability in patients with glenoid bone loss, a high risk of recurrent dislocations, prior failed soft-tissue repairs, or participation in high contact sports.[1][2] It involves transferring the coracoid process and the conjoint tendon to the anterior glenoid rim to reduce anterior translation.[2] It is performed to provide an osseous stabilisation to a shoulder where bone damage has occurred after traumatic shoulder dislocation(s). The surgery restores the bone loss and provides a muscle-sling at the front.[3][4] It is a highly successful surgical technique, with fewer than 5% of patients experiencing re-dislocations, and most patients achieve full return to sport.[2][5] It primarily aims to reduce pain and improve shoulder stability. The long term goal is to ensure the patient can perform their daily activities of daily living and return to their sport for athletes by improving function and strength.[1]

File:Latarjet-Procedure, Bankart repair.jpeg - Physiopedia (physio-pedia.com)

[6]

Surgical Technique

The procedure stabilises the shoulder with a "triple blocking effect".[3][1][4] The triple blocking effect consists of:

  1. The use of conjoint tendon as a sling for the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotated.[1] This provides 76-77% of the stability at end-range positions and 51-62% in a mid range position.[3]
  2. Addition of bone to the glenoid rim to increase its anteroposterior (AP) osseous diameter.[1] This provides 38-49% of the stability in a mid range position.[1]
  3. Reinforcement of the inferior capsule with a portion of the coracoacromial ligament.[1] This provides 23-24% of the stability at end-range positions.[3]

Indications

The Latarjet procedure is the most common bone-block method used in the presence of significant glenoid rim bone loss.[7] The Latarjet procedure may also be used in the presence of an Superior Labral Anterior Posterior SLAP Lesion.[7] Indications for a Latarjet procedure include:[7]

  • Instability with glenoid bone loss
  • Combinations of glenoid and humeral bone loss
  • Complex soft-tissue injury
  • Revision of a Bankart repair
  • Patients who engage in high-risk sports (climbing, rugby) or occupations (carpentry), or who have a high risk of recurrence due to the intensity and action of their activity (throwers), are ideal candidates for the Latarjet procedure

Physiotherapy Management

Preoperative Physiotherapy

Preoperative physiotherapy can be beneficial to improve strength and reduce inflammation ahead of surgery. Patients who underwent preoperative physiotherapy and scapular rehabilitation demonstrate a significant decrease in pain at one year post-operative, along with improved abduction range of motion.[8] Quality of life was significantly higher in the patients who underwent preoperative rehabilitation.[8]

Post-Operative Physiotherapy

Criterion driven guidelines are available for post-operative rehabilitation to help progress the patient through subsequent phases, and finally target return to sport in the final phase.[9][1] Patients are allowed to return to daily activities after 1 month if there are no complications, and are allowed to resume sports after 3 months only if they have recovered mobility and followed physical therapy protocols.[10]

Sample criteria to progress each stage of rehabilitation may be found below:[1]

Figure 1: Criteria to progress rehabilitation



Phase I: Protection phase

The goals of this phase of rehabilitation are:

  1. Protection of the surgical reconstruction to allow for tissue healing[11]
  2. Control pain, oedema and swelling[11][1]
  3. Begin range of motion (ROM) within protected range[11]

The arm is immobilised for 4-6 weeks in an abduction sling.[9][12] To protect the healing structures from shear or compressive forces, no isometric exercises should be performed during weeks 0-2 following Latarjet procedure.[1] Resisted elbow flexion or supination should be avoided to avoid placing stress on the coracoid.[11]

Manual therapy in Phase 1 may consist of passive range of motion (PROM), and soft tissue techniques. Early PROM exercises are beneficial in preventing postoperative stiffness of the shoulder, and are most often initiated within the first 2 weeks.[1][12] Shoulder external rotation (ER) should be limited to <30° for the first three weeks.[9][11][1][13] Soft tissue mobilisation techniques such as myofascial release and scar tissue release may be beneficial.[1] Full passive forward flexion is generally achieved within 3-6 weeks, full ER within 6-8 weeks, and full passive ROM in all planes within 8-10 weeks.[12]

Active range of motion (AROM) of the wrist, hand, and elbow can help to minimise stiffness of surrounding structures and encourage blood flow.[11] Active scapular exercises will help facilitate early neuromuscular control.[1] After two weeks, isometric exercises in neutral rotation may be initiated.[1][14] Rhythmic stabilisations are another option to introduce low-load contraction of shoulder girdle musculature, and will help facilitate co-contraction of anterior and posterior rotator cuff musculature.[1][15]

Phase II: Endurance Phase

The goals of this phase of rehabilitation are:

  1. Introduce and progress active shoulder ROM[12]
  2. Maintain full passive ROM[12]
  3. Improve muscular endurance and neuromuscular control [1][11]

Gentle glenohumeral joint mobilisations can be initiated at five to six weeks post-operatively.[1] Soft tissue techniques may be continued as needed to improve mobility.

AROM exercises should begin with active-assisted ROM (AAROM) around week 5-6 post op, which can progress to AROM as tolerated.[1][12] AROM should be started in supine or side-lying, which minimises the effect of gravity and reduces the effort required from active musculature.[9] Proprioceptive exercises, proprioceptive neuromuscular facilitation (PNF) exercises, and exercises for scapular control will help improve neuromuscular control and dynamic stabilisation of the shoulder.[1] Scapular control should focus on trapezius and the serratus anterior (SA), which significantly contribute to scapular stability.[16] Dynamic hugs and wall slides have been shown to produce good SA activation.[17] Prone horizontal abduction at 90° with ER, prone extension exercise and prone overhead arm raise at 125° help improve periscapular stability.[1]

It is important that the patient has good neuromuscular control, without compensatory patterns and muscular endurance to progress into the strengthening phase. Individuals should not start phase III until they are at least 6 weeks post-op, and phase II goals are met.[1]

Figure 2: Wall slides to activate Serratus Anterior Muscle


Phase III: Strength Phase

The goal of Phase III is to continue progression of muscular strength and motor control.[9][1]

Resistance training commonly begins between weeks 6 and 8 post-op.[12] Open chain scapular and rotator cuff strengthening may be performed in this phase.[11] Strengthening in this phase should start with loads corresponding to an 8-12 repetition maximum (RM) for 3-6 sets.[9][18] [19] External load can be added in this phase.[1] Maximal scapular muscle activation occurs when muscles are activated in functional patterns, such as resisted PNF exercises.[20] Closed kinetic chain (CKC) exercises may be introduced around week 8 to stress the joint in a weight bearing position and improve proprioception.[12] CKC exercises often begin on the wall, progressing to quadruped and full plank.[11][1][21][22]

Figure 3: PNF D2 Pattern with theraband

Patients may be discharged once Phase III criteria goals have been met if they do not participate in a sport requiring power, contact or overhead movements.[1] These patients may be discharged from therapy with a maintenance program.[10]

Patients may progress to Phase IV of the rehabilitation program once their strength values are >90% of their contralateral limb.[1][9]

Phase IV: Power Phase

The goal of Phase IV is to normalise strength, develop muscular power, and prepare for return to sport. [1][11][9]

For power development, the athlete should work at 80-100% of their 1RM for 3-6 repetitions for 3-6 sets for the shoulder.[19] [23][24] Training for power development generally begins around week 14.[12]

Plyometrics assist in the development of power, recruit fast twitch muscle fibres and enhance neuromuscular control.[24]  Upper extremity (UE) plyometrics performed in an open kinetic chain position such as two-handed drills such as chest pass, side-to-side throws and overhead soccer throws, can be progressed to one-handed drills such as, standing one-handed arm throws, one-handed side arm throw, 90/90 wall dribbles and prone ball drops.[25][26]

CKC UE plyometrics can be initiated in a partial weight bearing position by performing wall plyometric push‐ups or reformer plyometric UE jumps, progressing to full weight bearing plyometric push‐ups, depth drop plyometric push‐ups, and clap push‐ups.[24]

Criterion to progress from Phase IV is dependent upon the sport the athlete intends to return to.

Figure 5: Push and Pull cable
Figure 6 : Wall dribble
Phase V: Return to Play Program

The goal of the final phase is a gradual return to full participation in sports.[11] Return to sport generally begins after week 16.[12] Most patients will return to play following a Latarjet procedure.[5] Approximately 90% will return to play, but persistent pain, apprehension and weakness are the most common reasons an athlete will not return to sport.[5] Psychological factors may also contribute to a lack of return to sport.[5][27] The Shoulder Instability-Return to Sport After Injury may be used as a screening tool, using a score of 56 as a cut-off score for readiness to return to play. [5] Other return to sport assessments, such as the Closed Kinetic Chain Upper Extremity Stability Test, Unilateral Seated Shot Put Test and Upper Quarter Y Balance test may be used to determine readiness to return to play.[9]

Summary

The Latarjet procedure is a reliable option for the surgical management of recurrent anterior glenohumeral instability when glenoid surface bone loss is more than 20-30%.[28] Post-operative rehabilitation follows a criterion based progression with clearly defined phases addressing ROM, neuromuscular control, strength, power and a graded return to play.[1] Patients experience high rates of return to sport, low rates of recurrence and overall good clinical outcomes following the Latarjet procedure.[1]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 Bradley H, Lacheta L, Goldenberg BT, Rosenberg SI, Provencher MT, Millett PJ.. Latarjet Procedure For The Treatment Of Anterior Glenohumeral Instability In The Athlete – Key Considerations For Rehabilitation. Int J Sports Phys Ther. 2021; 16(1): 259–269.
  2. ↑ 2.0 2.1 2.2 Baur AJ, Houseman TJ, Mansour EZ, Heller RR, Posner MA. High rates of return to sport after surgical stabilization for anterior shoulder instability in athletes: a systematic review and meta-analysis. Orthop J Sports Med. 2026 Jun 9;14(6):23259671261450204
  3. ↑ 3.0 3.1 3.2 3.3 Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am. 2013 Aug 7;95(15):1390-7.
  4. ↑ 4.0 4.1 Bigliani LU, Kelkar R, Flatow EL, Pollock RG, Mow VC. Glenohumeral Stability: Biomechanical properties of passive and active stabilizers. Clin Orthop Relat Res. (1976-2007). 1996 Sep 1;330:13-30.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Hurley ET, Lau BC, Dickens JF. Editorial Commentary: failure to return to sport after the Latarjet Procedure may be due to diverse causes: psychological reasons are most common. Arthroscopy. 2025 Aug;41(8):3049-3051.
  6. ↑ (2) Whart is an Open Latarjet Stabilisation? - YouTube
  7. ↑ 7.0 7.1 7.2 Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in bone-block augmentation among recently trained orthopaedic surgeons treating anterior shoulder instability. J Bone Surg Joint Am. 2016 Jul 6;98(13):e56.
  8. ↑ 8.0 8.1 de Almeida LL, Mendes Júnior AF, Neto J da M, et al. Pre-operative scapular rehabilitation for arthroscopic repair of traumatic rotator cuff tear: results of a randomized clinical trial. Int J Sports Phys Ther. 2021;16(1):216-226.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 Herman ZJ, Reddy RP, Fails A, Lin A, Popchak A. Rehabilitation and Return to Sport following Operative and Nonoperative Treatment of Anterior Shoulder Instability. Clin Sports Med. 2024 Oct;43(4):705-722
  10. ↑ 10.0 10.1 Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation. Phys Sportsmed. 2015 Jan 2;43(1):73-9.
  11. ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 Sieng T, Cicciaro J, Michelini J, Farmer K, Zeppieri G. Rehabilitation Following a Latarjet After a Failed Labral Repair in a Female Overhead Athlete: A Resident’s Case Report. Int J Sports Phys Ther. 2025 Sep 2;20(9):1388–1400.
  12. ↑ 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 Beletsky A, Cancienne JM, Manderle BJ, Mehta N, Wilk KE, Verma NN. A comparison of physical therapy protocols between open Latarjet coracoid transfer and arthroscopic Bankart repair. Sports Health. 2020 Mar/Apr;12(2):124-131.
  13. ↑ Itoi E, Hatakeyama Y, Urayama M, Pradhan RL, Kido T, Sato K. Position of immobilization after dislocation of the shoulder. A cadaveric study. J Bone Joint Surg Am. 1999 Mar; 81(3):385–90.
  14. ↑ Popchak A, Patterson-Lynch B, Christain H, Irrgang JJ; Rehabilitation and return to sports after anterior shoulder stabilization. Ann Jt. Nov;2017  2(10):62–62.
  15. ↑ Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: Injury prevention and treatment. Sports Health. 2010 Mar;2(2):101-15.
  16. ↑ Speer KP, Cavanaugh JT, Warren RF, Day L, Wickiewicz TL. A role for hydrotherapy in shoulder rehabilitation. Am J Sports Med. 1993 Nov-Dec;21(6):850-3.
  17. ↑ Cricchio M, Frazer C. Scapulothoracic and scapulohumeral exercises: A narrative review of electromyographic studies. J Hand Ther. 2011 Oct-Dec;24(4):322-33
  18. ↑ Schoenfeld BJ. Potential mechanisms for a role of metabolic stress in hypertrophic adaptations to resistance training. Sports Med. 2013 Mar;43(3):179-94.
  19. ↑ 19.0 19.1 American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009 Mar;41(3):687-708
  20. ↑ De Mey K., Danneels L., Cagnie B., Cools A; Are kinetic chain rowing exercises relevant in shoulder and trunk injury prevention training? Mar 27;2011 Br J Sports Med. 45(4):320–320
  21. ↑ Ellenbecker TS. Shoulder Rehabilitation: Non-Operative Treatment. Thieme Medical Publishers; 2006.
  22. ↑ Sung-Kwang J, Yoo W. Electromyography activity of the deltoid muscle of the weight-bearing side during shoulder flexion in various weight-bearing positions. J Phys Ther Sci. 2015;27(10):3285–3286
  23. ↑ Kraemer WJ, Ratamess NA, French DN, Resistance training for health and performance. Curr Sports Med Rep. 2002 Jun;1(3):165-71
  24. ↑ 24.0 24.1 24.2 Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise, Int J Sports Phys Ther. 2015 Nov;10(6):760–786.
  25. ↑ Kraemer WJ, Newton RU. Training for muscular power. Phys Med Rehabil Clin N Am. 2000 May;11(2):341–368.
  26. ↑ Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder; J Orthop Sports Phys Ther. 1993 Jul;18(1):365-78
  27. ↑ Soares MN, Shirinskiy IJ, Schachner J MATASI collaborator group, Macken AA, Kling A, Lafosse T, van den Bekerom MPJ, Buijze GA. Multifactorial approach training for anterior shoulder instability after a Latarjet procedure: protocol for a randomised controlled trial. BMJ Open. 2026 Jan 21;16(1):e109378.
  28. ↑ McHale KJ, Sanchez G, Lavery KP, Rossy WH, Sanchez A, Ferrari MB, Provencher MT; Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss; Arthrosc Tech. 2017 Jun; 6(3): e791–e799.
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