Isokinetic strength testing may predict return to sport after Latarjet surgery
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Key takeaways:
- Isokinetic strength testing may predict return to sport outcomes after Latarjet surgery.
- Strength testing was performed at 4 months postoperatively to predict return to sport at 6 months postoperatively.
According to results published in the American Journal of Sports Medicine, isokinetic strength testing may predict return to sport outcomes for athletes who undergo a Latarjet procedure for glenohumeral instability.
Mohamad K. Moussa, MD, MSc, orthopedic surgeon from the Clinique du Sport in Paris, and colleagues performed a cohort study of 72 athletes (mean age, 27.43 years) who underwent Latarjet stabilization between January 2022 and June 2023. Among the athletes, 31 played a contact-overhead sport, 27 played a contact sport and 14 played a noncontact sport.
All athletes underwent isokinetic strength testing at 4 months postoperatively. Secondary outcomes included the modified Closed Kinetic Chain Upper Extremity Stability Test, Walch-Duplay scores, WOSI scores and the Shoulder Instability – Return to Sports after Injury scale.
Return to sport outcomes were assessed at 6 months. Among all athletes, 17 did not return to sport, 28 returned to sport at a lower level and 27 returned to sport at the same level.
Moussa and colleagues found athletes who did not return to sport had decreased strength in concentric external rotation at 60° per second, concentric external rotation at 240° per second, concentric internal rotation at 240° per second and eccentric internal rotation at 30° per second compared with athletes who did return to sport. Specifically, they noted isokinetic testing in concentric external rotation at 240° per second and eccentric external rotation at 30° per second were significant predictors of return to sport outcomes.
Moussa and colleagues also found a positive correlation between Walch-Duplay scores, WOSI scores and improved strength recovery.
“For patients who do not meet the isokinetic strength thresholds, clinicians are advised to continue targeted rehabilitation,” Moussa and colleagues wrote. “We recommend scheduling repeat isokinetic testing at the 6-month mark to assess the patient’s progress and determine readiness for a safe return to sport.”
Perspective
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The study published by Mohamad K. Moussa, MD, MSc, and colleagues entitled “Isokinetic strength and balance analysis for predicting return to sports after the Latarjet procedure” is an interesting publication.
I enjoyed this manuscript for several reasons. First, I believe it is important to utilize an objective, criteria-based return to sports testing protocol for athletes and patients. It has been shown several times with patients who underwent ACL reconstruction that reinjury can be dramatically affected if the athlete/patient fulfills specific criteria with certain return to play (RTP) functional tests.
Secondly, the article encourages physicians to embrace and utilize RTP testing for athletic patients. A study by Sue D. Barber-Westin, BS, and Frank R. Noyes, MD, reported 13% of clinicians utilized objective RTP testing in patients who underwent ACL reconstruction. Most clinicians in their study used time-based criteria. Thus, the manuscript by Moussa and colleagues illustrates the importance in these shoulder patients.
In this article, Moussa and colleagues showed 37.5% of patients returned to the same level of activities at 6 months. This reported outcome appears low to me. While there are a low number of studies reporting outcome rates with patients undergoing Laterjet procedure, Charles Milchteinn, MD, and colleagues reported an 82.5% return to same level of activities/sports following a Bankart procedure. Anecdotally, my clinical experience has seen a return to sport in athletes following a Latarjet procedure is approximately 85% or more.
There are several questions I have regarding the manuscript from Moussa and colleagues. The authors reported subjects were involved in regular sport activities. What does that mean? Are they competitive athletes? What type of sports do they play? Overhead sports? Contact sports? This will significantly affect the outcome rate.
The authors utilized isokinetic testing to determine muscular strength values of the glenohumeral joint external and internal rotators. This is excellent but when utilizing isokinetic testing, there is a learning curve for subjects to perform shoulder tests. It has been shown that patients require approximately one to two exposures to isokinetic exercise to produce a consistently valid test. In this study, the authors did not report if prior exposures were performed.
Furthermore, why isokinetics? Why not manual muscle testing with a handheld dynamometer?
Lastly, testing was performed at 4 months, with a goal of RTP at 6 months. How did the patients look at 6 months — better or worse?
I think several key points are reported in this study:
- Glenohumeral joint external rotation strength is a key indicator to functional outcomes following a Latarjet procedure.
- Glenohumeral joint external rotation strength also correlates to functional testing (the Davies CKCUEST).
- Strength and functional testing should be performed prior to return to sport activities.
My recommendations for RTP tests following the Latarjet procedure would include range of motion assessment, objective muscle strength using a handheld dynamometer, special tests for stability and reactive neurocognitive tests as described by myself and colleagues.
Additional research is needed to further examine best functional tests and specific criteria for return to sport following Latarjet procedures.
References:
Barber-Westin S, et al. Arthroscopy. 2011;doi:10.1016/j.arthro.2011.09.009.
Grindem H, et al. Br J Sports Med. 2016;doi:10.1136/bjsports-2016-096031.
Milchteim C, et al. Arthroscopy. 2016;doi:10.1016/j.arthro.2016.01.025.
Wilk KE, et al. Int J Sports Phys Ther. 2023;doi:10.26603/001c.89926.
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