Immediate Self-Rehabilitation With Versus Without Sling Immobilization After Open Latarjet Procedures for Recurrent Anterior Shoulder Instability: A Randomized Controlled Trial.
TL;DR
Immediate self-rehabilitation without sling immobilization yielded superior functional scores at 2 years after a Latarjet procedure, suggesting that sling avoidance did not negatively impact patient recovery and the practice of sling immobilization following open Latarjet procedures may be reconsidered.
Abstract
Background
Recent research has highlighted the adverse effects of immobilization in shoulder rehabilitation. The present study aimed to compare the efficacy of immediate self-rehabilitation with and without sling immobilization following an open Latarjet procedure for recurrent anterior shoulder instability.
Methods
This monocentric randomized controlled trial included 86 patients (median age, 26; 92% male) divided into 2 groups: sling immobilization for 3 weeks postoperatively and no sling immobilization. Patients were evaluated with use of patient-reported outcome measures (PROMs), motion-capture analysis, and computed tomography scans before and 6 months after surgery. An additional questionnaire was administered at 2 years postoperatively to update PROMs. The primary outcome was the Rowe score. Secondary outcomes included visual analogue pain scale scores, single assessment numeric evaluation (SANE) scores for instability, patient satisfaction, range of motion, return to work and sport activities, graft union, and osteolysis. Patient acceptable symptom states were calculated and utilized to interpret PROMs. Multivariable linear and modified Poisson regressions were utilized to evaluate the effect of sling immobilization on different outcomes, independent of age, sex, preoperative PROMs, and range of motion.
Results
Both groups had comparable PROMs, range of motion, and radiographic outcomes at 6 months postoperatively, with no statistically significant differences observed between groups. At 2 years postoperatively, the no-sling group reported greater Rowe and SANE instability scores by 12.5 points (p = 0.005) and 7.9 points (p = 0.001), respectively. The no-sling treatment was more likely to achieve very high patient satisfaction (relative risk [RR], 1.53; p = 0.015), Rowe patient acceptable symptom state (RR, 1.47; p = 0.012), and SANE instability scores (RR, 1.55; p = 0.001). Two recurrent shoulder dislocations occurred in the sling group (5%).
Conclusions
Immediate self-rehabilitation without sling immobilization yielded superior functional scores at 2 years after a Latarjet procedure. Both approaches resulted in excellent early functional outcomes and a high return-to-sport rate, suggesting that sling avoidance did not negatively impact patient recovery. As a result, the practice of sling immobilization following open Latarjet procedures may be reconsidered. Further investigation into optimal postoperative rehabilitation strategies is warranted. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.