Most Athletes Who Fail to Return to Sport After Latarjet Procedure Cite Psychological Factors: A Systematic Review

Purpose: To identify the return-to-sport (RTS) rate in athletes undergoing a Latarjet procedure while outlining the specific reasons for failure to RTS. Methods: An electronic literature search was conducted (PubMed/MEDLINE, Scopus, Web of Science). Studies in peer-reviewed journals with Latarjet procedures performed on athletes that reported rates and reasons for failure to RTS were included. Excluded studies were those that reported solely on nonathletes, non-Latarjet surgery, and missing rates of and reasons for failure to RTS. Study heterogeneity was assessed using the I2 statistic, and quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria. Results: After review of 3,617 articles, a total of 18 studies with 1,066 patients met the inclusion criteria. The level of evidence for included studies ranged from II to IV. Rates of not returning to sports (NRTS) ranged from 3.4% to 35.3%. More studies cited shoulder-unrelated reasons than shoulder-related reasons for why athletes failed to RTS. Ten (55.5%) studies, making up 656 (61.5%) patients, reported that shoulder-unrelated reasons were accountable for more than 50% of NRTS. Only 3 (16.7%) studies reported 100% NRTS because of shoulder-related reasons, which include fear of reinjury and psychological factors. Study heterogeneity was found to be moderate (I2 = 73.4%; 95% confidence interval 57.5-83.3; P < .001) and study quality was found to be satisfactory (mean Methodological Index for Non-Randomized Studies score 12.1 for noncomparative and 20.5 for comparative studies). Conclusions: According to this systematic review, the rate of NRTS after Latarjet ranged from 3.4% to 35.3% across 18 studies, with the majority of studies citing nonshoulder-related reasons such as fear or reinjury or psychological factors as the major deterrent for returning to sports. Level of Evidence: Level IV, systematic review of case series.