Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study

Abstract

Background: Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint. Purpose: To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS. Study Design: Cohort study; Level of evidence, 2. Methods: The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability–Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed. Results: A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s ( P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST ( P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities ( r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s ( r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s ( r = 0.30-0.38; P < .05). Conclusion: Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.