Internal rotation strength recovers fully after the open Latarjet via a subscapularis-split: A systematic review and meta-analysis.

Abstract

To systematically evaluate postoperative internal rotation (IR) and external rotation (ER) strength recovery following the open Latarjet (OL) procedure performed through a subscapularis-split approach using isokinetic dynamometry. A systematic search of PubMed, Embase, and the Cochrane Library following PRISMA guidelines was performed to identify clinical studies reporting postoperative shoulder rotational strength after OL. Extracted outcomes included IR and ER peak torque and ER/IR ratios. A random-effects meta-analysis was conducted for studies reporting peak torque at 60°/s. Eleven studies encompassing 274 patients met inclusion criteria. Across studies, rotational strength recovery followed a consistent temporal pattern. Early (<6 months) deficits were substantial for IR (18%-42%) and ER (8%-30%). Between 6 and 12 months, strength improved but did not fully normalise. At ≥18 months, IR strength typically recovered, whereas small but statistically significant ER deficits persisted (4%-15%). Meta-analysis demonstrated pooled deficits of 17.0% for ER (95% confidence interval [CI], 12.1-21.9) and 15.1% for IR (95% CI, 9.0-21.2), with significantly smaller deficits at late compared with early follow-up for both IR and ER strength. ER/IR ratios showed no overall asymmetry; however, subgroup analysis revealed a shift from early IR-dominant weakness to late ER-dominant weakness. Shoulder rotational strength recovery after the OL procedure through a subscapularis-split approach follows a predictable temporal pattern, with early internal rotation deficits resolving by 6-12 months and small but persistent external rotation deficits at long-term follow-up. These findings indicate that the split of the subscapularis muscle does not compromise IR strength at long-term follow-up, supporting its safety for young and active patients. Level III.