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Latarjet手术

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Rehabilitation protocol after the Latarjet coracoid bone-block transfer for anterior shoulder instability — union-gated loading and subscapularis/graft precautions.

一幅手绘插图，描绘了一名橄榄球运动员在擒抱时护住肩膀的场景。
Latarjet手术后的康复。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

本方案旨在指导您在 Mater Private Hospital Rockhampton 接受 Kieran Hirpara 医生实施的 Latarjet 手术后的康复过程。本方案将每个阶段的通俗解释与结构化康复计划相结合，您可以将此计划分享给您的物理治疗师；请在首次就诊时携带此页面或其 PDF 版本，以确保您的康复治疗协调一致。您的物理治疗师可能会根据您的康复进展调整该计划。

如果您对术后伤口有任何疑虑，请联系诊所。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。

预期情况

Latarjet手术是一种针对前向反复脱位肩关节的骨块手术。由于该手术使用螺钉固定的坚固骨块（而非仅缝合软组织），早期修复更为牢固，因此您的恢复速度通常快于软组织稳定术（Bankart修复）。平均而言，患者大约在20周后重返运动，而Bankart术后则约为32周。

但“更快”并不意味着“随心所欲”。您恢复的速度取决于最重要的一点：移植骨块在您肩胛盂上的愈合。这种骨性连接（称为骨性愈合）通常需要约6至8周。在您的外科医生确认骨性愈合之前，无论手臂感觉如何良好，均会限制肩关节的负重。Latarjet手术还有两项Bankart手术所不具备的保护结构，因此下文中的部分早期限制措施专门针对该手术。

手术过程

在 Latarjet 手术中，一块称为喙突（肩胛骨前方的一块骨性突起）的小骨块被移至肩胛盂（肩关节窝）前方骨缺损处，并用螺钉固定。这补充了缺失的骨量，并在肩关节前方形成“悬带”效应，有助于防止肩关节脱位。

为了将该骨块移至正确位置，外科医生必须将其穿过肩胛下肌（肩关节前方的一块肌肉），该肌肉被切开或部分剥离，随后进行修复。因此，在愈合过程中需要保护以下两个部位：

  • 骨块及其螺钉，必须与肩胛盂愈合（骨性愈合，约需 6–8 周）；以及
  • 位于前方的肩胛下肌，该肌肉在转移的骨块周围进行修复。

部分患者会遗留约 7–8 度的外旋活动度（将手向外转动）永久性轻微丧失。这是预期内的现象，并非并发症；对大多数人而言，这不会影响日常生活。

佩戴您的悬吊带

您将佩戴简单的肩关节悬吊带，而非外展枕或楔形悬吊带。Hirpara 医生在稳定术中使用简单悬吊带，因为骨性固定非常牢固，保护主要来自于将手臂保持在安全位置，而非悬吊带的形状。

  • 白天佩戴悬吊带约 2 周，以提供支撑和舒适感。骨性 Latarjet 手术在悬吊带中固定的时间远短于软组织修复术。
  • 您睡觉时不佩戴悬吊带。 睡觉时将其取下；睡眠时保持手臂处于安全位置：不要让手臂向侧面滑落并外旋（这是手术旨在避免的姿势）。将手臂支撑在横跨身体的枕头上或身体侧面，既舒适又安全。
  • 淋浴和进行锻炼时（在您被指导如何操作后）取下悬吊带。只要取下悬吊带，就请保持手臂放松并置于身体侧面。
  • 如果肩部肿胀或疼痛，请使用冰敷，尤其是在锻炼后。

佩戴悬吊带时请注意您的姿势：保持耳朵、肩膀和髋部在一条直线上，避免含胸驼背。

关键注意事项——禁止事项

这些措施旨在保护骨块、螺钉以及前方肌肉在愈合期间的安全。

  • 严禁早期强行将手臂置于外旋位（即手掌向外翻转）。在术后前2周内，外旋角度在支撑状态下限制在约25度，此后仅在您的主刀医生规定的范围内逐渐增加。
  • 严禁将手臂向后推（肩关节后伸），并避免手臂同时处于外旋和后伸的复合体位。这会牵拉附着于移植骨块的肌腱。
  • 严禁早期进行抗阻内旋力量训练（即对抗阻力将手掌用力向身体内侧推压）。这会牵涉到正在愈合的前方肌肉（肩胛下肌），需待您的主刀医生许可后方可进行。
  • 严禁在您的主刀医生确认骨性愈合（约需6–8周）之前，通过手臂或手掌承重、用手臂从椅子上撑起，或提、推、拉任何重物。能否增加负荷取决于骨性连接情况，而非日历时间。
  • 严禁早期进行剧烈的胸部或过头举重训练：在康复后期之前，禁止进行蝴蝶机夹胸、宽握卧推、推举（过头推举）、颈后高位下拉或肱三头肌双杠臂屈伸。
  • 避免手臂受到任何突然的牵拉、抓握或跌倒撞击。

第一阶段——即时保护（第0–2周）

最初两周的重点是保护新移植的骨块和修复的前侧肌肉，同时让肿胀消退。白天佩戴简易吊带，睡觉时不戴吊带（保持手臂处于安全位置），并进行温和的锻炼，以保持手、腕和肘部的活动度，避免对肩部造成压力。肩部本身仅进行温和的被动活动；尚不能依靠自身力量抬起手臂。

  • 吊带： 白天使用简易吊带以提供支撑和舒适感；睡觉时不佩戴吊带，手臂保持安全位置；进行锻炼和卫生清洁时可取下。
  • 允许的活动： 仅限温和的辅助活动和被动活动；禁止依靠肩部自身力量抬起手臂。前屈及向侧面伸展至舒适位置；外旋保持在约25度（有支撑状态下）；禁止将手臂向后推至身体后方。
  • 锻炼： 肩胛骨设定练习；握球练习；温和的手、腕和肘部活动；钟摆运动（手臂放松，不向后摆动）。

进入下一阶段的标准： 疼痛通过简单止痛药得到缓解和控制；伤口已愈合且无异常迹象；不戴吊带时感觉舒适；温和的活动范围保持在您的外科医生设定的安全范围内。

第二阶段——恢复活动度（第3–9周）

此时的重点是活动，而非力量。从大约第3周开始逐步停用悬吊带。您将从辅助活动过渡到依靠自身力量活动手臂，并逐渐增加外旋活动度；早期在支撑位下约至45度，随后从大约第6周起根据耐受程度进一步增加，但始终在您的外科医生规定的范围内。加入轻度的按压保持（等长）训练，同时保持内旋用力轻柔以保护前方肌肉。负荷训练仍需等待；在此阶段，骨块仅刚开始愈合。

  • 悬吊带： 从第3周开始逐步停用。
  • 允许的活动： 辅助活动逐渐过渡到依靠自身力量活动，大约在第六周达到（向大约90–110°的上举方向）。外旋逐渐打开；早期在支撑位下约45度，随后根据耐受程度增加，在外科医生规定的范围内。内旋轻柔至约45度。
  • 练习： 全举臂（full-can）抬举至肩高；毛巾卷上轻柔的外旋弹力带训练；使用拐杖轻柔内旋（无力量）；低拉训练；从大约第6周开始，轻柔的按压保持等长训练用于外旋和外展（内旋等长训练稍后开始）。您的物理治疗师可能还会加入轻柔的节律性稳定训练（即治疗师轻推您的手臂，您进行抵抗以保持稳定的训练），以重新训练控制能力；这是手法操作，无图示。

进入下一阶段的条件： 您的外科医生已确认（通常在6–8周的复查时）骨块已愈合；您能依靠自身力量良好控制地活动手臂；您的辅助活动和被动活动完全或接近完全且舒适；且轻柔的等长训练后不会引起疼痛加剧。力量训练直到确认愈合才开始：这取决于骨愈合情况，由您的外科医生确认，而非由日历决定。

第三阶段——强化训练（第10–15周）

一旦您的外科医生确认骨骼已愈合，您便可以开始对肩部进行负荷训练。强化训练初期使用轻阻力带和轻重量：高重复次数、低负荷，并逐步增加。黄金法则是一次只针对一个方向：只有在该方向上获得舒适且接近全范围的活动度后，才可对该方向进行强化训练。内旋和前侧肌肉（肩胛下肌）的强化训练仍需谨慎并在后期引入，因为该肌肉在您的手术中进行了修复。

  • 吊带： 无需使用；在对某一方向进行负荷训练前，应预期获得接近全范围且舒适的活动度。
  • 练习： 轻重量并逐渐增加重量的空罐上举；轻重量二头肌弯举；阻力带划船；针对前侧肌肉的墙壁俯卧撑加肩胛骨前伸（push-up-plus）和仰卧前冲拳；使用棍棒进行背后内旋（轻柔，约在第12周前侧肌肉愈合后开始）。逐步增加负荷，如果肩部疼痛或肿胀则停止。

进入下一阶段的条件： 您能够凭借自身力量实现全范围无痛活动，且肩胛骨控制良好；强化训练后无疼痛或肿胀；在肩高以下进行抗阻抬举时感觉舒适；且外旋力量正在向对侧水平发展。

第四阶段 — 过头动作及重返运动（第16–20周）

本阶段是恢复肩部完全功能并逐步重返运动及重体力工作的过渡期。您需保持已获得的关节活动度，并增强力量、爆发力和耐力，以自信地使用肩部，包括过头动作。重返过程是分阶段的，而非突然进行；对于运动，采用逐步增加运动量和强度的间歇性训练计划是重返赛场最安全的方式。

  • 支具： 无。
  • 练习： 当肩高以下力量良好时，进行轻重量且逐渐增加重量的过头全范围外旋抬举（full-can lifts）；渐进式弹力带划船；针对运动和工作的特异性体能训练；在本阶段后期，根据情况加入受控的高速（增强式）训练。可加入俯卧撑练习，但需注意肘部不要过度向后移动。

达到重返标准的标志： 外旋力量与对侧相差约8–10度以内，且整体旋转力量均衡增长；在较大负荷下拥有完全且无痛的活动范围，无反应性肿胀；并通过针对您所在运动或职业的任务特异性测试。重返运动的时间通常在20周左右，而接触性或碰撞性运动往往需要更晚（约5–6个月），这取决于是否满足上述标准以及Hirpara医生和您的物理治疗师的许可，而非仅依据日历时间。

重返运动与工作

您的重返标准基于临床指标：无痛，具备足够的关节活动度、力量和耐力，并经 Hirpara 医生及您的物理治疗师共同批准，而非仅由日历时间决定。由于 Latarjet 手术使用自体骨块，其恢复通常比软组织修复更快，但所有重于轻柔活动的动作均需等待骨块愈合（约 6–8 周，由您的外科医生确认）。

  • 胸部水平以下的轻度活动通常在术后 10–15 周恢复。
  • 过头动作及投掷活动通常在术后 4 个月左右恢复。
  • 重返运动的平均时间为术后 20 周；对抗性或冲撞性运动通常在术后 5–6 个月左右恢复，且必须满足力量和活动度标准后方可进行。

术后康复方案

本方案与诊所的一般康复建议配合使用；请参阅术后疼痛管理和伤口护理。

Reviewed by Dr Kieran Hirpara · 17 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Latarjet (Coracoid Transfer) for Anterior Instability with Bone Loss: Rehabilitation Evidence

Topic: Open Latarjet / Bristow-Latarjet coracoid transfer for anterior glenohumeral instability with glenoid bone loss (>~20% glenoid, or off-track Hill-Sachs / failed soft-tissue repair). Compiled: 2026-06-16. Sources: local RAG Orthopaedic corpus + published fellowship/PT "standard of care" protocols.

How Latarjet rehab DIFFERS from arthroscopic Bankart

  • It is a BONY procedure (coracoid autograft screw-fixed to the antero-inferior glenoid). Fixation is rigid -> the structural construct is stronger than soft-tissue suture anchors, so AROM and return to sport are generally FASTER than Bankart (Beletsky 2020: mean RTS ~19.6 wk Latarjet vs ~32.4 wk Bankart, p<0.001).
  • BUT two distinct soft-tissue structures must be protected that Bankart does not involve: (1) the subscapularis (split, or taken down and repaired, to pass the graft); (2) the coracoid graft osseous union (~6-8 weeks to unite) plus the conjoint-tendon (biceps short head + coracobrachialis) "dynamic sling" still attached to the graft.
  • Graft-protection precautions: avoid aggressive shoulder extension and combined extension + external rotation stretching early (tensions the conjoint origin on the graft). Progress biceps/coracobrachialis strengthening gradually. If subscapularis was taken down & repaired, slow ER progression and avoid aggressive IR strengthening until subscap healed - get an intra-operative "safe-zone" ER from the surgeon.
  • Expect a permanent mild ER deficit (Hovelius: mean loss ~7.4 deg in adduction, ~8 deg in abduction) - this is accepted, not a complication.

Consensus phased timeline (BWH Latarjet standard of care)

Phase Week window Sling/brace ROM allowed & restrictions AROM / strengthening RTS
I - Immediate post-surgical 0-2 wk Sling at all times (remove only to shower, arm at side); towel under elbow to prevent hyperextension (graft protection); sleep in sling No AROM. PROM only, no forcing: flexion/elevation & scaption to tolerance; IR to 45 deg at 30 deg abd; ER 0-25 deg in scapular plane at 30-40 deg abd (open-packed); respect anterior capsule; use intra-op ER measurements Scapular isometrics, ball squeezes; cryotherapy None
II - Intermediate / ROM 3-9 wk Wean from sling beginning wk 3 Early (wk 3-4): ER to 0-45 deg at 30-40 deg abd, IR 45 deg at 30 deg abd. Late (wk 6): ER to tolerance, progress to multiple abd angles once >=35 deg; IR multi-angle. AAROM from wk 3 -> AROM by ~wk 6 (good mechanics, up to 90-110 deg elevation) Begin balanced AROM/strengthening late phase II (~wk 6): high-rep/low-load (1-3 lb), full-can scaption to 90 deg, ER/IR tubing at 0 deg abd (towel roll), prone rows, rhythmic stabilisation. Subscap-specific work (upper+lower fibres) None
III - Strengthening 10-15 wk None Continue A/PROM; near-full ROM before loading a plane Biceps curls light; progressive pec major/minor (avoid anterior-capsule-stress positions); subscap strengthening (push-up plus, cross-body diagonals, IR band 0/45/90, forward punch) Chest-level functional activities
IV - Overhead / return to activity 16-20 wk None Full pain-free ROM Overhead strengthening once sub-90 strength good; progressive weightlifting (15-25 reps); plyometrics/interval program if cleared; push-ups allowed but elbows not past 90 deg Throwing/overhead not before 4 months; pre-injury sport when cleared by MD

Active ROM start: AAROM wk 3, AROM ~wk 6. Strengthening start: scapular isometrics immediately; isotonic/RC strengthening ~wk 6. RTS: chest-level ~10-15 wk; overhead/throwing >=4 months; full/contact sport typically ~5-6 months (RAG cohorts: open Latarjet RTS averages ~6 months; bone-block soft-tissue/graft healing requires the 3-month minimum). ER milestones to advance: PE >=155 deg, ER within 8-10 deg of contralateral at 20 deg abd and >=75 deg at 90 deg abd.

Graft-protection summary (the Latarjet-specific precautions): no aggressive extension or extension+ER stretch early; protect conjoint tendon/biceps origin; protect subscapularis (slower ER + delayed IR strengthening if taken down); no pec flys/wide-grip bench/military press/behind-neck lat pulls; tricep dips avoided; osseous union ~6-8 wk gates heavier loading.

Key controversies & evidence flags

  1. Is a sling even necessary after open Latarjet? An RCT (Kourimpetis/PMC9969622, "Is sling immobilization necessary after open Latarjet surgery...") challenges routine immobilisation - because rigid bony fixation may not need the soft-tissue protection a Bankart does. This is the leading edge of "accelerated Latarjet." Evidence: STRONG (single RCT) - emerging, not yet standard.

  2. Accelerated Latarjet rehab / faster RTS. Multiple comparative studies (Beletsky 2020; Delgado 2025 matched-pair; Rogowski 2025 JSES) confirm Latarjet RTS is earlier than Bankart and that bony union (~3 months) - not soft-tissue - is the rate limiter. Rogowski (JSES 2025) argues functional dominant/non-dominant testing at 4.5 months predicts successful RTS better than time alone, supporting criteria-based acceleration. Evidence: MODERATE (good cohorts, no large RCT on the rehab pace itself).

  3. Contact/collision-sport return & procedure choice. Latarjet is often preferred in collision athletes (rugby) precisely because of bone block + dynamic sling. Tanaka 2022 / Hirose 2026 (Bristow vs Latarjet in rugby) and Gowd 2021 (JSES, RTS after Latarjet) inform RTS rates and timing; subluxation/pain after RTS more frequent in some Latarjet vs Bristow series. Contact RTS still generally ~5-6 months and criteria-based. Evidence: MODERATE cohort-level.

  4. Subscapularis split vs takedown-and-repair changes ER progression: takedown demands slower ER and delayed IR strengthening. Protocol explicitly defers to an intra-operative surgeon-defined ER "safe zone." Evidence: consensus / biomechanical rationale.

CITATIONS

Published rehabilitation protocols (URLs)

  • Brigham & Women's Hospital, Dept. of Rehabilitation Services - Anterior Stabilization of the Shoulder: Latarjet Protocol (orig. 2009, updated May 2016): https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/shoulder-latarjet.pdf
  • Rehabilitation Guidelines for Latarjet/Coracoid Process Transfer (Eichinger, MD): https://www.josefeichingermd.com/pdf/rehab-guideline-for-latarjet.pdf
  • Rehabilitation Protocol - Latarjet (Coracoid Transfer/Eden-Hybinette), Lindsay Sports Med (2025): https://www.lindsaysportsmed.com/pdf/laterjet-and-edenhybinette-center-2025.pdf
  • Rehabilitation Protocol: Latarjet Coracoid Process Transfer (Utz, MD): https://www.christopherutzmd.com/pdfs/latarjet-protocol.pdf
  • Latarjet Procedure overview - Physiopedia: https://www.physio-pedia.com/Latarjet_Procedure

Local RAG corpus (article / journal / year)

  • Beletsky A, Cancienne JM, Manderle BJ, et al. A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair. Sports Health. 2020. [protocol comparison - Latarjet RTS ~19.6 wk vs Bankart ~32.4 wk, p<0.001; AAROM ~6-8 wk]
  • Matache BA, Hurley ET, Wong I, et al. Anterior Shoulder Instability Part III - Revision Surgery, Rehabilitation and Return to Play - An International Consensus Statement. Arthroscopy. 2021;38(2). (Poses the open questions on immobilisation duration after coracoid transfer vs Bankart vs glenoid bone grafting.) [consensus]
  • Gowd AK, Liu JN, Polce EM, et al. Return to sport following Latarjet glenoid reconstruction for anterior shoulder instability. Journal of Shoulder and Elbow Surgery. 2021;30(11):2549-2559. [systematic review - RTS]
  • Rogowski I, Nove-Josserand L, Godeneche A, et al. Are the dominant-nondominant functional differences at 4.5 months after open Latarjet better predictors for successful RTS at 1 year than operated-nonoperated differences? Journal of Shoulder and Elbow Surgery. 2025;34(10):2338-2349. (3-month delay needed for graft healing; RTS ~6 months; criteria-based prediction.) [prospective cohort]
  • Delgado C, Calvo E, Valencia M, et al. Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Anterior Shoulder Instability: A Matched-Pair Long-Term Follow-up Study. Orthopaedic Journal of Sports Medicine. 2025. [matched-pair comparative]
  • Tanaka M, Hanai H, Kotani Y, et al. Open Bristow Versus Open Latarjet for Anterior Shoulder Instability in Rugby Players. Orthopaedic Journal of Sports Medicine. 2022. [comparative - contact athletes]
  • Hirose T, Tanaka M, Nakai H, et al. Comparing Bristow and Latarjet procedures for anterior shoulder instability in competitive rugby players. Journal of Shoulder and Elbow Surgery. 2026;35(4). [within-subject comparative]
  • Bonnevialle N, Girard M, Dalmas Y, et al. Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet. The American Journal of Sports Medicine. 2021. [fixation/union]
  • Salem HS, Vasconcellos AL, Sax OC, et al. Intra-articular Versus Extra-articular Coracoid Grafts: A Systematic Review of Capsular Repair Techniques During the Latarjet Procedure. Orthopaedic Journal of Sports Medicine. 2022. (Documents post-Latarjet ER loss ~4.5-6.3 deg.) [systematic review]

Additional online RCT/evidence

  • "Is sling immobilization necessary after open Latarjet surgery for anterior shoulder instability? A randomized controlled trial." PMC9969622: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9969622/ [STRONG - RCT challenging routine immobilisation]
  • "Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores." PMC8298242: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298242/ [cohort - RTS rate/timing]

Overall evidence grade for the phased protocol itself: CONSENSUS / institutional standard-of-care (Level V). The "sling necessary?" question is the only RCT-level datapoint; accelerated/criteria-based RTS rests on good comparative cohorts (Level III).

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