When Can I Return to Contact Sport After Latarjet Surgery?
Criteria over chronology. Rebuild the shoulder, the athlete and the demands of collision sport together — so return to contact is earned through demonstrated capacity, not a date on the calendar.
Book a Return-to-Contact AssessmentThe Latarjet procedure is a well-established surgical option for athletes with recurrent anterior shoulder instability, particularly where there is significant glenoid bone loss or a high risk of recurrent instability. By transferring the coracoid process and attached conjoint tendon to the anterior glenoid, the procedure provides both a bony augmentation and a dynamic stabilising effect to the shoulder.
For the contact athlete, however, surgery is only the beginning. The ultimate goal is not simply to achieve a pain-free shoulder or normal
range of motion, but to restore the strength, endurance, stability, power and confidence required to tolerate the unpredictable demands of
collision sport — Gaelic football, hurling, rugby, martial arts and other contact sports, where the shoulder may be exposed to
tackles, falls, forced abduction and external rotation, bracing and high-speed impacts.
Written by Christian Coombs and David Harrington — Physio Tullamore, Co. Offaly
When can an athlete return to contact sport?
Traditionally, return to sport following Latarjet surgery has been based heavily on time. However, contemporary rehabilitation increasingly supports a criteria-based approach, where time from surgery is only one component of the decision.
The 2024 ESSKA–ESA consensus recommends that return to sport following anterior shoulder stabilisation should be individualised according to the athlete, sport and level of competition. Importantly, the athlete should demonstrate a stable, pain-free shoulder, full active range of motion, appropriate scapulothoracic control and sufficient strength compared with the opposite side. Sport-specific physical and functional demands, as well as psychological readiness, should also be considered.
For bony procedures such as Latarjet, unrestricted return is often possible around four months, although this should not be interpreted as an automatic clearance date. Contact athletes may require longer depending on their rehabilitation, strength deficits and sport-specific demands.
The rehabilitation guidance of shoulder specialist Ruth Delaney similarly highlights that the transferred bone graft requires time to heal and that return to sport depends on restoration of range of motion, strength and scapular stability. Her Latarjet protocol incorporates progressive strengthening and sport-specific rehabilitation rather than relying solely on a calendar-based approach.
This distinction is crucial: four months may represent a potential timeframe, but it should never represent the only criterion for return to contact.
The return-to-contact pathway
From surgery to the pitch, each phase unlocks the next — progress is demonstrated, not assumed.
Latarjet surgery
The coracoid graft is fixed to the anterior glenoid — the clock starts, but the calendar is only one input.
Protected rehabilitation
Range of motion, scapular control and progressive loading while the graft heals and integrates.
Strength rebuild
Dynamometry tracks internal and external rotation strength and ER:IR ratios until symmetry is restored.
Objective testing battery
VALD ASH peak force and RFD, cuff endurance and functional testing against the uninvolved shoulder.
Graduated contact
From controlled drills to unpredictable, full-intensity collision situations — step by step.
Full return to contact
Cleared when every criterion is passed — earned through demonstrated capacity, not the calendar.
Building objective criteria into rehabilitation
One of the major challenges following Latarjet surgery is determining whether an athlete is genuinely ready to tolerate contact. An athlete may report feeling excellent, have full range of motion and be participating in normal training, yet still demonstrate meaningful deficits in force production or endurance.
This is where objective testing becomes particularly valuable. A criteria-based return-to-sport study following open Latarjet surgery assessed athletes using four domains: isometric strength, isokinetic strength, endurance and functional performance. Testing was performed at an average of 5.3 months post-operatively. Only four of ten athletes passed the complete testing battery initially, despite all being at a stage where traditional time-based clearance might have been considered. Seven athletes demonstrated a deficit in at least one component of strength testing, while two failed endurance testing and two failed functional testing.
This demonstrates why testing matters: time alone can tell us how long an athlete has been recovering, but it cannot tell us how well they have recovered.
The VALD Athletic Shoulder Test
The Athletic Shoulder (ASH) Test is particularly useful when assessing an athlete approaching return to contact sport. It assesses isometric force production through the shoulder girdle using three long-lever positions:
ASH-I
Full-length long-lever position — the most demanding force test of the shoulder girdle.
ASH-Y
Arm positioned approximately 45° from the body — replicating tackle and brace angles.
ASH-T
Arm positioned out to the side — a shorter lever, closer to traditional strength testing.
Using VALD ForceDecks, the athlete produces a maximal isometric contraction through the
hand while lying prone. The system can quantify variables such as peak force and rate of force development (RFD).
The value of the ASH test following Latarjet is that it moves beyond traditional isolated shoulder strength testing. Contact athletes rarely use their shoulder with the elbow tucked by their side. Tackling, falling, reaching, pushing and bracing all require the athlete to produce and absorb force through longer lever positions.
Recent research demonstrates excellent test-retest reliability for the ASH test, with reported ICCs of approximately 0.94–0.98 across positions when performed using force-plate methodology.
For return-to-contact testing, the clinician can therefore monitor peak force, RFD, limb asymmetry and progression over time. The important point is not necessarily achieving one universal number. Instead, the clinician should establish the athlete’s pre-injury or baseline profile where possible and compare the surgical shoulder with the contralateral side while also considering normative data and the demands of the athlete’s sport.
Dynamometer testing
Hand-held or fixed dynamometry provides another important component of the assessment. Following Latarjet surgery, particular attention should be given to internal rotation, external rotation, abduction and flexion strength, with external and internal rotation particularly relevant to dynamic glenohumeral stability.
Hand-held dynamometry provides a more objective assessment than manual muscle testing and can identify relatively small strength deficits that may not be apparent clinically. Criteria-based shoulder return-to-sport frameworks recommend dynamometry as athletes progress towards higher-level testing.
At Physio Tullamore, we use a hand-held dynamometer to objectively measure shoulder internal and external rotation strength at every key stage of rehabilitation. Testing the shoulder in rotation — the positions most relevant to dynamic glenohumeral stability — gives us precise newton readings for both sides, allowing us to track ER:IR ratios, quantify exactly when the surgical shoulder has caught up with the opposite side, and give the athlete and the orthopaedic consultant objective evidence that strength symmetry has been restored before contact is introduced.
A useful return-to-contact profile could therefore include external rotation strength, internal rotation strength, ER:IR strength ratio, abduction strength, flexion strength, comparison with the uninvolved shoulder, and absolute strength relative to body mass where appropriate.
Rather than simply asking, “Is the shoulder strong?”, the clinician can ask, “Is the shoulder capable of producing the amount and type of force required by this athlete's sport?”
Cuff Endurance: The missing piece
Maximum strength is only one part of shoulder function. A Gaelic footballer, rugby player or martial artist may produce excellent peak force during a single maximal contraction but still struggle to maintain shoulder stability after repeated tackles, contests or collisions.
This makes a rotator cuff endurance test an important addition to the return-to-contact assessment. The test should reproduce the athlete’s sporting demands while monitoring the ability of the shoulder to repeatedly generate force without excessive deterioration in performance. Variables such as total repetitions, time under tension, force maintenance and percentage decline from the initial effort can be recorded.
For example, a significant drop in force output during repeated external-rotation contractions may indicate that the athlete has adequate maximal strength but insufficient capacity to maintain dynamic glenohumeral control under fatigue. This is particularly relevant because fatigue can alter scapular and glenohumeral mechanics and potentially reduce the athlete's ability to protect the shoulder during contact.
The Latarjet return-to-sport literature supports including endurance within a broader testing battery; in the previously mentioned case
series, 20% of athletes failed the endurance component despite having progressed to return-to-sport assessment.
Key Principle
Return to contact should be earned through demonstrated capacity — not simply reached because the calendar says so.
The Role of the Orthopaedic Consultants
A criteria-based return to contact sport is a team effort, and the orthopaedic consultant sits at the centre of it. The consultant performs the Latarjet procedure, monitors graft healing and integration, and provides the medical clearance that underpins Criterion 1 of the nine-stage pathway — the surgeon must be satisfied with the healing and clinical status of the reconstruction before any contact progression begins.
Our athletes are fortunate to work alongside leading Irish shoulder specialists. Mr John Lunn, Ms Ruth Delaney, Hannon Mullet, Cathal Moran who perform the Latarjet procedure and provide the surgical direction that shapes each stage of rehabilitation: when the graft is ready for progressive loading, when resisted work can be advanced, and when contact can be considered. Professor Cathal Moran — a contributor to the international literature on athletic shoulder stabilisation and a member of the Anterior Shoulder Instability International Consensus Group alongside Ruth Delaney — has long championed objective, criteria-based rehabilitation over calendar-based clearance.
Ruth Delaney’s post-operative Latarjet protocol similarly progresses athletes through range of motion, strengthening, proprioception and sport-specific work rather than treating the surgical date as the sole determinant of readiness. That close consultant–physiotherapy communication means rehabilitation milestones are always aligned with the surgical reality of the reconstruction, rather than an assumed timeline.
So, when is the athlete ready?
The evidence increasingly supports moving away from a simple “six months and you're cleared” approach. A time-based framework provides structure, but objective testing provides the information required to determine whether the individual athlete is actually ready.
For the contact athlete, combining VALD ASH testing, dynamometry, rotator cuff endurance and sport-specific functional testing provides a
much more comprehensive picture of readiness than clinical assessment or time alone. A complete return-to-contact testing battery covers:
ASH peak force & RFD
Dynamometry & ER:IR ratio
Cuff endurance
Functional testing
Contact clearance
ASH peak force, RFD and limb asymmetry across all three long-lever positions. Dynamometry: external rotation, internal rotation, abduction and flexion strength. ER:IR strength ratio and comparison with the uninvolved shoulder. Rotator cuff endurance: force maintenance and decline under repeated efforts. Functional testing: push, pull, closed-chain and sport-specific demands. Graduated contact progression and psychological readiness.
Ultimately, the goal following Latarjet surgery is not simply to get the athlete back onto the pitch. It is to ensure that they are
physically and psychologically prepared to cope with the demands of their sport.
Key academic references
Matache, B.A. et al. (2022). Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical
Follow-Up—An International Consensus Statement. Arthroscopy.
Ashworth, B. et al. (2018). The Athletic Shoulder (ASH) Test — development of an objective upper-limb isometric strength assessment.
Moran, C.J., Fabricant, P.D., Kang, R. & Cordasco, F.A. (2014). Arthroscopic Double-Row Anterior Stabilization and Bankart Repair for
the “High-Risk” Athlete. Arthroscopy Techniques, 3(1), e65–e71.
Criteria-based return to sport testing after open Latarjet reveals residual deficits and can be utilized for sports clearance with excellent
outcomes at mean 3.6-year follow-up. Physical Therapy in Sport, 65, 23–29 (2024).
Otley et al. (2022). Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and
Inform Return-to-Play Decision Making. Arthroscopy, Sports Medicine, and Rehabilitation.
Delaney, R.A. et al. Anterior Shoulder Instability International Consensus Group contribution and clinical post-operative rehabilitation
guidance.
Book a Shoulder Assessment in Tullamore
If you are recovering from shoulder stabilisation surgery — or considering a Latarjet procedure — and want a structured, criteria-based plan for your return to contact sport, we can help. Physio Tullamore provides physiotherapy, sports rehabilitation and VALD ForceDecks performance testing from our clinic in Tullamore, Co. Offaly, serving athletes across Offaly and the Midlands.
Book an AssessmentRecovering from shoulder pain? See our Shoulder pain treatment and VALD testing pages.
