{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T07:18:24Z","timestamp":1769066304281,"version":"3.49.0"},"reference-count":51,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,29]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Latarjet procedure is the mainstay treatment in high-demand patients with substantial glenoid bone loss or after failed capsulolabral repairs. Patients typically return to sport (RTS) within 6 months postoperatively, requiring intensive rehabilitation. Current rehabilitation protocols focus on mobility, strength and stability. Yet, psychological factors, such as fear of reinjury, are the main reason not to RTS. Therefore, this study aims to determine whether integrating psychological interventions into postoperative rehabilitation improves patient-reported shoulder function compared with physical therapy alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This monocentric randomised controlled trial will enrol 52 patients undergoing a Latarjet procedure for anterior shoulder instability. Participants will be equally and randomly assigned to either postoperative physical therapy combined with cognitive behavioural therapy or physical therapy alone. Eligibility criteria include patients aged 18\u201367 years undergoing an open or arthroscopic Latarjet procedure at our institution. Exclusion criteria include posterior or multidirectional instability, rotator cuff tear, prior shoulder surgery, anxiety disorder, using anxiolytics, neurological disorder, systemic disease, previous hospitalisation for shoulder pain and proximal humerus fractures.<\/jats:p>\n                    <jats:p>The primary outcome is the Western Ontario Shoulder Index at 6 months postoperatively. Secondary outcomes include incidence of recurrent dislocations, RTS and return-to-work rates, Tampa Scale of Kinesiophobia for Shoulder Instability, subjective shoulder value and visual analogue score for pain at 6 months postoperatively as well as the Shoulder Instability Return to Sport after Injury scale at 4.5 months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      This study was approved by the French Committee of Person Protection West I. The national registration number is 2023-A02057-38. The study has been registered at Clinicaltrials.gov with trial registration number\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06154889\">NCT06154889<\/jats:ext-link>\n                      . Patients are not financially compensated for participation and are allowed to withdraw from the study at any time without any preconditions. The final results of the study will be submitted for publication in a peer-reviewed journal and an abstract of the study will be submitted to international scientific meetings by the end of 2026. Data will be made available by the corresponding author on reasonable request.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration details<\/jats:title>\n                    <jats:p>\n                      The study has been registered at Clinicaltrials.gov with trial registration number\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06154889\">NCT06154889<\/jats:ext-link>\n                      . The trial sponsor is Vivalto Sant\u00e9.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06154889\">NCT06154889<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109378","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:05:18Z","timestamp":1769007918000},"page":"e109378","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multifactorial approach training for anterior shoulder instability after a Latarjet procedure: protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06154889","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06154889","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06154889","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06154889","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0708-3967","authenticated-orcid":false,"given":"Madu N.","family":"Soares","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"},{"name":"Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands"},{"name":"Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor J.","family":"Shirinskiy","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"},{"name":"Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands"},{"name":"Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e9r\u00e9my","family":"Schachner","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Clinique G\u00e9n\u00e9rale d'Annecy, S\u00e9vrier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MATASI collaborator group","family":"MATASI collaborator group","sequence":"additional","affiliation":[{"name":"Spaarne Gasthuis, Haarlem, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7513-7437","authenticated-orcid":false,"given":"Arno A.","family":"Macken","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agathe","family":"Kling","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thibault","family":"Lafosse","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel P.J.","family":"van den Bekerom","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands"},{"name":"Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geert A.","family":"Buijze","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Alps Surgery Institute, Clinique G\u00e9n\u00e9rale d'Annecy, Annecy, France"},{"name":"Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of Orthopaedic Surgery, Hospital Lapeyronie Hand and Upper Arm Surgery Service, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"2026012107050951000_16.1.e109378.1","doi-asserted-by":"crossref","unstructured":"Riff AJ , Frank RM , Sumner S , et al . 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