Treatment Algorithm for Recurrent Anterior Shoulder Instability: Putting It All Together

Abstract

Our understanding of recurrent anterior shoulder instability has increased over the past decade. Treatment is a challenging dilemma for the treating surgeon, especially in young athletes. Recurrent dislocation rates after nonoperative management of first-time dislocations in young athletic patients remains high, and many patients ultimately require operative intervention. A thorough history and physical exam is essential to evaluate concomitant pathology and risk factors for failure of nonoperative and operative treatment. Once surgical intervention is warranted, imaging modalities including radiographs, computed tomography, and magnetic resonance imaging are important for surgical planning to evaluate the extent of the tear, quality of the tissue and surrounding capsule, identifying concomitant pathology, and evaluating bone stock of the glenoid and humerus. Various surgical options exist, including arthroscopic Bankart repair, open Bankart repair, and bony augmentation procedures such as Latarjet, Bristow, and distal tibia allograft. Postoperative rehabilitation is crucial to success and should be performed with a systematic approach with ultimate return to play testing before allowing an athlete to return to sport. This review discusses the presentation, diagnosis, and treatment algorithm for recurrent anterior shoulder instability.