Abstract
Anterior shoulder instability is common in young athletes. Male individuals younger
than 20 years who are involved in contact sports are at particular risk of injury
and recurrence. Essential imaging includes radiography and magnetic resonance imaging
in all patients, with 3-dimensional computed tomography being helpful to evaluate
glenoid bone loss and Hill-Sachs lesions. Evaluation of the glenoid track is essential
to help determine appropriate treatment because off-track scenarios in which the Hill-Sachs
width is greater than the glenoid width impart a risk of failure with isolated arthroscopic
treatment. Associated injuries also must be evaluated, including bone loss, Hill-Sachs
lesions, humeral avulsion of the glenohumeral ligament (HAGL), glenolabral articular
disruption (GLAD), anterior labroligamentous periosteal sleeve avulsion (ALPSA), rotator
cuff injury, other fractures, and axillary nerve injury. Optimal treatment continues
to be debated. Conservative management with physical therapy for rotator cuff and
periscapular strengthening can be attempted, with the addition of bracing if continued
play is desired until the season’s conclusion. Surgical intervention is considered
in patients with recurrent dislocations, glenoid bone loss, or large Hill-Sachs lesions
or in young athletes involved in contact or high-risk sports. Treatment options include
arthroscopic capsulolabral repair with at least 4 anchors if good tissue quality and
no bone loss exist. Remplissage has been recommended by some surgeons if a large Hill-Sachs
exists. Open repair is suggested in patients with a high number of recurrent dislocations
without bone loss or in those who participate in high-risk sports. Coracoid transfer
or the Latarjet procedure is suggested in patients with bone loss greater than 20%.
Bone grafting for glenoid bone loss using autograft or allograft, such as distal tibial
allograft, is recommended in patients with a failed Latarjet procedure or those with
significant bone loss. Hill-Sachs lesion grafting may also be beneficial in those
with large lesions that engage.
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Article info
Footnotes
The authors report the following potential conflicts of interest or sources of funding: J.P.B. receives royalties from Arthrex, outside the submitted work. M.T.P. receives royalties from Arthrex, outside the submitted work; is a consultant for Arthrex, Joint Research Foundation, and SLACK, outside the submitted work; receives honoraria from Arthrosurface, outside the submitted work; is an editorial or governing board member of Arthroscopy, Knee, Orthopedics, and SLACK; and is a board or committee member of the Arthroscopy Association of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, San Diego Shoulder Institute, and Society of Military Orthopaedic Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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Published by Elsevier on behalf of the Arthroscopy Association of North America
