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Anterior Shoulder Stabilisation

Arthroscopic Bankart repair for anterior shoulder instability — distinct from open Latarjet.

Overview

Arthroscopic anterior shoulder stabilization is a primary intervention for anterior instability, though outcomes vary significantly by patient demographics and activity level. While the procedure generally restores stability, males may experience higher recurrence rates than females following primary arthroscopic stabilization [2], although other data indicate similar recurrence rates between sexes [3]. The heterogeneity of existing studies precludes definitive conclusions regarding these sex-based differences [2]. Surgical positioning does not significantly influence recurrent instability, complications, or patient-reported outcomes [7, 14].

Functional recovery and satisfaction are influenced by shoulder dominance and age. Stabilization of the dominant shoulder often results in residual functional impairments on both sides, whereas nondominant stabilization leads to impairments primarily in the operative shoulder [1]. In contact athletes, results are less predictable with higher rates of recurrent instability and revision surgery [6]. For patients older than 40 years with recurrent instability, the open Latarjet procedure reliably restores stability and yields high patient satisfaction [10].

Outcome reporting remains a challenge due to methodological limitations. A large proportion of studies on Bankart repair are of low methodological quality [29], and significant recurrence rates persist; one series reported 30% recurrent instability at midterm follow-up [11]. Recent work defines thresholds for MCID and PASS achievement at minimum two-year follow-up [4], while other evidence underscores the need for standardized outcome reporting specifically in adolescents [51]. Overall complication rates in modern stabilization surgery are documented in large systematic reviews [8].

Anatomy & Pathophysiology

Osseous and Glenoid Morphology

Male patients are significantly more likely to present with anterior shoulder instability, whereas female patients are significantly more likely to have posterior shoulder instability [9]. While glenoid version appears to have only limited clinical impact on anterior stability [13], glenoid morphology can be normalized during the mid- to long-term postoperative period [39]. Preliminary findings highlight the need for further large cohort studies investigating the role of coracoid morphology on shoulder stability [40]. In an active-assisted model with intact soft tissue surrounding and muscular compression forces, glenoid concavity correlates with shoulder stability [36]. The bone remodeling process contributes to the recovery of the normal anatomy of the anteroinferior glenoid following an all-arthroscopic Latarjet procedure [47].

Biomechanics and Soft Tissue Integrity

The presence of arthroscopic anchors did not decrease the forces necessary to fracture the anterior inferior glenoid in a biomechanical model [38]. Completely resecting the anterior glenohumeral capsule does not appear to have a detrimental effect on shoulder proprioception [49]. An individualized capsular shift restores physiological capsular volume in patients with anterior shoulder instability [48]. Current findings allow for individual adjustment and intraoperative control of capsular volume reduction to avoid over- or under correction of the shoulder joint volume [48].

Kinematics and Functional Outcomes

The Latarjet procedure more commonly affects range of motion rather than shoulder and elbow strength [43]. During the first 3 months postoperatively, kinematics and periscapular muscle activity after the open Latarjet procedure remained consistent and similar to patterns observed for healthy athletes [46]. Scapular kinematics and proprioception should be evaluated after arthroscopic Bankart repair [34]. The modified shoulder-rating system places greatest emphasis on pain-free function followed by stability and motion [19].

Classification

Functional Impairment by Dominance: Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides [1], whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder [1].

Demographic Phenotypes: Male patients were significantly more likely to have anterior shoulder instability [9], while female patients were significantly more likely to have posterior shoulder instability [9]. Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization [2], though the heterogeneity of included studies precludes definitive conclusions regarding sex-based differences in recurrence rates [2].

Athletic Risk Stratification: Results of anterior shoulder stabilization in contact athletes are less predictable, with higher reported rates of recurrent instability and revision surgery [6]. Open stabilization is considered a more reliable method for anterior shoulder instability in collision athletes [17]. Conversely, arthroscopic anterior shoulder stabilization significantly improved functional scores in a cohort of martial arts athletes [59].

Outcome Metrics and Consensus: Thresholds for Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) have been defined at a minimum 2-year follow-up for arthroscopic anterior shoulder stabilization [4]. The Constant score is maintained for use in shoulder instability studies due to its common application, which allows for comparison of results [24], with preoperative Constant scores around 60 points widely reported in the literature for patients undergoing arthroscopic anterior shoulder stabilization [24]. A modified shoulder-rating system places greatest emphasis on pain-free function followed by stability and motion [19]. An international consensus statement on shoulder instability was achieved using the Delphi method to cover diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up [5].

Technical Parameters: There was unanimous consensus on minimizing complications and anchor placement 5-8 mm apart in anterior shoulder instability management [20], with at least four anchor points recommended to obtain secure shoulder stabilization after arthroscopic Bankart repair [30]. There was no consensus on optimal shoulder immobilization position for anterior shoulder instability [20], and the type of immobilization after arthroscopic shoulder stabilization does not influence clinical results after mid- to long-term follow-up [55]. The arthroscopic Latarjet procedure enables shoulder surgeons to treat all cases of instability arthroscopically [12]. A large systematic review demonstrates overall complication rates in modern shoulder stabilization surgery [8].

Other Considerations: The evidence base includes broad demographic trends, sport-specific outcome variability, and technical consensus statements rather than a single unified anatomical classification system.

Clinical Presentation

History taking must account for laterality and activity level, as stabilization of the dominant shoulder may result in residual functional impairments on both sides, whereas nondominant stabilization typically impairs the operative shoulder [1]. Male patients present with significantly higher rates of anterior instability compared to females, who are more prone to posterior instability [9]. Contact athletes face less predictable outcomes with higher rates of recurrent instability and revision surgery [6], often leading authors to believe open stabilization is more reliable for collision athletes [17]. While the Bankart procedure augmented by coracoid transfer can achieve good outcomes in contact athletes [16], the open Latarjet procedure reliably restores stability and yields high patient satisfaction in patients older than 40 years with recurrent anterior instability [10, 25].

Diagnosis requires distinguishing between frank instability and microinstability, which is diagnostically challenging and presents in young patients with ambiguous shoulder pain during motion without overt instability [23]. Glenoid bone loss is a common finding in patients undergoing primary arthroscopic stabilization [22], though glenoid version appears to have only limited clinical impact on anterior stability [13]. Arthroscopic subscapularis augmentation of Bankart repair has been demonstrated safe and effective for restoring joint stability in patients with chronic anterior instability, anterior glenoid bone loss (<25%), and engaging Hill-Sachs lesions [18].

Clinical outcomes and recurrence rates vary significantly by demographic and surgical approach. Overall, male patients may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization [2], although one study found female patients had similar recurrence rates to males [3]. Conversely, the heterogeneity of included studies precludes definitive conclusions regarding sex-based differences in recurrence rates [2]. At midterm follow-up, recurrent instability following primary arthroscopic anterior capsulolabral repair was 30% in one series [11], while significant variability exists in the rate of recurrent instability after revision anterior shoulder stabilization surgery [26]. Surgical positioning for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, or patient-reported outcomes [7, 14].

Standardized assessment tools are essential for evaluating these cohorts. The Delphi method has been used to achieve an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up [5]. Thresholds for the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) have been defined at a minimum 2-year follow-up for patients undergoing arthroscopic anterior shoulder stabilization [4]. While concerns exist regarding the Constant score, its common application allows for result comparison, with preoperative scores around 60 points widely reported in this population [24].

Investigations

Plain radiography: While bone defects are visible on preoperative plain radiographs, these findings are considered less important and may not accurately reveal the true role of bone loss in instability recurrence, necessitating advanced imaging for definitive assessment [67]. The presence of a posterior glenoid fracture (bony Bankart lesion) does not constitute a contraindication to arthroscopic shoulder stabilization [27].

MRI: Microinstability, characterized by small and easily overlooked anterior labral or Hill-Sachs lesions, is diagnostically challenging and may present in young patients with ambiguous shoulder pain during motion without frank instability [23]. Despite these diagnostic challenges, no significant structural differences were found between adolescent and later-onset instability groups on MRI at a mean 6-year follow-up [76].

CT: Glenoid version appears to have only limited clinical impact on anterior stability [13]. Future studies should utilize advanced imaging for precise glenoid bone loss measurements and consider a lower predictive threshold for the Instability Severity Index Score [71].

Other Considerations: Thresholds for Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) have been defined at a minimum 2-year follow-up for patients undergoing arthroscopic anterior shoulder stabilization [4]. Initial shoulder instability during adolescence is associated with a higher recurrence rate and lower functional scores after arthroscopic Bankart repair compared with later onset instability [76]. Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization, though the heterogeneity of included studies precludes definitive conclusions regarding sex-based differences [2]. Conversely, female patients have demonstrated a similar recurrence rate to male patients after arthroscopic anterior shoulder stabilization [3]. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides, whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder [1]. Glenoid bone loss is a common finding in patients undergoing primary arthroscopic stabilization, and "subcritical" glenoid bone loss increases redislocation rates in primary arthroscopic Bankart repair [22]. Eighteen percent of patients had signs of instability during an 8-year follow-up period after arthroscopic intra-articular Bankart repair using absorbable tacks [32]. At a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained after the arthroscopic Latarjet procedure, which avoided a recurrent 'off-track' lesion in 32% of patients [77]. Both arthroscopic and open Latarjet procedures are effective for the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss [79]. The arthroscopic Latarjet procedure is an efficient and irreplaceable option for recurrent anterior shoulder instability with bone loss, offering accurate bone block positioning, safety for neurovascular structures, and excellent clinical results with no recurrence of instability at 2-year follow-up [33]. An international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up was achieved using the Delphi method, a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner [5].

Treatment

Non-Operative

Evidence indicates that arthroscopic stabilization yields a significantly lower rate of recurrent instability compared with non-operative management in young, active patients, particularly military cadets [58]. Given the high recurrence risk in this demographic, physicians should maintain a sense of urgency toward surgical treatment for young, high-demand athletes with persistent instability, specifically performing surgery before the second dislocation [52].

Operative

Indications: Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication [53]. The presence of a posterior glenoid fracture (bony Bankart lesion) did not represent a contraindication to arthroscopic shoulder stabilization [27]. For recurrent anterior shoulder instability in patients older than 40 years, the open Latarjet procedure reliably restores stability and leads to high patient satisfaction [10].

Surgical Approach / Technique: Surgical positioning (beach chair vs. lateral decubitus) for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, or patient-reported outcomes [7], nor did it affect post-operative clinical and patient-reported outcomes [14]. The arthroscopic Latarjet procedure enables shoulder surgeons to treat all cases of instability arthroscopically [12] and is a challenging yet viable technique to treat anterior shoulder instability, achieving results equal to the open technique with advantages of the arthroscopic setting [35]. It is an efficient and irreplaceable option for recurrent anterior shoulder instability with bone loss, offering accurate bone block positioning, safety for neurovascular structures, and excellent clinical results with no recurrence of instability at 2-year follow-up [33]. Arthroscopic Bankart repair and subscapularis augmentation is a reproducible and effective technique to restore joint stability in patients engaged in sports with anterior recurrent shoulder dislocation associated with glenoid bone loss [15]. The combination of Bankart repair with Remplissage and arthroscopic subscapularis augmentation provides a viable option for managing recurrent anterior instability, particularly in cases with poor tissue quality and glenoid bone loss less than 15% [21]. Bankart procedure augmented by coracoid transfer can achieve a good clinical outcome for contact athletes with traumatic anterior shoulder instability [16].

Implant Selection: At least four anchor points should be used to obtain secure shoulder stabilization [30]. Glenoid faceplate fixation did not make the shoulder more stable compared to glenoid rim fixation, and creating a tissue 'bumper' did not increase stability [62]. The arthroscopic Latarjet procedure with coracoid stabilization using 2 screws can achieve satisfactory clinical outcomes for the treatment of anterior shoulder instability [31]. Screw removal alleviated pain in 14 shoulders (67%) and reduced pain in the remaining 7 shoulders (33%) after open Latarjet procedures [68].

Alignment / Balancing Strategy: There was unanimous consensus on minimizing complications and anchor placement 5-8 mm apart, but no consensus on optimal shoulder immobilization position [20].

Other Considerations: Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization, though study heterogeneity precludes definitive conclusions [2], while female patients had a similar recurrence rate as that of male patients after arthroscopic anterior shoulder stabilization [3]. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides [1], whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder [1]. Thresholds for MCID and PASS achievement at minimum 2-year follow-up have been defined for patients undergoing arthroscopic anterior shoulder stabilization [4]. An international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up was achieved using the Delphi method [5]. A modified shoulder-rating system places greatest emphasis on pain-free function followed by stability and motion [19]. Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning [61]. In patients who did not undergo further surgery, good to excellent shoulder function as well as low pain and instability levels were observed at a minimum 20 years after arthroscopic Bankart repair [69].

Complications

Instability: Recurrence rates vary significantly by patient demographics and surgical approach. Males may exhibit higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization [2], though heterogeneity in studies precludes definitive conclusions on sex-based differences [2], and some data indicate similar recurrence rates between sexes [3]. In contact athletes, stabilization is less predictable with higher rates of recurrent instability and revision surgery [6]. At midterm follow-up, recurrent instability following primary arthroscopic anterior capsulolabral repair reached 30% in one series [11]. Immediate surgical stabilization after a first-time dislocation significantly diminishes recurrent dislocation risk compared to delayed intervention after two events [70], with comparable clinical outcomes [78]; however, the number of preoperative dislocation episodes and delayed intervention did not increase postoperative recurrence rates [72]. Pediatric and adolescent populations may benefit from more aggressive stabilization strategies [73]. In revision settings, instability rates are significantly higher in all-arthroscopic groups (19%) compared to Latarjet procedures (7–8%) [84, 85], and arthroscopic revision stabilization is generally associated with high recurrence rates [82], necessitating critical patient selection [82]. High recurrence rates with moderate revision rates were also noted in collision athletes aged 18 years or less following open Bankart repair [83].

Functional Outcomes and Satisfaction: Stabilization of the dominant shoulder resulted in residual functional impairments on both sides, whereas nondominant shoulder stabilization primarily affected the operative side [1]. While recurrence rates may increase over time, patient satisfaction remains high with no revision surgeries required after long-term arthroscopic Bankart repair [75]. The Latarjet procedure effectively prevents chronic anterior instability and is associated with high patient satisfaction as both a primary and revision procedure [28], and the open Latarjet in patients older than 40 years yields good functional outcomes and stability [25]. When performed by an experienced surgeon, the open Latarjet demonstrates good safety with low major complication risks in primary and revision settings [74]. The arthroscopic Latarjet with coracoid stabilization using two screws can also achieve satisfactory clinical outcomes [31].

Surgical Technique and Positioning: Surgical positioning for arthroscopic anterior shoulder stabilization does not significantly affect recurrent instability, complications, or patient-reported outcomes [7]. There is unanimous consensus on minimizing complications through anchor placement 5–8 mm apart, but no consensus exists on optimal shoulder immobilization position [20]. Reported complications are generally lower in the arthroscopic stabilization group compared with open surgeries [86].

Other Considerations: A large systematic review documents overall complication rates in modern shoulder stabilization surgery [8]. Significant variability exists in recurrent instability rates after revision anterior shoulder stabilization [26]. A large proportion of studies reporting Bankart repair outcomes are of low methodological quality and evidence level [29]. Eighteen percent of patients showed signs of instability during an 8-year follow-up after arthroscopic intra-articular Bankart repair using absorbable tacks [32].

Recovery

Light activity (weeks): Patients undergoing arthroscopic or open Latarjet procedures can expect high rates of return to work, with over 89% returning to employment [50]. Immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation, facilitating early functional recovery [54].

Full activity (months): While patients with anterior shoulder instability undergoing arthroscopic or open Latarjet procedures can expect high rates of return to sport, outcomes for contact athletes are less predictable with higher reported rates of recurrent instability and revision surgery [6, 50]. Compared with noncontact athletes, contact athletes demonstrate similar rates of return to sport and preinjury level of play but a higher rate of recurrent instability after primary arthroscopic anterior Bankart repair [64]. Despite high scores on shoulder outcome measures, the athlete's rate of return to their sport after arthroscopic anterior shoulder stabilization was only moderate [66]. Following Hill-Sachs remplissage, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level despite having a stable shoulder [60]. Evaluating readiness after shoulder instability is extremely difficult, and a validated, normalized return to play objective metric is still being sought [63]. When assessed 4.5 months postoperatively, the balance of function between dominant and nondominant shoulders in reference to those of healthy athletes would be better predictors of returning to preinjury sport at the preinjury level [65].

Complete recovery / outcome plateau (months): Thresholds for Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) have been defined at a minimum 2-year follow-up for patients undergoing arthroscopic anterior shoulder stabilization [4]. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides, whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder [1]. Recurrent shoulder instability following primary arthroscopic anterior capsulolabral repair was 30% at midterm follow-up [11]. Among fellowship-trained orthopaedic surgeons, the overall failure of primary arthroscopic anterior shoulder stabilization was 15.7% in a high-demand population [57].

Rehabilitation protocol: The Delphi method was used to achieve an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up [5]. The open Latarjet procedure could be considered for primary shoulder stabilization, particularly in competitive athletes who have high functional demands and great risks of redislocation [56]. Bankart procedure augmented by coracoid transfer can achieve a good clinical outcome for contact athletes with traumatic anterior shoulder instability [16]. Arthroscopic Bankart repair with subscapularis augmentation is a reproducible and effective technique to restore joint stability in patients engaged in sports with anterior recurrent shoulder dislocation associated with glenoid bone loss [15]. Arthroscopic subscapularis augmentation of Bankart repair is safe and effective to restore joint stability in patients practicing sports with chronic anterior shoulder instability associated with anterior glenoid bone loss less than 25% and engaging Hill-Sachs lesions [18].

Functional milestones: Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization, though study heterogeneity precludes definitive conclusions [2]. Female patients had a similar recurrence rate as that of male patients after arthroscopic anterior shoulder stabilization [3]. Male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability [9]. The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years reliably restores stability and leads to high patient satisfaction [10]. The Latarjet procedure effectively prevented chronic anterior shoulder instability and was associated with high patient satisfaction as both a primary and a revision procedure [28]. Open Latarjet results in excellent clinical outcomes and low recurrence rates for those with primary shoulder instability, those with recurrent instability, and those undergoing open Latarjet for failed prior instability surgery [80]. The Latarjet procedure is effective for treating primary chronic anterior instability and for stabilizing a shoulder after a failed Bankart repair [81]. Prior Bankart repair is associated with significantly lower functional scores and higher pain compared to primary Latarjet cases [81]. Equivalent outcomes may be anticipated with arthroscopic Bankart repair performed in the beach chair or lateral decubitus position [57].

Other Considerations: The open Latarjet procedure effectively prevents chronic anterior shoulder instability and is associated with high patient satisfaction as both a primary and a revision procedure [28].

Key Evidence

  • [L3] Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides, whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. (10.1177/03635465231156181)
  • [L4] Males may have higher recurrence rates than females following primary arthroscopic anterior shoulder stabilization; however, the heterogeneity of the included studies precludes any definitive conclusions. (10.1016/j.asmr.2020.04.004)
  • [L3] Female patients had a similar recurrence rate as that of male patients after arthroscopic anterior shoulder stabilization. (10.1177/23259671211008841)
  • [L3] This study defines the thresholds for MCID and PASS achievement at minimum 2 year follow-up in a cohort of patients undergoing arthroscopic anterior shoulder stabilization. (10.1177/2325967125s00147)
  • [L5] The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner, resulting in an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up. (10.1016/j.arthro.2021.11.052)
  • [L4] The results of anterior shoulder stabilisation in contact athletes is much less predictable, with higher reported rates of recurrent instability and revision surgery. (10.1136/jisakos-2018-000224)
  • [L3] Surgical positioning for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, and patient-reported outcomes. (10.1177/23259671221106474)
  • [L4] This large systematic review demonstrates the overall complication rates in modern shoulder stabilization surgery. (10.1177/0363546518810711)
  • [L4] Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability. (10.1177/23259671211006437)
  • [L4] The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years reliably restores stability and leads to high patient satisfaction. (10.1177/0363546519872501)
  • [L3] At midterm follow-up, recurrent shoulder instability following primary arthroscopic anterior capsulolabral repair was 30% in this series. (10.1016/j.arthro.2019.11.109)
  • [L4] This technique enables shoulder surgeons to treat all cases of instability arthroscopically. (10.1016/j.arthro.2007.06.008)
  • [L3] In contrast to recent biomechanical studies, glenoid version appears to have only limited clinical impact on anterior stability. (10.1016/j.jseint.2024.09.029)
  • [L3] Surgical positioning for arthroscopic anterior shoulder stabilization did not affect post-operative clinical and patient-reported outcomes. (10.1177/2325967121s00743)
  • [L4] The described procedure is a reproducible and effective technique used to restore joint stability in patients engaged in sports who have incurred anterior recurrent shoulder dislocation associated with glenoid bone loss. (10.1016/j.jse.2015.09.025)
  • [L4] This procedure can achieve a good clinical outcome for contact athletes with traumatic anterior shoulder instability. (10.1177/03635465990270011201)
  • [L4] The authors believe open stabilization to be a more reliable method for anterior shoulder instability in collision athletes. (10.1177/0363546505283267)
  • [L4] This procedure has been demonstrated safe and effective to restore joint stability in patients practicing sports, affected by chronic anterior shoulder instability associated with anterior glenoid bone loss (<25%) and engaging Hill-Sachs lesions. (10.1016/j.arthro.2016.03.071)
  • [L4] The study presents a modified shoulder-rating system that places greatest emphasis on pain-free function followed by stability and motion. (10.2106/00004623-199706000-00008)
  • [L5] There was unanimous consensus on minimizing complications and anchor placement (5-8 mm apart), but no consensus on optimal shoulder immobilization position. (10.1016/j.arthro.2021.07.022)
  • [L3] The combination of these techniques provides a viable option for managing recurrent anterior instability, particularly in cases with poor tissue quality and glenoid bone loss less than 15%. (10.1177/23259671261418677)
  • [L3] This study suggests that glenoid bone loss is a common finding in patients undergoing primary arthroscopic stabilization. (10.1177/2325967114s00025)
  • [L3] Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. (10.1007/s00167-022-06941-4)
  • [L5] The authors acknowledge concerns regarding the Constant score but maintain its use due to its common application in shoulder instability studies, which allows for comparison of results, and state that preoperative scores around 60 points are widely reported in the literature for this population. (10.1016/j.arthro.2007.03.095)
  • [L3] The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years is associated with good functional outcome and stability. (10.1016/j.jse.2018.11.003)
  • [L4] There is significant variability in the rate of recurrent instability after revision anterior shoulder stabilization surgery. (10.1016/j.arthro.2013.11.019)
  • [L4] By contrast, the presence of a posterior glenoid fracture (bony Bankart lesion) did not represent a contraindication to arthroscopic shoulder stabilization. (10.1177/03635465251403499)
  • [L3] The Latarjet procedure effectively prevented chronic anterior shoulder instability and was associated with high patient satisfaction as both a primary and a revision procedure. (10.1177/23259671251343807)
  • [L1] A large proportion of studies reporting the clinical outcomes of Bankart repair for anterior shoulder instability are of low methodological quality and have a low level of evidence. (10.1016/j.arthro.2023.07.010)
  • [L4] At least four anchor points should be used to obtain secure shoulder stabilization. (10.2106/jbjs.e.00817)
  • [L4] The arthroscopic Latarjet procedure with coracoid stabilization with 2 screws can achieve satisfactory clinical outcomes for the treatment of anterior shoulder instability. (10.1016/j.jse.2022.01.022)
  • [L4] Eighteen per cent of the patients had signs of instability during the 8-year follow-up period. (10.1007/s00167-008-0534-x)
  • [L5] The arthroscopic Latarjet procedure is an efficient and irreplaceable option for recurrent anterior shoulder instability with bone loss, offering accurate bone block positioning, safety for neurovascular structures, and excellent clinical results with no recurrence of instability at 2-year follow-up. (10.1016/j.arthro.2017.08.269)
  • [L3] Scapular kinematics and proprioception should be evaluated after ABR. (10.1177/2325967120985207)
  • [L4] The arthroscopic Latarjet is a challenging yet viable technique to treat anterior shoulder instability, achieving results equal to the open technique with advantages of the arthroscopic setting. (10.1016/j.arthro.2019.03.035)
  • [L5] In an active-assisted model with intact soft tissue surrounding and muscular compression forces, the glenoid concavity correlates with shoulder stability. (10.1177/23259671241253836)
  • [L5] The presence of arthroscopic anchors did not decrease the forces necessary to fracture the anterior inferior glenoid in this biomechanical model. (10.1016/j.arthro.2011.03.009)
  • [Abstract] Glenoid morphology can be normalized during the mid- to long-term postoperative period. (10.1016/j.jse.2012.10.013)
  • [L3] These preliminary findings highlight the need for further large cohort studies investigating the role of coracoid morphology on shoulder stability. (10.1177/2325967124s00122)
  • [L4] The findings of this study suggest that the Latarjet procedure more commonly affects range of motion rather than shoulder and elbow strength. (10.1177/17585732231165227)
  • [L3] Notably, during this period, both kinematics and periscapular muscle activity remained consistent and similar to the patterns observed for healthy athletes. (10.1016/j.jse.2024.03.037)
  • [L4] Furthermore, the bone remodeling process contributes to the recovery of the normal anatomy of the anteroinferior glenoid. (10.1016/j.arthro.2022.01.020)
  • [L3] Current findings allow for individual adjustment and intraoperative control of capsular volume reduction to avoid over- or under correction of the shoulder joint volume. (10.1007/s00167-020-05952-3)
  • [L3] This might imply that completely resecting the anterior glenohumeral capsule does not have a detrimental effect on shoulder proprioception. (10.1016/j.jse.2024.09.002)
  • [L4] Patients with anterior shoulder instability who undergo an arthroscopic or open Latarjet procedure can expect high rates of return to work and sport. (10.1016/j.arthro.2024.09.056)
  • [L1] This study supports the need for standardized outcome reporting after arthroscopic anterior shoulder instability surgery in adolescents. (10.1016/j.arthro.2017.10.041)
  • [L5] Physicians must maintain a sense of urgency toward surgical treatment, particularly in young, high-demand athletes with persistent instability; you don't have to fix the shoulder after the first anterior dislocation, but you should definitely do it before the second! (10.1016/j.arthro.2022.11.014)
  • [L4] Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication. (10.1177/0363546504268037)
  • [L4] Immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation. (10.1007/s00167-007-0453-2)
  • [L3] The type of immobilization after arthroscopic shoulder stabilization does not influence the clinical results after a mid- to long-term follow-up. (10.1016/j.jseint.2021.07.004)
  • [L3] The OLP could be considered for primary shoulder stabilization, particularly in competitive athletes, who have high functional demands and great risks of redislocation. (10.1177/0363546518759730)
  • [L3] Among fellowship-trained orthopaedic surgeons the overall failure of primary arthroscopic anterior shoulder stabilization was 15.7% in a high-demand population and equivalent outcomes may be anticipated with arthroscopic Bankart repair performed in the BC or LD position. (10.1177/2325967121s00240)
  • [L2] Arthroscopic stabilisation resulted in a significantly lower rate of recurrent instability compared with non-operative management in young, active patients, particularly military cadets. (10.1136/jisakos-2016-000091)
  • [L4] In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. (10.1177/2325967117725031)
  • [L3] Furthermore, following this procedure, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level, despite having a stable shoulder. (10.1302/0301-620x.103b4.bjj-2019-0736.r2)
  • [L3] Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning. (10.1016/j.jse.2019.10.022)
  • [L5] Glenoid faceplate fixation did not make the shoulder more stable compared to glenoid rim fixation, and creating a tissue 'bumper' did not increase stability. (10.1016/j.arthro.2011.03.005)
  • [L5] Evaluating readiness after shoulder instability is extremely difficult, and the study demonstrates that we are still searching for a validated, normalized return to play objective metric. (10.1016/j.arthro.2025.02.035)
  • [L4] Compared with noncontact athletes, contact athletes demonstrate similar rates of return to sport, return to preinjury level of play, and need for revision surgery but a higher rate of recurrent instability after primary arthroscopic anterior Bankart repair for anterior shoulder instability. (10.1177/03635465251328974)
  • [L2] They suggest that when assessed 4.5 months postoperatively, the balance of function between dominant and nondominant shoulders in reference to those of healthy athletes would be better predictors of returning to preinjury sport at the preinjury level. (10.1016/j.jse.2024.12.046)
  • [L4] Despite high scores on the shoulder outcome measures, the athlete's rate of return to their sport was only moderate. (10.1177/2325967113s00098)
  • [L3] Bone defects seen in preoperative plain radiographs are less important and more accurate imaging is needed to reveal their true role for recurrence of instability. (10.1007/s00167-010-1105-5)
  • [L4] Screw removal alleviated pain in 14 shoulders (67%) and reduced pain the remaining 7 shoulders (33%). (10.1016/j.jse.2021.03.058)
  • [L4] In patients who did not undergo further surgery, good to excellent shoulder function as well as low pain and instability levels were observed at a minimum 20 years after ABR. (10.1177/03635465251388108)
  • [L3] Immediate surgical stabilization following a 1st time dislocation significantly diminishes the risk of recurrent dislocation in comparison to those who undergo surgery following two dislocation events. (10.1177/2325967121s00713)
  • [L4] Future studies should attempt to control for all relevant factors, use advanced imaging for glenoid bone loss measurements, and consider a lower predictive threshold for the Instability Severity Index Score. (10.1177/03635465211038712)
  • [L4] The number of episodes of dislocation before surgery and the delayed surgical intervention did not increase the recurrent anterior shoulder instability rates postoperatively. (10.1016/j.jseint.2022.12.003)
  • [L3] Patients may benefit from more aggressive stabilization strategies and techniques. (10.1177/2325967119s00179)
  • [L4] When performed by an experienced shoulder surgeon, the open Latarjet procedure shows good safety with low risk of major complications in treating anterior shoulder instability in a primary and revision surgical setting. (10.1002/arj.70066)
  • [L4] While recurrence rates increased over time, patient satisfaction remained high, and no revision surgeries were required, demonstrating the long-term reliability of ABR for anterior shoulder instability. (10.1016/j.jseint.2025.07.004)
  • [L3] Initial shoulder instability during adolescence was associated with a higher recurrence rate and lower functional scores after arthroscopic Bankart repair compared with later onset instability, although no significant structural differences were found between the groups on MRI at a mean 6-year follow-up. (10.1177/2325967120964881)
  • [L4] At a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained, avoiding a recurrent 'off-track' lesion in 32% of patients. (10.1177/0363546517728717)
  • [L3] Immediate arthroscopic surgical stabilization after a first-time anterior shoulder dislocation significantly decreases the risk of recurrent dislocation in comparison to those who undergo surgery after 2 dislocation events, with comparable clinical outcome scores. (10.1016/j.arthro.2022.10.012)
  • [L3] Both procedures are effective for the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss. (10.1177/0363546517693845)
  • [L3] Open Latarjet results in excellent clinical outcomes and low recurrence rates for those with primary shoulder instability, those with recurrent instability and those undergoing OL for failed prior instability surgery. (10.1016/j.arthro.2021.03.062)
  • [L3] The Latarjet procedure is effective for treating primary chronic anterior instability and for stabilizing a shoulder after a failed Bankart repair, but prior Bankart repair is associated with significantly lower functional scores and higher pain compared to primary Latarjet cases. (10.1177/2325967119s00204)
  • [L4] Arthroscopic revision anterior stabilization is associated with a high rate of recurrent instability, and patient selection is of critical importance in order to minimize recurrence. (10.2106/jbjs.17.01028)
  • [L4] However, there were high rates of recurrence with moderate rates of revision surgical stabilization in the medium term. (10.1016/j.jse.2021.11.001)
  • [L3] Recurrent instability rates were higher in the all-arthroscopic group (19% versus 8%). (10.1016/j.jse.2016.07.052)
  • [L3] Recurrent instability rates were higher in the all-arthroscopic group (19% versus 7%). (10.1177/2325967115s00048)
  • [L4] Reported complications were lower overall in the arthroscopic stabilization group when compared with open surgeries. (10.1177/0363546511406869)

See Also

References

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[5] Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone‐Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow‐Up. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2021.11.052

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[38] Glenoid Fracture Following Arthroscopic Bankart Repair: A Biomechanical Study (SS‐06). Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.009

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[63] Editorial Commentary : Upper‐Extremity Limb Asymmetry May Complicate Objective Evaluation of Criteria on the Basis of Return to Sport Evaluation After Arthroscopic Bankart Repair. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.02.035

[64] Similar Rate of Return to Sport and Reoperation but Higher Rate of Recurrent Instability in Contact Versus Noncontact Athletes After Primary Arthroscopic Anterior Bankart Repair: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251328974

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b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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