Shoulder Instability Management: A Survey of the American Shoulder and Elbow Surgeons

Despite an abundance of peer-reviewed literature, there is wide surgical practice variability for symptomatic shoulder instability. In this study, we identified consensus trends among specialists in glenohumeral instability. A survey was distributed to 417 members of the American Shoulder and Elbow Surgeons (ASES). Surveys consisted of 3 sections: surgeon demographics, presentation of 5 case scenarios, and instability management. Consensus responses were defined as more than 50% of participants giving a single response with more than 2 answer choices or more than 67% of participants giving a single response when 2 answer choices were available. We assessed 125 completed surveys (29.9% response rate); 68% of questions reached a consensus answer. Arthroscopic Bankart repair was the preferred technique for young noncontact (82%), young contact (57%), and weekend-warrior athletes (60%). In the setting of glenoid bone loss, 72.8% recommended the Latarjet procedure. Remplissage was the procedure of choice (60%) for engaging Hill-Sachs lesions. The ASES members favored arthroscopic Bankart repair in the absence of glenoid bone loss or engaging Hill-Sachs lesion, regardless of age (20 to 35 years) or nature of sport (contact vs noncontact). For Hills-Sachs lesions, consensus response favored remplissage, while a Latarjet procedure was advocated for glenoid lesions.