Management of Anterior Shoulder Instability for the In-Season Athlete

Management of in-season anterior instability poses a unique challenge to providers as they are faced with the conundrum of helping an athlete return to play as quickly as possible, while minimizing the risk of recurrent instability and progressive damage to the glenohumeral joint. The decision for early return to play versus in-season surgery ultimately is a collective decision-making process between the athlete, provider and training staff. However, it is the physician's obligation to properly counsel the athlete on the risks of early return to play following conservative management. Apart from athletes who are in the last season of their career or have other extenuating circumstances, requiring return to play (RTP) in the same season (i.e. upcoming championship or combine), given the high risk of recurrence in athletes managed conservatively, physicians should strongly encourage early surgical stabilization. Surgical management of instability most commonly includes arthroscopic Bankart repair and capsulorrhaphy, however open Bankart repair should be considered in high-risk athletes (i.e. contact athletes, recurrent instability, sub-critical glenoid bone loss). In athletes with critical glenoid bone loss an osseous augmentation procedure should be performed, such as the Latarjet procedure.