Anterior Shoulder Instability Management: Indications, Techniques, and Outcomes

Area of Science:

• Orthopedics
• Sports Medicine
• Radiology

Background:

• Anterior shoulder instability is prevalent in young athletes, particularly males under 20 in contact sports.
• Risk factors include specific sports participation and anatomical considerations like glenoid bone loss.

Purpose of the Study:

• To outline diagnostic imaging and treatment strategies for anterior shoulder instability in young athletes.
• To emphasize the importance of evaluating associated injuries and glenoid track parameters for surgical planning.

Main Methods:

• Utilizes radiography, MRI, and 3D CT for comprehensive evaluation of bone loss and lesions.
• Assesses glenoid track to predict treatment success and identify 'off-track' scenarios.
• Considers associated injuries such as HAGL, GLAD, ALPSA, and rotator cuff tears.

Main Results:

• Off-track lesions (Hill-Sachs width > glenoid width) increase failure risk with isolated arthroscopic treatment.
• Surgical intervention is indicated for recurrent dislocations, significant bone loss, or in high-risk athletes.
• Treatment options vary from arthroscopic repair and Remplissage to open repair, Latarjet procedure, and bone grafting based on pathology.

Conclusions:

• Accurate diagnosis through advanced imaging is crucial for tailoring treatment.
• Glenoid bone loss and Hill-Sachs lesions significantly influence surgical approach and prognosis.
• A range of surgical techniques, including bone grafting and the Latarjet procedure, are available for complex cases.