Editorial Commentary: Anterior Shoulder Instability in Adolescent Athletes: "Slaying the Hydra" Is a Subtle Art

Anterior shoulder instability in adolescent athletes can be cumbersome to identify and treat. An algorithm is to divide the patients into primary and revision cases then to further subdivide patients who have glenoid bone loss <20% and/or an engaging or off-track Hill-Sachs lesion. A bipolar lesion with either of these conditions is an indication for a bone block open Laterjet procedure. In the revision setting, the threshold for Laterjet is lower. Soft-tissue lesions are indications for a Bankart or labral repair. With the proper attention given to concomitant labral, biceps, and rotator cuff pathology, Hill-Sachs lesions less than 1 cm are left alone. However, in situations where lesions are deeper than 1 cm, an arthroscopic remplissage is indicated. An optimal repair aims to create a labral bumper and a bony bed for the soft tissue to heal, whereas inferior quality of soft tissue indicates a segmental labral reconstruction. Reconstructing large capsular rents with torn ligaments with allograft anterior capsular repair is also needed for proper biomechanical restoration.