Anterior shoulder instability in the teenage athlete: State of the art

Anterior shoulder instability is common in the teenage population, especially among patients enrolled in contact or overhead sports. With the rise in teenage sports participation, there has been a concomitant increase in the prevalence of shoulder instability. Moreover, multiple studies have demonstrated that adolescents-particularly those between 14 and 20 years of age-are at the highest risk of recurrence, whereas patients younger than 14 tend to show lower recurrence rates. Redislocation has been associated with the development of off-track Hill-Sachs (HS) lesions and the impairment of quality of life and sports performance. Although there is still debate regarding the surgical management of the first dislocation episode, several studies have reported decreased rates of recurrent instability and improved outcomes in patients who undergo early surgical intervention. Given the increased incidence of anterior shoulder instability in the teenage athlete population, along with the recognition of the potential need for surgical intervention following a primary dislocation, the number of arthroscopic stabilization procedures has increased. Identifying a durable surgical solution for anterior shoulder instability in the teenage athlete has proved challenging. Although the arthroscopic Bankart repair has shown good short-term clinical and functional outcomes, high rates of recurrence have been observed in the long-term, especially in the young active population. These elevated failure rates have prompted a growing shift toward the use of remplissage and Latarjet procedures in adolescent athletes. Both techniques have proven to be effective in this population, demonstrating high rates of restored shoulder stability, successful return to sports (RTS), and a low incidence of complications. However, the role of the free graft position is yet to be determined. However, in cases with significant glenoid bone loss or off-track lesions, free bone grafting has emerged as a potential alternative. Still, the role of these grafts remains to be fully defined in this population.