Management of the Athlete with a Failed Shoulder Instability Procedure

Athletes often expose their shoulders to significant forces and stresses and treatment of recurrent shoulder instability in this population is challenging. Recurrence after surgical shoulder stabilization in an athlete warrants a systematic approach to the diagnosis and treatment, The surgeon must develop a dear understanding of the etiology of the failure and take the necessary steps during the management algorithm to prevent a subsequent recurrence. When planning revision surgical stabilization, the surgeon must analyze and address risk factors for recurrence, which include younger age, contact/collision sports, higher level of competition, capsular laxity, glenoid bone loss, and engaging Hill-Sachs deformities. The surgeon must provide the athlete with the surgery that provides the best chance to return to sport and the lowest risk of recurrent instability. While revision arthroscopic Bankart repair may be appropriate in some cases in which there is minimal glenoid bone loss and robust labral and capsular tissue is available, an open procedure such as a Latarjet may be indicated for athletes at high risk for recurrence.