SHOULDER INSTABILITY: CURRENT OPERATIVE TECHNIQUES

Shoulder instability exists on a spectrum ranging from subluxation and pain during different physical activities to recurrent shoulder dislocations and can be the result of a traumatic event or repetitive micro trauma. It can lead to significant disability and often requires surgical intervention, especially amongst younger, more active patients. The optimal treatment choice of shoulder instability depends on its degree and the concomitant pathology involving the glenoid labrum, the shoulder joint capsule, and the bony anatomy of the glenoid and humeral head. Even after surgical treatment, recurrent instability remains a relatively common and difficult problem to address. The surgical management of shoulder instability is not straight-forward. There are numerous patient-oriented and anatomic factors to be considered. Some of those factors include age, level of activity, and the nature of sport participation. The essential anatomic lesions of recurrent instability are Bankart lesion, anterior labroligamentous periosteal sleeve avulsion, and glenolabral articular disruption lesions, capsular injuries including humeral avulsion of glenohumeral ligament lesion and Hill-Sachs lesion. Among these essential lesions, the size of glenoid bone defect (most commonly a bony Bankart lesion) has been most clearly associated with a high risk of recurrent instability. Studies have shown that a notable risk of glenohumeral instability occurs at close to 20% glenoid bone loss. For that reason the management of shoulders with significant glenoid bone loss is debatable. There is a spectrum of surgical techniques which could be done for anterior shoulder stabilization. Commonly used procedures today include the arthroscopic Bankart repair, Bankart plus remplissage, double row capsulolabral repair and Latarjet technique. The management of shoulder instability needs to have a multifaceted, individualized approach that combines comprehensive imaging, different surgical techniques, and rehabilitation strategies to improve patient outcomes and reduce the rates of reccurrance.