Demographic and Clinical Risk Factors for Recurrent Instability After First-time Traumatic Anterior Shoulder Dislocation in Adults: A Narrative Review

Recurrent instability following first-time traumatic anterior shoulder dislocation occurs in 19-88% of patients. It is a major clinical challenge that requires a personalised treatment decision, especially in young and active people. Younger age at first dislocation, particularly below 25 years; male sex; participation in overhead and contact sports; and generalised hypermobility independently increase recurrence rates. Key structural factors, including bony Bankart lesions, off-track Hill-Sachs lesions, and glenoid bone loss exceeding 20%, play a central role in destabilising the glenohumeral joint. The glenoid track concept provides a biomechanical basis to understand bipolar bone loss and engagement risk. Additional contributors include capsuloligamentous insufficiency and neuromuscular deficits. Current predictive models have shown modest discriminative ability, and most clinicians depend on readily identifiable risk factors to plan treatment. The correct identification of patients with numerous high-risk characteristics, especially young and active males with structural injuries, is crucial for individualised risk stratification to guide appropriate management decisions. This narrative review synthesises current evidence on demographic, biomechanical, and structural risk factors associated with recurrent anterior shoulder instability in adults to guide clinical management.