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Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents

  • Pediatric Orthopedics (N Pandya, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Recurrent shoulder instability after stabilization is common in pediatric and adolescent athletes. The purpose of this review is to understand the risk factors that lead to failure of primary surgery and management principles in the setting of recurrent instability following surgical stabilization.

Recent Findings

Rates of recurrence after primary and revision surgical stabilization remain higher than desirable. Risk factors for failure in include glenoid and humeral bone loss, capsular or ligamentous laxity, and young age though few studies have focused specifically on the adolescent population. Arthroscopic, open, and bone block techniques have been described in this population similar to adults.

Summary

Failure after a primary shoulder stabilization remains a common problem in adolescents in no small part because a high proportion of these athletes return to high levels of activity. A thorough understanding of the index procedure and patient-specific risk factors for failure are key to successful planning of revision surgery. The current literature does not allow for firm treatment recommendations in individual pediatric or adolescent athletes, but the guiding principles are similar to those in adults. Specifically, all bony and soft tissue pathology should be identified and assessed, with an understanding that simply repeating the steps of the index procedure typically results in poor outcomes, and often an “escalation” of surgical complexity is required at the time of revision. When appropriately indicated, arthroscopic or open soft tissue procedures and Latarjet coracoid transfer can be safely and successfully implemented for revision shoulder stabilization in young athletes.

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  1. Duke Sports Science Institutes, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Nicholas A. Bonazza & Jonathan C. Riboh

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Nicholas A. Bonazza declares that he has no conflict of interest. Jonathan C. Riboh reports Stock options in Restor3d; Research support from Sparta Biopharma.

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Bonazza, N.A., Riboh, J.C. Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents. Curr Rev Musculoskelet Med 13, 164–172 (2020). https://doi.org/10.1007/s12178-020-09612-4

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