Surgical Management of Anterior Shoulder Instability in Skeletally Immature Patients: A Systematic Review.

Abstract

Purpose of review: Anterior shoulder instability management within skeletally immature patients presents a unique challenge for providers. This systematic review examines the surgical management of traumatic anterior shoulder instability in skeletally immature patients, focusing on recurrence rate, pre-operative conditions, post-operative conditions, demographics, and risk factors for failure. Four full-length articles met the inclusion and exclusion criteria, consisting of two retrospective cohort studies and two case series. In total, 77 patients and 79 shoulders underwent surgical stabilization. Mean age at time of surgery ranged from 12 to 15.9 years with a male proportion ranging from 58 to 86%. The indication for surgery in these studies was recurrent anterior shoulder instability. The most used surgeries for stabilization were bone block procedures, such as the Latarjet, followed by the arthroscopic Bankart repair. This review found that surgically managed traumatic anterior shoulder instability in skeletally immature patients had low recurrence rates. The studies examined had recurrence rates of 8%, 4.4% and 0% after surgical stabilization and a singular study showed a return to sport rate of 75%. Subsequently, this study suggests that open bony procedures may be a safe and effective solution to recurrent anterior shoulder instability in the skeletally immature population, but further research is needed to determine the optimal surgical approach with a larger sample of different surgical approaches.

Level of evidence: Level IV.