Meyer Alex M, Lorentz Samuel G, Droz Lindsey G, Ralph Julia E, Lau Brian C
Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Jt. 2025 Apr 22;10:19. doi: 10.21037/aoj-24-65. eCollection 2025.
Anterior shoulder instability (ASI) is a common occurrence in the athletic population with specific management challenges in contact athletes due to the high activity demand and repetitive trauma during sport. This study aims to provide a narrative review of the current literature on ASI in contact athletes, with an emphasis on pathophysiology, mechanisms of injury, clinical presentation, diagnostic strategies, treatment options, including in-season management, and outcomes.
A narrative review of the current literature on ASI in contact athletes was conducted, including key studies on the management and outcomes of conservative and surgical interventions.
ASI typically occurs from abduction and external rotation forces. Diagnosis relies on clinical assessment and imaging (magnetic resonance imaging or computed tomography), to evaluate soft tissue and bony injuries. Non-operative management is associated with high recurrence rates in contact athletes. Surgical options include arthroscopic Bankart repair (ABR) with or without remplissage, open Bankart repair (OBR), or bone block procedure such as Latarjet procedure or distal tibia allograft. All of which have been shown to decrease risk of recurrence and have a high rate of return to sport. The choice of procedure depends on the extent of soft tissue and bony involvement and the athlete's individual demands. ABR with glenoid bone loss >13.5% have high recurrence rates, therefore, additional procedures such as remplissage or bone block procedures should be considered.
ASI in the contact athlete is a common and challenging injury to manage. Surgical intervention provides superior outcomes in terms of stability and recurrence prevention compared to non-operative management of ASI in the contact athlete. Patient-specific considerations including level of sport, patient goals, and timing of season are considerations for treatment. Labral injury with <13.5% of glenoid bone loss and on-track Hill-Sachs lesion ABR is recommended, labral injury with 13.5-20% of glenoid bone loss with off-track Hill-Sachs lesion ABR with remplissage or OBR with capsule shift is recommended, and if >20% then bone block procedure is recommended.
前肩不稳（ASI）在运动员群体中很常见，由于接触性运动员在运动中对活动的高需求以及反复创伤，其治疗面临特殊挑战。本研究旨在对当前关于接触性运动员ASI的文献进行叙述性综述，重点关注病理生理学、损伤机制、临床表现、诊断策略、治疗选择（包括赛季内管理）及治疗结果。
对当前关于接触性运动员ASI的文献进行叙述性综述，包括保守和手术干预的管理及结果的关键研究。
ASI通常由外展和外旋力引起。诊断依赖临床评估和影像学检查（磁共振成像或计算机断层扫描），以评估软组织和骨损伤。非手术治疗在接触性运动员中复发率较高。手术选择包括带或不带 remplissage 的关节镜下 Bankart 修复术（ABR）、开放 Bankart 修复术（OBR）或骨块手术，如 Latarjet 手术或胫骨远端同种异体移植。所有这些手术均已证明可降低复发风险，并具有较高的重返运动率。手术方式的选择取决于软组织和骨受累程度以及运动员的个人需求。关节盂骨丢失>13.5%的 ABR 复发率较高，因此应考虑额外的手术，如 remplissage 或骨块手术。
接触性运动员的 ASI 是一种常见且具有挑战性的损伤。与接触性运动员 ASI 的非手术治疗相比，手术干预在稳定性和预防复发方面提供了更好的治疗效果。治疗时应考虑患者的具体情况，包括运动水平、患者目标和赛季时间。对于关节盂骨丢失<13.5%且 Hill-Sachs 损伤在正常轨迹的盂唇损伤，建议行 ABR；对于关节盂骨丢失13.5%-20%且 Hill-Sachs 损伤偏离正常轨迹的盂唇损伤，建议行带 remplissage 的 ABR 或行带关节囊移位的 OBR；如果>20%，则建议行骨块手术。
