BACKGROUND: Shoulder proprioception, in which the anterior glenohumeral capsule plays a major role, is critical to the functioning of the shoulder. Consequently, most surgeons either do not resect or reinsert the anterior capsule in shoulder stabilization surgery. In the original Open Latarjet Procedure (OLP), the anterior capsule is preserved. However, in the all-Arthroscopic Latarjet Procedure (ALP), complete anterior capsule resection is recommended for better view and access to the coracoid. This raises the question if there is a postoperative difference in proprioception between these two procedures. Therefore, the aims of this study are (1) to assess the difference in postoperative proprioception between the operated and healthy sides after the OLP and ALP, and (2) to compare the difference in postoperative proprioception on the operated side between the OLP and ALP.
METHODS: We conducted a retrospective analysis including all patients who underwent a proprioception test after an OLP or ALP at our center. Collected baseline characteristics included sex, age at surgery, operated side, hand dominance, presence of a Hill-sachs lesion, and time between surgery and the proprioception test. For the test, patients were positioned 1 meter from a wall. They were blindfolded and had to point at a target with a laser pointer taped to their index finger. The laser point was marked and the errors were measured horizontally and vertically and categorized as < 4 centimeters, 4-8 centimeters, 8-16 centimeters, and >16 centimeters.
RESULTS: Between April 2022 and April 2024, 91 cases were identified, of which 24 underwent an OLP and 67 underwent an ALP. No significant difference was found in error distribution between the healthy and operated side after both the OLP (p = 0.30 horizontally, p = 0.67 vertically) and ALP (p = 0.20 horizontally, p = 0.34 vertically). Moreover, there was no significant difference in error distribution between the operated sides after the OLP versus ALP (p= 0.52 horizontally, p = 0.61 vertically).
CONCLUSIONS: Our data suggests that postoperative proprioception is not significantly different between the operated and healthy sides after both the OLP and ALP, nor between the operated sides after the OLP versus after the ALP. This might imply that completely resecting the anterior glenohumeral capsule does not have a detrimental effect on shoulder proprioception. However, these results are multifactorial and prospective studies are needed to better understand the regeneration potential of glenohumeral capsule mechanoreceptors and the importance of the anterior capsule for shoulder proprioception.

BACKGROUND: Posterior shoulder dislocation frequently results in a centrally located impression fracture of the anterior humeral head, known as reverse Hill-Sachs lesion (RHSL). Depending on size and location of RHSL the RHSL can lead to engagement with the posterior glenoid rim and subsequently re-dislocation of the shoulder joint. The objective of this study was to present the clinical and radiological outcomes of anatomical reconstruction of the humeral articular surface using arthroscopically assisted disimpaction in patients with acute posterior shoulder dislocation and an engaging RHSL.
METHODS: As part of a retrospective analysis, nine shoulders in nine patients (1 female, 8 males) with engaging RHSL following acute posterior shoulder dislocation (Type A2 according to the ABC classification) who underwent arthroscopically assisted disimpaction of the RHSL between 2016 and 2023 were identified. Eight patients were included, as one patient refused to participate. In all patients a radiological analysis of the RHSL was accomplished on preoperative and postoperative cross-sectional imaging including alpha, beta and gamma angle as well as depth measurements. The clinical examination included an assessment of active range of motion, instability tests, and patient-reported outcome measures (PROMs), such as the Western Ontario Shoulder Instability (WOSI) Index, the Constant Score (CS), and the Subjective Shoulder Value (SSV).
RESULTS: The mean follow-up period for all eight patients was 34.4 ± 38 months (range: 6-102 months). The mechanisms of injury included falls (n=6), traffic accident (n=1), and convulsive episode (n=1). The average time from injury to surgery was 6.8 ± 4.7 days (range: 2-16). Patient-reported outcomes at the final follow-up indicated an average WOSI Index of 77.8 ± 17 %, a mean Constant Score of 88.3 ± 11 points, and a mean Subjective Shoulder Value (SSV) of 87 ± 16 %. None of the patients experienced recurrent dislocations during the follow-up period. Post-traumatically, the mean absolute defect depth was 8.4 ± 2.2 mm and mean gamma angle was 115.8 ± 13 °. In the radiological follow-up, the RHSL depth measurements showed a significant reduction in the mean defect depth from 8.4 ± 2 mm to 1.2 ± 1 mm resulting in an average reduction of the RHSL by 7.1 mm (p<0.001). In three of the eight patients (37.5%) the RHSL was not identifiable anymore at follow-up and in 5 patients barely identifiable.
CONCLUSIONS: Arthroscopically assisted disimpaction of acute RHSLs leads to close to anatomic reduction of RHSL, achieving a stable shoulder and good clinical outcomes.
METHODS: Level IV; Case Series; Treatment Study.

Posterior glenohumeral instability represents a wide spectrum of pathoanatomic processes. A key consideration is the interplay between the posterior capsulolabral complex and the osseous anatomy of the glenoid and humeral head. Stability is dependent upon both the presence of soft tissue pathology (eg, tears to the posteroinferior labrum or posterior band of the inferior glenohumeral ligament, glenoid bone loss, reverse Hill Sachs lesions, and pathologic glenoid retroversion or dysplasia) and dynamic stabilizing forces. This review highlights unique pathoanatomic features of posterior shoulder instability and associated biomechanics that may exist in patients with posterior glenohumeral instability.

There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.

In young athletes, anterior shoulder instability is a prevalent condition. Because of high-energy traumas, contact athletes often suffer recurrent instability, bone loss and postoperative recurrences. Patients younger than 20 years, symptomatic for more than 6 months, with ≥ 2 dislocations, with off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, Instability Severity Index Score > 3, and Glenoid Track Instability Management Score > 3 are at higher risk of failure. In cases of multiple dislocations with critical or subcritical glenoid bone loss, notably in collision and contact athletes, the Latarjet procedure is widely recognized as the treatment of choice.

Historically considered the gold standard technique for glenohumeral instability, the open Bankart repair is being performed at decreased rates because of the current trends favoring arthroscopic Bankart repair and the lack of consistent training of the open technique. However, open Bankart repairs may be more appropriate for certain high-risk populations (ie, high-level collision athletes) because of their reduced recurrent instability rates. Further investigations are needed to identify the indications for arthroscopic versus open Bankart repair and compare their outcomes in high-level athletes. This review highlights the indications, surgical technique, and clinical outcomes following open Bankart repairs in athletes.

Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.

In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.

In the evaluation of shoulder instability, recognition of relevant pathology on imaging is critical to planning a surgical treatment that minimizes the risk for recurrent instability. The purpose of this review is to (1) discuss the use of radiography, computed tomography, and MRI in evaluating shoulder instability and (2) demonstrate how various imaging modalities are useful in identifying critical pathologies in the shoulder that are relevant for treatment.

Shoulder glenohumeral joint dislocations and subluxations are a relatively common injury among athletic populations. Evaluating the patient both on the field initially and through early recovery helps to determine the best treatment strategies and predict the natural history of each unique injury.