Editorial Commentary: Urgency Toward Arthroscopic Bankart Repair Is Essential for Anterior Shoulder Dislocation: You Don't Have to Fix After the First Dislocation, but Definitely Before the Second!

Abstract

While still hotly debated, primary arthroscopic management of the first-time anterior shoulder dislocation has an extensive list of known benefits: lower overall health care costs, improved patient-reported outcomes, a vast reduction in secondary instability, and higher quality-of-life measures. Yet, despite these meaningful contributions to health care quality, we continue to bypass the predictable success of an acute arthroscopic Bankart repair in order to tempt fate with "a trial" of nonoperative care for our young, high-risk collision athletes. Whether for the in-season athlete, the "early responder" with limited apprehension, subluxations with spontaneous reduction, or those stoically committed to nonsurgical care, we as physicians are often complicit in this shared risk taking and ceremonial weighing of the risks and benefits for treatment options after primary shoulder instability. Even just 1 additional episode of instability recurrence can double (or triple) the rate of glenohumeral bone loss. Furthermore, subsequent anterior shoulder instability compromises subjective shoulder function, heightens risk of secondary recurrence and/or revision, and increases the likelihood of requiring more advanced surgical management, such as with a Latarjet or other anterior bone block procedure. We must maintain a sense of urgency toward surgical treatment, particularly in young, high-demand athletes with persistent instability. To parrot the wisdom of our shoulder mentors, hear my humble plea: you don't have to fix the shoulder after the first anterior dislocation, but you should definitely do it before the second!