A Level 1 randomized trial in patients aged 18 to 25 with a first anterior shoulder dislocation. It compared arthroscopic Bankart repair within 2 weeks against standard 3-week immobilization. The question: does primary surgery reduce recurrent instability at 2 years?
The younger the patient, the higher the recurrence risk after a first anterior dislocation, reaching 73.8% at 5 years in the 21-25 age group and higher still under 20. This trial reframes the decision: instead of waiting for a second dislocation before offering stabilization, surgery after the first event dropped 2-year recurrence from 70% to 10% and roughly doubled return to prior sport level.
Measure instability by more than dislocation alone. Subluxation and a positive apprehension test both fell dramatically with surgery, and both matter to a young athlete's function even when the shoulder never fully dislocates again.
Use the imaging thresholds that guide technique: exclude soft-tissue Bankart repair when glenoid bone loss exceeds 25%, and recognize that an off-track Hill-Sachs lesion managed nonoperatively went on to instability in every case here. The main caveats are the small sample (n=40) and short 2-year follow-up, so this favors surgery but does not settle the question for every patient.
A Level 1 randomized trial in patients aged 18 to 25 with a first anterior shoulder dislocation. It compared arthroscopic Bankart repair within 2 weeks against standard 3-week immobilization. The question: does primary surgery reduce recurrent instability at 2 years?
The younger the patient, the higher the recurrence risk after a first anterior dislocation, reaching 73.8% at 5 years in the 21-25 age group and higher still under 20. This trial reframes the decision: instead of waiting for a second dislocation before offering stabilization, surgery after the first event dropped 2-year recurrence from 70% to 10% and roughly doubled return to prior sport level.
Measure instability by more than dislocation alone. Subluxation and a positive apprehension test both fell dramatically with surgery, and both matter to a young athlete's function even when the shoulder never fully dislocates again.
Use the imaging thresholds that guide technique: exclude soft-tissue Bankart repair when glenoid bone loss exceeds 25%, and recognize that an off-track Hill-Sachs lesion managed nonoperatively went on to instability in every case here. The main caveats are the small sample (n=40) and short 2-year follow-up, so this favors surgery but does not settle the question for every patient.