Conservative and Surgical Treatment of Anterior Shoulder Instability

The part opens with the debate over first-time dislocations. Conservative care suits older patients with minimal or no bone loss, low-demand sports and female sex, while young male athletes face recurrence risk near 80%. Rehabilitation follows a sling for 3 to 10 days, strengthening of the dynamic stabilizers and a pain-free return to sport in about 21 days. Sling position made no difference to recurrence. CT with 3D reconstruction is the gold standard for measuring glenoid bone loss, and loss above 20 to 25% usually points to a bone block procedure. João shows algorithms that combine bone loss, Hill-Sachs track status, age, sport and hyperlaxity. Anatomic options include arthroscopic Bankart repair with several anchors, glenoid reconstruction with distal tibia allograft and autografts such as iliac crest. Non-anatomic options are dynamic anterior stabilization using the long head of biceps, remplissage of the infraspinatus into the Hill-Sachs defect, and the Latarjet with its triple stabilizing effect. Long-term Latarjet data show low recurrence, but also osteoarthritis and scapular dyskinesis.