Management of in-season anterior instability poses aunique challenge to providers as they are faced with theconundrum of helping an athlete return to play as quicklyas possible, while minimizing the risk of recurrent instabilityand progressive damage to the glenohumeral joint.The decision for early return to play versus in-season surgeryultimately is a collective decision-making processbetween the athlete, provider and training staff. However,it is the physician’s obligation to properly counsel theathlete on the risks of early return to play following conservativemanagement. Apart from athletes who are inthe last season of their career or have other extenuatingcircumstances, requiring return to play (RTP) in the sameseason (i.e. upcoming championship or combine), giventhe high risk of recurrence in athletes managed conservatively,physicians should strongly encourage early surgicalstabilization. Surgical management of instabilitymost commonly includes arthroscopic Bankart repairand capsulorrhaphy, however open Bankart repair shouldbe considered in high-risk athletes (i.e. contact athletes,recurrent instability, sub-critical glenoid bone loss).In athletes with critical glenoid bone loss an osseousaugmentation procedure should be performed, such asthe Latarjet procedure.
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