Shoulder Instability Pediatric Management of Shoulder Instability in the Pediatric Athlete: A Contemporary Review of Current Evidence.
4 affiliations
- 1Department of Orthopaedic Surgery, University of California, San Fracisco, San Francisco, CA, USA.
- 2Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
- 3Department of Orthopaedic Surgery, University of California, San Fracisco, San Francisco, CA, USA. [email protected].
- 4Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens St, San Francisco, CL, 94158, USA. [email protected].
Abstract
Purpose of review
Shoulder instability in pediatric and adolescent athletes is increasingly common and clinically complex due to early sport specialization and high-demand participation. This review aims to inform clinical decision-making by synthesizing contemporary evidence on injury patterns, diagnostic techniques, treatment options, and associated outcomes when faced with treating pediatric athletes.Recent findings
Unique anatomic and developmental features specific to the pediatric population including capsular elasticity, collagen composition, open physes, and evolving glenoid and humeral morphology contribute to age-specific injury patterns and influence treatment outcomes. Younger children more frequently sustain atypical soft-tissue lesions, while adolescents experience markedly higher recurrence risk with rates of 44-77% following nonoperative management. Adolescents also develop off-track Hill-Sachs lesions more frequently than adults (24.4% vs. 3.3%), reflecting differences in immature bone mechanics. Diagnosis requires thorough history, physical examination, assessment of social and socioeconomic factors, and advanced imaging. Arthroscopic Bankart repair remains the most common surgical intervention and yields high return to sport rates (75-90%), though recurrence in pediatric patients (15-50%) substantially exceeds adult rates. Remplissage reduces recurrence in adolescents with off-track lesions, and bone augmentation procedures such as the Latarjet demonstrate lower recurrence (3-8%) in patients with significant glenoid bone loss or failed prior stabilization. Long-term outcomes in skeletally immature patients and alternative bone block procedures remain incompletely studied. Management requires individualized risk stratification based on adherence, skeletal maturity, sport demands, bone loss, lesion morphology and patient history and adherence. Although surgical stabilization provides favorable functional outcomes and high return to sport rates, recurrence remains a significant concern in younger and collision-sport athletes.
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BibTeX
@article{wong2026shoulder,
title = {{Shoulder Instability Pediatric Management of Shoulder Instability in the Pediatric Athlete: A Contemporary Review of Current Evidence.}},
author = {Liam H Wong and Hannah M Chi and Erick M Marigi and Nirav K Pandya and Michael R Davies},
journal = {Current reviews in musculoskeletal medicine},
year = {2026},
month = oct,
doi = {10.1007/s12178-026-10062-7},
url = {https://europepmc.org/article/MED/42905392},
note = {CC BY},
}
RIS
TY - JOUR
TI - Shoulder Instability Pediatric Management of Shoulder Instability in the Pediatric Athlete: A Contemporary Review of Current Evidence.
AU - Liam H Wong
AU - Hannah M Chi
AU - Erick M Marigi
AU - Nirav K Pandya
AU - Michael R Davies
PY - 2026
DA - 2026/10/21
JO - Current reviews in musculoskeletal medicine
DO - 10.1007/s12178-026-10062-7
UR - https://europepmc.org/article/MED/42905392
AB - Purpose of review Shoulder instability in pediatric and adolescent athletes is increasingly common and clinically complex due to early sport specialization and high-demand participation. This review aims to inform clinical decision-making by synthesizing contemporary evidence on injury patterns, diagnostic techniques, treatment options, and associated outcomes when faced with treating pediatric athletes.Recent findings Unique anatomic and developmental features specific to the pediatric population including capsular elasticity, collagen composition, open physes, and evolving glenoid and humeral morphology contribute to age-specific injury patterns and influence treatment outcomes. Younger children more frequently sustain atypical soft-tissue lesions, while adolescents experience markedly higher recurrence risk with rates of 44-77% following nonoperative management. Adolescents also develop off-track Hill-Sachs lesions more frequently than adults (24.4% vs. 3.3%), reflecting differences in immature bone mechanics. Diagnosis requires thorough history, physical examination, assessment of social and socioeconomic factors, and advanced imaging. Arthroscopic Bankart repair remains the most common surgical intervention and yields high return to sport rates (75-90%), though recurrence in pediatric patients (15-50%) substantially exceeds adult rates. Remplissage reduces recurrence in adolescents with off-track lesions, and bone augmentation procedures such as the Latarjet demonstrate lower recurrence (3-8%) in patients with significant glenoid bone loss or failed prior stabilization. Long-term outcomes in skeletally immature patients and alternative bone block procedures remain incompletely studied. Management requires individualized risk stratification based on adherence, skeletal maturity, sport demands, bone loss, lesion morphology and patient history and adherence. Although surgical stabilization provides favorable functional outcomes and high return to sport rates, recurrence remains a significant concern in younger and collision-sport athletes.
SN - 1935-973X
SN - 1935-9748
ER -