Instability

Chronic Glenohumeral Instability

Recurrent shoulder instability. Complete lesion assessment to guide choice between Bankart and Latarjet.

The chronic glenohumeral instability is defined by the recurrence of dislocation or subluxation episodes of the shoulder following an initial traumatic dislocation. It affects mainly young and active subjects (recurrence rate 80-90% before age 20). The complete lesion assessment includes: Bankart lesion (anterior labral detachment), Hill-Sachs defect (posterior humeral head impression), glenoid bone loss (critical threshold 13.5% according to the ISIS score). The choice between Bankart (arthroscopic labral repair) and Latarjet (coracoid bone block) depends on the bone loss assessment, number of dislocations, level of sports activity, and bone quality.

Characteristics

  • History of recurrent dislocations or subluxations of the shoulder, with a feeling of apprehension in abduction + external rotation position. Spontaneous reduction episodes.
  • Apprehension test (positive in 90°-90° abduction-external rotation), Jobe relocation test (reduction of apprehension by posterior pressure), anterior drawer test.
  • CT with 3D reconstruction: glenoid bone loss quantification (> 13.5% = Latarjet indication). Hill-Sachs index measurement. En-face glenoid view.
  • ISIS score (Instability Severity Index Score, Balg & Boileau): ≤ 3 = arthroscopic Bankart, ≥ 4 = Latarjet preferred. Integrates age, sport level, hyperlaxity, Hill-Sachs, bone loss.

Medical and surgical management

  • First dislocation in young patients: conservative treatment debated. Immobilization 3-4 weeks then rehabilitation. High recurrence rate (80-90% < 20 years).
  • Recurrent instability without significant bone loss: arthroscopic Bankart repair with resorbable anchors. Reattachment of the anterior labrum. Recurrence rate 5-15%.
  • Bone loss > 13.5%, contact athlete, ISIS ≥ 4: Latarjet procedure (coracoid bone block transfer to the anterior glenoid). Triple effect (bone, tendon, ligament). Recurrence < 5%.

Physiotherapy rehabilitation

  • Post-operative Bankart: sling 4-6 weeks, passive mobilization from W3, no external rotation > 0° for 6 weeks. Progressive strengthening from W8.
  • Post-operative Latarjet: sling 3-4 weeks, more rapid mobilization (bone block effect). External rotation possible earlier. Strengthening from W6.
  • Both procedures: progressive proprioception work. Reintroduction of at-risk positions (abduction + external rotation) from M3. Confidence recovery.
  • Return to contact/overhead sports: M6 minimum after Bankart, M4-6 after Latarjet. Isokinetic and functional testing before return to competition.

Surgical techniques

  1. Arthroscopic Bankart repair

    Reattaches the anteroinferior labrum to the glenoid using resorbable anchors. Indicated when there is no significant bone loss.

  2. Latarjet procedure

    Transfer of the coracoid process to the anterior glenoid rim. Triple stabilizing effect: bony, capsular and muscular.

  3. Hill-Sachs remplissage (HARO)

    Arthroscopic filling of the humeral notch with the infraspinatus tendon. Combined with Bankart or Latarjet depending on bone loss.

Average duration

12 to 24 weeks post-operative

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.