Managing Shoulder Instability in the Contact and Collision Athlete.

PURPOSE OF REVIEW: condition among collision and contact athletes, frequently resulting in significant time away from sport and long-term functional limitations. Due to the high physical demands and risk of recurrent injury in this population, accurate diagnosis and treatment are essential. This review provides a comprehensive overview of the clinical assessment and management of shoulder instability in these high-risk athletes. RECENT FINDINGS: Shoulder instability can be managed non-operatively or operatively. Recurrent instability is common with non-operative treatment, particularly in young male contact and collision athletes. Surgical management significantly reduces recurrence and improves return-to-sport outcomes. Anterior instability treated with arthroscopic Bankart repair generally demonstrates good results, but risk factors for failure include multiple dislocations, hyperlaxity, glenoid bone loss, and delayed intervention. Augmentation with remplissage improves outcomes over Bankart repair alone and yields results comparable to the Latarjet procedure, which is reserved for critical glenoid bone loss but is technically demanding. Posterior instability treated with arthroscopic posterior capsulolabral repair shows high return-to-sport rates and superior patient-reported outcomes compared with conservative management. Clinical decision-making should prioritize restoring stability, regaining function, and facilitating a safe return to sport. Patient-specific factors such as age, level of play, athletic goals, risk of recurrence, and extent of bone loss must also be carefully considered. A thorough understanding of shoulder instability in this population is essential to guide management and minimize the risk of recurrent instability, progressive bone loss, and long-term shoulder dysfunction.