Why do young people have a high rate of recurrent shoulder dislocation?

One of the notable characteristics of shoulder dislocation is that the risk of recurrence varies significantly across different age groups. In fact, the younger the patient, the higher the rate of recurrent shoulder dislocation.

Figure 1: Dr. Vu Anh explains the imaging results to a patient with shoulder dislocation

Many studies show that in patients under 20 years of age, the risk of recurrent shoulder dislocation after the initial episode is very high. Therefore, in certain cases, surgeons must consider indicating surgery right after the first dislocation rather than waiting for the shoulder joint to dislocate repeatedly.

So why are young people more prone to recurrent dislocations?

1. Young people have higher functional demands

This is the most understandable factor. Young people frequently engage in sports activities, gym workouts, ball games, swimming, or high-intensity labor. Movements involving arm abduction, external rotation, or heavy collisions subject the shoulder joint to continuous stress, increasing the risk of re-dislocation if the joint-stabilizing structures have not fully healed.

2. Joint-stabilizing structures are often more distinctly injured

When a shoulder dislocation occurs, not only is the joint displaced, but important structures such as the labrum, joint capsule, and shoulder ligaments may also be torn.

In young people, following successful reduction, these injuries do not always heal spontaneously in their original anatomical position. This causes the shoulder joint to become unstable and prone to recurrent dislocations during subsequent activities.

3. Each recurrent dislocation causes more severe damage

Every time the shoulder joint dislocates, the surrounding structures suffer further damage. Initially, it may only be a labral tear, but over time, conditions such as anterior glenoid bone loss, humeral head lesions, or progressively worsening shoulder instability may develop.

When bone loss becomes significant, treatment is also more complex and sometimes no longer suitable for isolated arthroscopic surgery.

The treatment decision will depend on many factors, including:

• The degree of shoulder instability upon clinical examination.
• The extent of tears observed on magnetic resonance imaging (MRI).
• The degree of glenoid and humeral head bone loss.
• The patient's age and activity demands. The higher the activity level, the higher the rate of recurrence.

For example, a 17-year-old patient I examined had suffered up to 10 shoulder dislocations within just one year. Fortunately, the bone damage was not yet significant, so it could still be treated with arthroscopic repair. If left untreated for longer, the risk of bone loss lesions would increase significantly, and the treatment would become much more complex.

Several surgical methods can be used:

For cases of glenoid bone loss exceeding 25%, arthroscopic surgery is generally no longer sufficient to restore shoulder joint stability. In such cases, we prioritize open procedures for anterior glenoid reconstruction, most commonly the Latarjet procedure.

In the Latarjet procedure, the surgeon transfers the coracoid process along with the conjoint tendon to the anterior aspect of the glenoid. This bone block acts as a biological "barrier" or "buttress," increasing the surface area of the anterior glenoid and preventing the humeral head from sliding outward during movement. As a result, the shoulder joint becomes more stable, and the risk of recurrence is significantly reduced.

Alongside the Latarjet procedure, in some major medical centers worldwide, surgeons may also use allograft bone to reconstruct the deficient glenoid. Typically, the graft is harvested from the distal tibia, which has a curvature quite similar to the natural anatomy of the glenoid. This bone graft, including the articular cartilage portion, is fixed with screws to the site of bone loss to restore the original anatomical shape and enhance joint stability.

Conversely, for recent shoulder dislocations or cases with minimal glenoid bone loss (typically under 20%), patients can still be treated with arthroscopic surgery. In these instances, the surgeon performs a repair of the labrum and injured soft tissue structures to re-establish joint stability.

Additionally, in some cases with a Hill-Sachs lesion—which is an indentation or bone defect on the posterior aspect of the humeral head caused by impact during shoulder dislocation—the surgeon may indicate an additional procedure called the Wolf technique or Remplissage.

With this technique, the infraspinatus tendon is sutured and pressed into the bone defect of the humeral head to "fill" the lesion. This helps limit the engagement of the humeral head against the glenoid rim during movement, thereby increasing joint stability and reducing the risk of recurrence.

The choice between arthroscopy, Remplissage, Latarjet, or bone grafting is not the same for every patient. The final decision depends on the extent of the damage assessed intraoperatively by the surgeon.

Figure 2: Dr. Vu Anh and his surgical team during an arthroscopic procedure

Therefore, for young people with a shoulder dislocation, early medical evaluation is extremely important. Accurately assessing the extent of injury and the risk of recurrence will help determine the appropriate timing for treatment, minimize cumulative damage, and preserve long-term shoulder function.