In this episode of The Sports Docs Podcast, Dr. Bassett & Dr. Logan sit down LIVE from the Arthrex Team Physician Controversies with shoulder instability expert Dr. Kevin Farmer to discuss the modern management of traumatic anterior shoulder instability in athletes.

The conversation focuses on the instability continuum, including when to operate, how to evaluate bipolar bone loss, and when to add remplissage, with an emphasis on optimizing outcomes in young, high-risk athletes.

Who Needs Surgery?

Young athletes—especially males less than 20—have 70–80% recurrence rates with nonoperative care
Higher risk populations:
Collision athletes
Overhead athletes
Military/tactical athletes

Key insight:
Early surgical stabilization can be career-protective in high-risk athletes

MRI evaluates:

Bankart lesions
Hill-Sachs size and orientation
Capsulolabral quality

Advanced assessment includes:

Percent glenoid bone loss
Hill-Sachs engagement
On-track vs off-track lesions

Arthroscopic Bankart Repair

Remains the workhorse procedure in absence of critical bone loss

Modern advances:

Knotless anchors
Improved efficiency and reproducibility
Better capsular tensioning

Anchor strategy:

Typically 3–4 anchors
Start low (5:30–6 o’clock) and work superiorly
Fewer than 3 anchors associated with higher failure rates
Capsular Management

Capsular shift is critical in:

Young patients
Hyperlax athletes

Goal:

Restore anterior stability
Re-tension IGHL complex

Knotless technology allows fine-tuned tensioning

Remplissage

Traditionally used for off-track Hill-Sachs lesions
Now increasingly used in:

Subcritical glenoid bone loss (~10–15%)
High-risk athletes
Borderline “on-track” lesions

Benefits:

Decreases recurrence rates
Reduces need for revision surgery

Key insight:
Low threshold in young, male contact athletes

Remplissage Technique

Two anchors placed in Hill-Sachs lesion
Sutures passed through capsule and infraspinatus
Secured in subdeltoid space

Pearls:

Use knotless anchors for low-profile fixation
Visualize subacromial space to avoid soft tissue capture
Motion vs Stability

Concern: loss of external rotation

Reality:

Minimal, clinically insignificant loss with modern techniques
Stability benefits outweigh small motion tradeoffs
Postoperative Rehab

Sling: 3–4 weeks
Early passive motion
Strengthening at 6 weeks
Return to sport: ~5–6 months

Return to Sport Testing

Criteria-based return reduces recurrence (5% vs 22%)

Key components:

Full ROM
Greater/equal to 90% strength vs contralateral side
Functional testing (CKCUEST, shot-put, plank taps, etc.)
Patient-reported outcomes (WOSI greater than 90%, KJOC greater than 88%)

Featured Guest
Dr. Kevin Farmer – University of Florida, Team Physician for the Florida Gators

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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com