173: Anchors Away! Stabilizing the Athlete’s Shoulder

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 careHigher risk populations:Collision athletesOverhead athletesMilitary/tactical athletesKey insight:Early surgical stabilization can be career-protective in high-risk athletesMRI evaluates:Bankart lesionsHill-Sachs size and orientationCapsulolabral qualityAdvanced assessment includes:Percent glenoid bone lossHill-Sachs engagementOn-track vs off-track lesionsArthroscopic Bankart RepairRemains the workhorse procedure in absence of critical bone lossModern advances:Knotless anchorsImproved efficiency and reproducibilityBetter capsular tensioningAnchor strategy:Typically 3–4 anchorsStart low (5:30–6 o’clock) and work superiorlyFewer than 3 anchors associated with higher failure ratesCapsular ManagementCapsular shift is critical in:Young patientsHyperlax athletesGoal:Restore anterior stabilityRe-tension IGHL complexKnotless technology allows fine-tuned tensioningRemplissageTraditionally used for off-track Hill-Sachs lesionsNow increasingly used in:Subcritical glenoid bone loss (~10–15%)High-risk athletesBorderline “on-track” lesionsBenefits:Decreases recurrence ratesReduces need for revision surgeryKey insight:Low threshold in young, male contact athletesRemplissage TechniqueTwo anchors placed in Hill-Sachs lesionSutures passed through capsule and infraspinatusSecured in subdeltoid spacePearls:Use knotless anchors for low-profile fixationVisualize subacromial space to avoid soft tissue captureMotion vs StabilityConcern: loss of external rotationReality:Minimal, clinically insignificant loss with modern techniquesStability benefits outweigh small motion tradeoffsPostoperative RehabSling: 3–4 weeksEarly passive motionStrengthening at 6 weeksReturn to sport: ~5–6 monthsReturn to Sport TestingCriteria-based return reduces recurrence (5% vs 22%)Key components:Full ROMGreater/equal to 90% strength vs contralateral sideFunctional testing (CKCUEST, shot-put, plank taps, etc.)Patient-reported outcomes (WOSI greater than 90%, KJOC greater than 88%)Featured GuestDr. Kevin Farmer – University of Florida, Team Physician for the Florida Gators🎤 Stay ConnectedIf you enjoyed this episode, be sure to subscribe, rate, and review on:Apple PodcastsSpotifyFollow us on Instagram Arthrex Team Physician Controversies 2026Our Hosts:Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com