Rate of Shoulder Arthroplasty After Anterior Shoulder Instability Surgery: A Systematic Review

Abstract

Background:

Recurrent or persistent anterior shoulder instability (ASI), the most common form of shoulder instability, may progress over time to osteoarthritis (OA) necessitating shoulder arthroplasty. Anterior shoulder instability surgery (ASIS) techniques, including soft-tissue and bony augmentation procedures, have been shown to reduce the risk of recurrent dislocation.

Purpose:

The purpose of this review is to evaluate the rates of progression to shoulder arthroplasty, time to conversion to shoulder arthroplasty, OA grades at time of conversion, and clinical outcomes of shoulder arthroplasty in patients with a history of ASI initially managed with ASIS, including glenoid labrum repair, Bankart repair, or coracoid transfer procedures.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using combinations of keywords related to shoulder arthroplasty and ASIS. The search was performed on February 26, 2026, across the PubMed, Ovid, MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases. Outcomes analyzed included the rate of shoulder arthroplasty after ASIS, time to conversion to shoulder arthroplasty, age at each procedure, OA grade at the time of conversion, range of motion, infection rate, revision rate, failure rate, and clinical outcome scores.

Results:

A total of 52 studies met preliminary inclusion criteria, and 19 studies met full inclusion criteria. Current studies suggest that the conversion rate from ASIS to shoulder arthroplasty is 1.25% and that shoulder arthroplasty was performed, on average, 25.3 years after initial ASIS. ASIS was performed at a mean age of 29 years, while shoulder arthroplasty was performed at a mean age of 61 years. Also, 55% of patients undergoing shoulder arthroplasty after ASIS had Walch grade A1 lesions.

Conclusion:

ASIS was associated with a low long-term conversion rate to shoulder arthroplasty, occurring at a mean of 2.5 decades postoperatively. These findings suggest that ASIS provides durable joint preservation with conversion to shoulder arthroplasty remaining rare over long-term follow-up.

Keywords

anterior shoulder instability Bankart repair coracoid transfer Latarjet osteoarthritis shoulder arthroplasty

The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults and adolescents.³³ The Multicenter Orthopedic Outcomes Network Shoulder Instability Group found that patients undergoing shoulder stabilization were typically in their ≤20s, and that anterior instability was more prevalent than posterior instability.¹⁹ Anterior glenoid labral tears were the most common injury and accounted for 66% of all shoulder instability injuries.¹⁹ Treatment options for glenoid labral tears include both operative and nonoperative approaches, and the optimal strategy is individualized to the patient, depending on factors such as age, sex, injury pattern, activity level, participation in sports, type of sport, and lifestyle goals.^28,33

Anterior shoulder instability (ASI) disrupts normal glenohumeral biomechanics, often leading to osteoarthritis (OA) through repetitive microtrauma, recurrent dislocations, and altered joint loading.³¹ To prevent the sequelae of these biomechanical changes, surgical stabilization aims to restore joint stability. However, the type of surgical treatment depends on the location and extent of damage to the labrum and the amount and location of any subsequent bone loss.¹⁴ Current techniques include arthroscopic or open labral repair with capsulorrhaphy, coracoid transfer procedures, such as the Bristow-Latarjet, and newer techniques, such as Remplissage, distal tibia allograft, distal clavicle autograft, scapular spine autograft, and subtalar allograft. However, these newer techniques were not evaluated in this review as the current literature lacks sufficient long-term follow-up data to assess conversion rates to shoulder arthroplasty. Historical procedures developed in the mid-20th century, such as Magnuson-Stack, Putti-Platt, arthroscopic stapling, and transosseous suture fixation, have been largely abandoned.²¹ In older patients or those who progress to symptomatic OA, shoulder arthroplasty (SA) is intended to restore optimal function and alleviate pain. SA options include anatomic total shoulder arthroplasty, hemiarthroplasty (HA), and reverse total shoulder arthroplasty (RTSA).

Shoulder arthroplasty, while a successful treatment for glenohumeral arthritis, can be a financial burden for patients and the health care system and carries significant risks. Anterior shoulder instability surgery (ASIS) aims to prevent both acute and long-term instability events and reduce the risk of OA development. The purpose of this review was to evaluate the rate of progression to SA after initial ASIS, time to conversion to SA, OA grades at time of conversion, and clinical outcomes of SA in patients with a history of ASI initially managed with glenoid labrum repair, Bankart repair, or coracoid transfer procedures.

Methods

Search Strategies

A reviewer (J.R.) performed a systematic review according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines in accordance with the PRISMA checklist. The PubMed, Ovid, MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were used. The search was conducted on February 26, 2026. Keywords for the search were as follows: (Total Shoulder OR TSA OR Total Shoulder Arthroplasty OR Total Shoulder Replacement OR Reverse Total Shoulder OR RTSA OR Reverse Total Shoulder Arthroplasty OR Reverse Total Shoulder Replacement OR Hemiarthroplasty) AND (Labral OR Labrum OR Bankart OR Bankart Lesion OR Latarjet OR Bristow OR Latarjet-Bristow OR Coracoid OR DTA OR Distal Tibial Allograft OR Hill-Sachs Lesions OR Remplissage OR Shoulder Instability OR Shoulder Dislocation). A flow chart of the systematic review process is presented in Figure 1.

Figure 1.

Literature search according to the 2020 PRISMA guidelines. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Inclusion and Exclusion Criteria

The following inclusion criteria were utilized in identifying eligible studies for the systematic review: randomized control trial, cohort, case-control, and case series study designs; male or female patients who have received glenoid labral tear repair, Bankart repair, coracoid transfer procedures (Bristow-Latarjet, bone block), or remplissage; studies published in the English language; studies published in peer-reviewed journals; any publication date; and any patient ages. The exclusion criteria for the systematic review were as follows: case study, narrative review, or systematic review study designs; studies with abstract only texts; animal studies; studies involving superior labrum anterior to posterior tears; studies with mixed primary and revision arthroplasty cohorts without disaggregated outcomes or revision arthroplasty only studies; studies including Magnuson-Stack, Putti-Platt, or capsulorrhaphy procedures; studies lacking a baseline denominator population or procedural stratified outcomes. Using these criteria, the titles of all papers identified during the literature review were screened by 1 reviewer (J.R.). Paper titles that did not meet the study design's inclusion criteria were excluded. The abstracts of the remaining papers were screened, and those that met the exclusion criteria were eliminated. Full texts of the remaining papers were then reviewed. Papers included by the first reviewer were screened and confirmed by a second reviewer (N.D.). Thirteen level 4 evidence, five level 3 evidence, and one level 2 evidence studies were included in this review. The outcomes in the studies analyzed included the rate of previous ASIS progressing to SA, the time interval between ASIS and SA, range of motion (ROM) after SA with previous ASIS, complications, and outcome scores. Complications included revision rates, infection rates, and failure rates. The outcome scores reported included Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores.

Data Preparation

Data extraction and analysis were performed by 2 authors (J.R. and N.D.)

Statistical Analysis

Statistical analysis was performed, and the weighted average, median, and standard deviation were calculated, along with the minimum, maximum, and range, which were displayed in the tables below. This was performed for all combinations of Bankart and coracoid transfer, only Bankart, and only coracoid transfer paired with all shoulder arthroplasties, only HA, only TSA, and only RTSA. Analysis of the ASIS-to-SA rate is presented in Table 4; the time interval between ASIS and SA in Table 5; the revision and infection rates in Table 6; and the OA grade at the time of conversion in Table 7. Forward elevation ROM, external rotation ROM, and the Constant score were also analyzed.

Results

Literature Search

The initial literature search produced 9622 studies; 3657 were duplicates and were removed. The titles and abstracts of 6265 studies were screened. The full texts of 55 studies were assessed using the inclusion and exclusion criteria. A total of 36 articles were excluded, and 19 met the full inclusion criteria.

Study Characteristics

Eight studies examined the clinical outcomes of ASIS, with some cases proceeding to SA; a total of 984 patients were treated with ASIS, 14 of whom underwent SA surgery, and met the inclusion criteria for the systematic review. A summary of these studies can be seen in Table 1.^{5,7,8,10,11,16,27,30} Eleven studies examined the clinical outcomes of SA, with some cases having a history of ASIS that met the inclusion criteria for the systematic review. In these studies, there were a combined 315 patients treated with SA, 101 of whom had a history of ASIS. A summary of these studies can be seen in Table 2.^‖ Patients from the studies underwent ASIS at a mean age of 29 years and SA after ASIS at a mean age of 61 years. An analysis of the ages of patients undergoing ASIS (Table 1) and those undergoing SA after ASIS (Table 2) is shown in Table 3.

Table 1

Study Characteristics of ASIS Outcome Studies ^a

Study (Year)	Type of Study (Level of Evidence)	Mean Age, Years	ASIS		Subsequent Arthroplasty
Study (Year)	Type of Study (Level of Evidence)	Mean Age, Years	Bankart	Coracoid Transfer (Latarjet, Bristow, Bone Block)	HA	TSA	RSA
Domos et al⁷ (2019)	Case series (4)	46	0	99	0	0	2
Dumont et al⁸ (2014)	Case series (4)	29.4	0	62	0	1	0
Ernstbrunner et al¹⁰ (2019)	Case series (4)	48.2	0	40	0	0	1
Frank et al¹¹ (2019)	Case series (4)	28.5	0	133	1	1	0
Pelet et al²⁷ (2006)	Case series (4)	23.6	30	0	0	5	0
Davey et al⁵ (2022)	Retro comparative cohort (3)	24	103	97	0	0	1
Hovelius et al¹⁶ (2012)	Retro case control (3)	27	0	319	0	1	0
Rodkey et al³⁰ (2021)	Retro comparative cohort (3)	26.8	0	234	1	0	0

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; RSA, reverse shoulder arthroplasty; TSA, total shoulder arthroplasty.

Table 2

Study Characteristics of SA with Previous ASIS Studies ^a

Study (Year)	Type of Study (Level of Evidence)	Arthroplasties in Study				Arthroplasties With Previous ASIS				Previous ASIS
Study (Year)	Type of Study (Level of Evidence)	Mean Age (Years)	HA	TSA	RSA	Mean Age (Years)	HA	TSA	RSA	Bankart	Coracoid Transfer (Latarjet, Bristow, Bone Block)
Kany et al¹⁸ (2017)	Case series (4)	66.3	8	19	0	42	0	1	0	0	1
Clavert et al³ (2019)	Case series (4)	69.9	0	0	25	69.9	0	0	25	18	7
Garret et al¹² (2017)	Case series (4)	49.3	0	67	0	—	0	6	0	0	6
Matsoukis²³ (2006)	Case series (4)	69.3	7	4	0	71.6	1	2	0	1	2
Parsons et al²⁶ (2007)	Case series (4)	50	0	20	0	51.86	0	7	0	3	4
Raiss et al²⁹ (2014)	Case series (4)	70	0	0	13	70	0	0	13	3	10
Waterman et al³⁴ (2023)	Case series (4)	63	1	7	4	64.4	0	5	4	0	9
Willemot et al³⁵ (2018)	Case series (4)	50.7	5	14	11	51.6	3	9	7	0	19
Deutsch et al⁶ (2007)	Retro cohort (3)	62	0	32	0	—	0	2	0	0	2
Cadet et al² (2014)	Case control study (3)	57	0	22	0	38	0	2	0	1	1
Bender et al¹ (2021)	Retro comparative cohort (2)	57	0	56	0	56.7	0	14	0	0	14

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; RSA, reverse shoulder arthroplasty; TSA, total shoulder arthroplasty.

Table 3

Analysis of Ages at Procedure ^a

	Total Papers	Total Patients	Mean (Years)	Median (Years)	Standard Deviation (Years)	Minimum (Years)	Maximum (Years)	Range (Years)
Age at ASIS	8	984	29.1	27	6.8	14	66	53
Age at SA with previous ASIS	9	93	61.4	64.4	8.9	33	83	50
Age at HA with previous ASIS	2	4	48.3	77	16.6	0	0	0
Age at TSA with previous ASIS	7	40	55.1	69	5.8	33	77	44
Age at RSA with previous ASIS	4	49	67.7	69.9	5.5	42	83	41
Age at TSA with previous Bankart	3	5	50.4	51	10.5	33	66	33
Age at TSA with prior coracoid transfer	7	35	57	56.7	5.1	42	72	30

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; RSA, reverse shoulder arthroplasty; SA, shoulder arthroplasty; TSA, total shoulder arthroplasty.

Rate of SA After ASIS

Across the reviewed studies, patients undergoing all ASIS types demonstrated a progression rate to SA of 1.25% (14 of 1,117), ranging from 0.3% to 16% across studies. For coracoid transfer, the conversion rate was 0.91% (9 of 984 patients), with 2 patients progressing to HA, 2 to TSA, and 5 to RTSA. Among specific SA types, 3.1% of ASIS patients progressed to TSA, 0.76% to RTSA, and 0.75% to HA, with rates varying by SA type across all ASIS patients (Table 4).

Table 4

Analysis of the Rates of ASIS Proceeding to SA ^a

	Total Papers	Total ASIS Patients	Total SA after ASIS Patients	Mean Rate	Median Rate	Rate Standard Deviation	Minimum Rate	Maximum Rate	Rate Range
Bankart and Coracoid transfer to all SA	8	1117	14	0.01	0.01	0.03	0.00	0.17	0.16
Bankart and coracoid transfer to HA	1	133	1	0.01	—	—	—	—	—
Bankart and coracoid transfer to TSA	3	225	7	0.03	0.01	0.05	0.01	0.17	0.16
Bankart and coracoid transfer to RSA	4	658	5	0.01	0.01	0.01	0.00	0.03	0.02
Bankart to all SA	1	30	5	0.17	—	—	—	—	—
Bankart to all TSA	1	30	5	0.17	—	—	—	—	—
Coracoid transfer to all SA	7	984	9	0.01	0.00	0.01	0.00	0.03	0.02
Coracoid transfer to HA	2	367	2	0.01	0.00	0.00	0.00	0.01	0.00
Coracoid transfer to TSA	2	195	2	0.01	0.01	0.00	0.01	0.02	0.01
Coracoid transfer to RSA	4	555	5	0.01	0.00	0.01	0.00	0.01	0.01

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; RSA, reverse shoulder arthroplasty; SA, shoulder arthroplasty; TSA, total shoulder arthroplasty.

Time Frame for Conversion to SA

The mean interval from ASIS to subsequent SA was 25.3 years, with a range of 0.58 to 50.3 years. Patients underwent ASIS at a mean age of 29 years and required SA at a mean age of 61 years. For specific SA types, the time from ASIS to HA averaged 11.2 years, with a mean age at HA of 48.3 years. The interval to TSA was 22.7 years, with a mean age of 55.1 years, while RTSA occurred after 30 years, with a mean age of 67.7 years. Comparing procedures, the mean time to SA was 19.1 years for Bankart repair and 20.9 years for coracoid transfer, suggesting similar long-term durability despite procedural differences (Tables 3 and 5).

Table 5

Analysis of the Time Duration Between ASIS and SA ^a

	Total Papers	Total SA after ASIS Patients	Mean Age, Years	Median, Years	Standard Deviation, Years	Minimum, Years	Maximum, Years	Range, Years
Bankart and coracoid transfer to all SA	14	98	25.26	20.8	14.02	0.58	50.3	49.72
Bankart and coracoid transfer to HA	3	7	11.24	15.4	6.58	0.66	15.4	14.74
Bankart and coracoid transfer to TSA	10	46	22.72	22	6.94	0.5	29	28.5
Bankart and coracoid transfer to RSA	6	47	29.99	21.2	17.66	7.16	50.3	43.14
Bankart repair to All SA	4	10	19.08	17.66	9.21	0.83	26.6	25.77
Bankart repair to all TSA	4	10	19.08	17.66	9.21	0.83	26.6	25.77
Coracoid transfer to all SA	10	54	20.87	20.8	7.58	0.58	29	28.42
Coracoid transfer to HA	3	7	11.24	15.4	6.58	0.66	15.4	14.74
Coracoid transfer to TSA	9	41	22.24	22	7.20	0.5	29	28.5
Coracoid transfer to RSA	4	14	14.88	13.7	4.56	7.16	21.2	14.04

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; RSA, reverse shoulder arthroplasty; SA, shoulder arthroplasty; TSA, total shoulder arthroplasty.

Table 6

Analysis of Revision and Infection Rates after SA With Previous ASIS (Bankart and Coracoid Transfer) ^a

	Total Papers	Total SA After ASIS Patients	Number of SA Patients With Complications	Mean Rate	Median Rate	Rate Standard Deviation	Minimum Rate	Maximum Rate	Rate Range
Revision	4	41	7	0.17	0.21	0.09	0.08	0.5	0.42
Infection	3	52	4	0.077	0.05	0.04	0.05	0.14	0.09

ASIS, Anterior Shoulder Instability Surgery; SA, shoulder arthroplasty.

OA Grade at Time of Conversion to SA

OA grade at the time of conversion was assessed using the Walch Classification. Among patients requiring SA, 55.1% exhibited A1-type OA, 18.4% A2, 16.3% B1, and 10% B2, indicating a predominance of milder glenoid wear patterns. Pathologies reported at the time of conversion included avascular necrosis, large engaging Hill-Sachs lesions, rotator cuff tears, and graft dislocation in coracoid transfer cases (Table 7).

Table 7

Analysis of OA Grade at Time of Conversion to SA With Previous ASIS ^a

			Fraction of Patientswith a Walch A1 Grade			Fraction of Patientswith a Walch A2 Grade
	Total Papers	Total SA with Prior ASIS Patients	Average	Median ± SD	Range (min-max)	Average	Median ± SD	Range (min-max)
Bankart and Coracoid Transfer to
All SA	4	49	0.55	0.68 ± 0.18	0.71 (0.29-1)	0.18	0.16 ± 0.07	0.33 (0-0.33)
TSA	3	20	0.35	0.29 ± 0.16	0.71 (0.29-1)	0.2	0.14 ± 0.12	0.4 (0-0.4)
RSA	3	42	0.69	0.68 ± 0.02	0.07 (0.68-0.75)	0.17	0.16 ± 0.03	0.09 (0.16-0.25)
Coracoid Transfer to
All SA	3	24	0.42	0.29 ± 0.18	0.71 (0.29-1)	0.21	0.14 ± 0.10	0.33 (0-0.33)
TSA	3	20	0.35	0.29 ± 0.16	0.71 (0.29-1)	0.2	0.14 ± 0.12	0.4 (0-0.4)
RSA	1	4	0.75	—	—	0.25	—	—
			Fraction of Patientswith a Walch B1 Grade			Fraction of Patientswith a Walch B2 Grade
	Total Papers	Total SA with Prior ASIS Patients	Average	Median ± SD	Range (min-max)	Average	Median ± SD	Range (min-max)
Bankart and Coracoid Transfer to
All SA	4	49	0.16	0.12 ± 0.08	0.29 (0-0.29)	0.10	0.04 ± 0.12	0.29 (0-0.29)
TSA	3	20	0.25	0.29 ± 0.07	0.29 (0-0.29)	0.2	0.29 ± 0.13	0.29 (0-0.29)
RSA	3	42	0.10	0.12 ± 0.04	0.12 (0-0.12)	0.03	0.04 ± 0.01	0.04 (0-0.04)
Coracoid Transfer to
All SA	3	24	0.21	0.29 ± 0.09	0.29 (0-0.29)	0.17	0.29 ± 0.14	0.29 (0-0.29)
TSA	3	20	0.25	0.29 ± 0.07	0.29 (0-0.29)	0.2	0.29 ± 0.13	0.29 (0-0.29)
RSA	1	4	0	—	—	0	—	—

ASIS, anterior shoulder instability surgery; HA, hemiarthroplasty; OA, osteoarthritis; RSA, reverse shoulder arthroplasty; SA, shoulder arthroplasty; TSA, total shoulder arthroplasty.

Clinical Outcomes and Complications

SA after ASIS yielded significant functional improvements. After arthroplasty, patients achieved a mean increase of 55.7° in forward elevation, reaching 126.9°, and 13.8° in external rotation, reaching 18.2°. The Constant score improved by 49.7 points to a postoperative mean of 69.1, reflecting enhanced shoulder function and patient satisfaction. Complications were reported in a small subset of studies with a revision rate of 17% (7 of 41 patients) and an infection rate of 7.7% (4 of 52 patients); however, these findings should be interpreted with caution, given the small sample sizes reporting complication data.

Discussion

ASI affects approximately 24 per 100,000 people annually in the United States, with a cumulative incidence of up to 2.8% over 4 years in athletic populations, such as military cadets.^25,37 Anterior glenoid labral tears are the most common injury, comprising 66% of shoulder instability cases.¹⁹ Surgical interventions, including arthroscopic labral repair and bony procedures such as coracoid transfer (eg, Bristow-Latarjet), aim to restore joint stability, reduce pain, and prevent recurrent dislocations that increase OA risk and potential need for SA.²² Despite advances in ASIS, the absence of recurrent instability does not eliminate long-term SA requirements, necessitating evaluation of conversion rate, time frames, and clinical outcomes to guide patient management and optimize surgical strategies. This systematic review demonstrates that ASIS has a low progression rate to SA, with a conversion rate of approximately 1.25% over a mean of 25.26 years, which is similar to or lower than the rate observed in the general population. These findings suggest that surgical stabilization of ASI may normalize long-term SA risk relative to the baseline population trends, supporting its role in limiting degenerative joint consequences over time.

Conflicting evidence exists regarding the rate and indications for conversion to SA after ASIS, particularly regarding OA severity and grading scales. Yeo et al³⁶ report a high prevalence of any glenohumeral OA (60%) and moderate-to-severe OA (28%) after arthroscopic Bankart repair at a mean of 10.7 years. However, they found no correlation between OA severity and clinical scores.³⁶ They suggest OA may be largely asymptomatic and may not require SA.³⁶ Menon et al²⁴ found a lower rate of OA (25.8%) after Latarjet with predominantly mild OA (88.6% Samilson-Prieto grade 1), emphasizing that graft position influences OA development, but they did not link OA severity to SA conversion.²⁴ Ernstbrunner et al⁹ compared Bankart and Latarjet in patients >40 years old and found similar rates of advanced arthropathy (47%) and progression (62%), with no significant difference in revision rate. This indicates that the 2 procedures may not prevent substantial OA long- term, but the development of OA may not warrant SA. No large-scale registries or meta-analyses explicitly report a conversion rate to SA or time intervals after ASIS. Discrepancies arise from differences in OA grading systems, follow-up duration, patient age, surgical technique, and outcome definitions, highlighting a lack of systematic support to define this measure of long-term success. In addition, editorials such as Lawhorn and Guevara caution that nonanatomic procedures, such as Latarjet, may complicate future SA due to altered anatomy and scarring, further complicating the assessment of long-term arthroplasty requirements. ^15,20

A small number of studies have directly reported conversion to SA after ASIS, and the low rate observed in these reports is consistent with the low but nonnegligible conversion rate identified in our analysis. However, none have explored the rate as a measure of ASIS's success. Gilat et al¹³ demonstrated that 0.17% (7 of 3917 shoulders) of patients in their review of Latarjet outcomes proceeded to SA. Likewise, Hurley et al¹⁷ found that 0.12% (1 of 845 shoulders) of their patients in a review on Latarjet outcomes proceeded to SA. These values are significantly lower than the 0.91% conversion rate among coracoid transfer patients observed in this review. Craig et al reaffirmed that SA remains the definitive treatment for end-stage OA and that severe OA remains the primary indication for the procedure.⁴ While rates of end-stage OA after ASIS procedures have been reported, radiographic OA does not necessarily correlate with clinical symptoms or the need for SA, so direct extrapolation of future arthroplasty rates should be interpreted cautiously. Victor et al³² noted that 11% of 59 shoulders demonstrated severe OA (Samilson-Prieto grade) at a mean follow-up of 15 years after Bankart repair. There remains a lack of longitudinal data describing OA progression and subsequent arthroplasty after arthroscopic Bankart or labral repair, which represents a limitation of both the current literature and our study. Most available ASIS-to-SA conversion data reflect older, open stabilization procedures. As more recent arthroscopic techniques mature and longer follow-up becomes available, future studies may better characterize these outcomes.

This study has several limitations. There is a significant paucity of data on SA conversion after labral repair with or without concomitant Remplissage. The predominance of coracoid transfer procedures among included studies compared with other ASIS techniques, combined with the paucity of data on labral repair techniques, may bias reported conversion rates. The retrospective nature of included studies introduces potential selection bias, and the long follow-up periods (mean 25.26 years) may not reflect current surgical techniques. Newer surgical techniques, including multiple autograft and allograft augmentation procedures, were included in the search terms but yielded no eligible studies, reflecting insufficient long-term follow-up data in the current literature to assess conversion rates for these interventions. Additionally, the variability in clinical outcome measures (eg, Constant, ASES, SSV, SST, and Single Assessment Numeric Evaluation scores) and OA progression scales (Walch and Samilson-Prieto grading systems) across studies hindered direct comparisons. Limited data on SA rates after nonoperative management of labral tears prevented direct comparison with operative treatment, as distinguishing anterior shoulder instability from other degenerative processes is challenging without a comprehensive patient history and advanced imaging. Patients receiving such imaging often prefer surgical fixation, having sought orthopaedic evaluation for their symptoms. Despite these limitations, this systematic review provides, within the available data, a comprehensive analysis of SA rates and outcomes after ASIS, offering valuable insights into long-term patient outcomes.

Residual or recurrent ASI after ASIS remains a significant clinical challenge, with a notable proportion of patients progressing to SA due to OA or recurrent instability. This systematic review highlights a 1.25% conversion rate from ASIS, predominantly consisting of coracoid transfer procedures and Bankart repair, to SA, with a mean interval of 25.3 years, and significant improvements in range of motion and clinical scores after arthroplasty. Future research should focus on the rate of SA after arthroscopic labral repair, with or without glenoid reconstruction or augmentation, to better reflect outcomes of the most common current surgical techniques. Future studies should also focus on standardizing outcome measures and comparing operative versus nonoperative management to better elucidate the long-term efficacy of ASIS in preventing SA.

Footnotes

Final revision submitted March 21, 2026; accepted April 11, 2026.

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution.

ORCID iDs

John Ruyle

Nicholas Dombrowski

Isaiah Roepe

Sterre van den Anker

Notes

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