Introduction: Glenohumeral instability has been shown to be common in sporting activities, with the highest rates particularly within contact sports such as wrestling. While operative management of shoulder instability has been published in the literature, few studies highlight outcomes and return to wrestling (RTW) in this subset of athletes. As such, the purpose of this study was to systematically review the current literature to identify reports of wrestlers with glenohumeral shoulder instability injuries to better understand the current state of treatment, outcomes, and RTW rate.

Methods: We performed a systematic review examining treatments and RTW rates in competitive wrestlers. Studies published in PubMed, EMBASE, and the Cochrane Library reporting on competitive wrestlers who experienced shoulder instability from inception to July 2024 were identified. Human subjects, articles published in English, and studies reporting treatment (operative versus nonoperative), outcomes, RTW rates, and any complications were included.

Results: 8 studies, consisting of 134 wrestlers presenting with shoulder instability with a weighted mean follow-up of 58.3 months, were identified. Weighted mean patient age was 18.8 years (range, 17-22 years), with 99% of patients included in this study being male. The most frequently reported instability was anterior shoulder instability, with 73.9% (n = 99/134) of athletes experiencing this shoulder instability. Instability events were reported in 132 athletes, with first time instability events occurring in 50.7% (n = 68/134) of athletes. Anterior labral tears were the most reported pathologic finding on imaging (n = 69/373), with anteroinferior labral tears representing 89.9% (n = 62/69) of these tears. Operative management was performed in 96.3% (n = 129/134) of athletes, and arthroscopic Bankart procedures were the most frequent surgical procedure at 76% (n = 98/129). Complications following treatment were reported in 17.9% (n = 24/134) of patients, with recurrent instability comprising 87.5% (n = 21/24) of noted complications. Eligibility for RTW was reported in 65% (n = 87/134) of wrestlers, with 62% (n = 54/87) RTW, while 60% (n = 52/87) returned to their previous level of activity.

Conclusion: In competitive wrestlers, anterior instability represents the most common direction of shoulder instability. Operative management was the most preferred treatment option, being reported in 96.3% of cases. Given the low RTW rate and relatively high rate of recurrent instability, alternative procedures such as laterjet or open bankart repair may serve as more beneficial treatments in shoulder instability. Future studies should build on the present literature for wrestlers, to include increased detail regarding reoperation rates and time to RTW for various surgical revision procedures, as well as identifying when to perform adjunct procedures when treating these competitive athletes to gauge optimal management strategies.