Do I Need Surgery After My First Shoulder Dislocation?

The shoulder is a ball-and-socket joint with a very shallow socket, which is what lets the arm move through such a wide range. Much of its stability comes from the labrum — a rim of firm cartilage that runs around the edge of the socket, deepening it and anchoring the ligaments that hold the ball in place.

Almost all dislocations are anterior: the ball is forced out the front of the socket, typically with the arm raised and pulled backward — a tackle, a fall on an outstretched arm, a blocked spike. As the ball leaves, it usually tears the front-lower part of the labrum off the bone. That injury is called a Bankart lesion. The labrum does not reliably heal back to the bone on its own in the correct position, and without it, the ball has less holding it in. That is the mechanical reason a first dislocation so often leads to a second.

An arthroscopic Bankart repair reattaches the labrum to the socket rim through small incisions, using a camera and small suture anchors placed in the bone. It is the operation tested in the trials below.

The French trial enrolled 40 patients aged 18 to 25 after a first forward dislocation and randomized them evenly.¹ One group had an arthroscopic Bankart repair within two weeks of the injury. The other was treated without surgery. Both groups wore a sling for three weeks and followed the same physical therapy program, so the only planned difference was the repair itself. The main outcome was any further instability — a dislocation needing to be put back or a partial slip, called a subluxation. The researchers reached 37 of the 40 patients at an average of 6.8 years.

Two recent pooled analyses reach the same conclusion from different directions. A 2025 network meta-analysis in Arthroscopy combined eight randomized trials with 439 participants under 40. Arthroscopic repair cut the risk of recurrence to about one-seventh of that with a sling (risk ratio 0.14).³ It also found no difference between slinging the arm across the body and the once-popular approach of bracing it rotated outward.

A 2025 position statement from the Arthroscopy Association of Canada pooled 11 comparative studies and 694 patients with an average age of about 22. Early repair sharply reduced further instability, re-dislocation, and later surgery, and gave patients nearly four times the odds of returning to the same level of sport.⁴ One result pointed the other way: the pooled score on the main shoulder-instability questionnaire did not differ significantly between the groups.

The older trials fit the same pattern. In young military athletes, 75% of shoulders treated without surgery became unstable again within about three years, against 11.1% after arthroscopic repair.⁵ A Danish trial of open repair found recurrence in more than half of patients treated without surgery against 3% with repair at two years, and ten-year results rated good or excellent in 72% of repaired shoulders.⁶ A Canadian trial followed patients for about six years and found a clear difference in re-dislocation but no significant difference on two general shoulder-function scores.⁷

If you choose not to have surgery

A large UK trial, ARTISAN, randomized 482 adults with an average age of 45 who were being treated without surgery. A full course of physical therapy was no better at six months than a single advice session with written materials and the option to book therapy later.⁸ For an older patient whose shoulder feels stable, a structured home program and a clear plan for what to do if it slips again appear to be as effective as scheduled therapy.

1. The trials are small

In the new trial, each patient in the repair group accounts for more than five percentage points. The gap between the groups is large enough that it would survive a few patients landing differently, but the precise figures — 27.8%, 82% — should be read as approximate. The pooled analyses help, yet even the network meta-analysis rests on 439 people.

2. Fewer re-dislocations did not always mean a better-functioning shoulder

Recurrence is the outcome surgery changes most reliably. On patient-reported function, the results are mixed: the new trial found clear differences, while the Canadian pooled analysis found no significant difference on the main instability questionnaire, and an earlier trial found none on two general function scores.⁴⁷ Part of the explanation is that many patients in the non-surgical groups had a later stabilization and were then scored on a repaired shoulder. The defensible claim is that early repair prevents instability episodes and the time lost to them — not that it guarantees a better shoulder years later.

3. The patients studied are narrow

The pooled trials enrolled mostly young men, with an average age in the low twenties and only about one patient in seven female.⁴ Several of the older trials studied military cadets or competitive athletes. Applying these numbers to a 35-year-old office worker who dislocated a shoulder on a ski trip extrapolates well beyond the data.

4. A policy of early surgery treats some shoulders that would have been fine

In the new trial, two of the 19 patients in the sling group never had a further episode, and in the 25-year study, half of the young shoulders treated without surgery eventually stopped dislocating.¹² That trade-off belongs in the conversation, particularly for a patient whose activities do not put the arm at risk.

5. Arthritis after repair is common, and the data cannot say whether surgery adds to it

A 2025 review of patients followed an average of more than ten years after arthroscopic Bankart repair found some arthritic change on X-ray in 60% and moderate-to-severe change in 28%, though it was generally not causing symptoms and was not associated with shoulder-function scores.⁹ Repeated dislocations also damage the joint, and the review had no untreated comparison group, so it cannot tell us whether repair lowers, raises, or leaves unchanged the long-term arthritis risk.