{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:17:28Z","timestamp":1791901048526,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To establish age\u2010 and time\u2010specific recommendations for the treatment of traumatic anterior shoulder instability (TASI) and for return\u2010to\u2010sport (RTS) decision\u2010making through a formal consensus process among European experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The European Society of Sports Medicine, Knee Surgery and Arthroscopy\u2013European Shoulder Associates (ESSKA\u2013ESA) formal consensus methodology was followed. A steering group formulated 35 clinically relevant questions, 23 of which addressed treatment and RTS and are reported in Part 2. A structured literature review was conducted. Statements were drafted and graded based on the level of scientific support. Then, the rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Recommendations were tailored by age group (adolescents, young adults and older adults) and timing of instability (first\u2010time vs. recurrent).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final global median (range) of the 23 questions was 9 (8\u20139). Eleven questions achieved strong agreement, 11 relative agreement and 1 uncertain agreement. The grades of recommendations were: A in 0 (0%) statements, B in 30 (35.3%) statements, C in 24 (28.2%) statements and D in 31 (36.5%) statements (each statement could have more than one grade of recommendation). Bone loss and soft tissue lesions were key factors in decision\u2010making. The consensus emphasized individualized thresholds for surgical versus conservative management, highlighting the role of bone augmentation in subcritical (bone loss 10%\u201315%) (especially in bipolar bone loss) and critical defects (bone loss &gt;20%), lesion\u2010specific soft tissue repair and the limited role of immobilization. RTS criteria included pain\u2010free full range of motion, shoulder stability, strength and sport\u2010specific readiness, typically achieved between 4 and 6 months depending on the procedure and sport demands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This ESSKA\u2013ESA European Formal Consensus delivers practical, evidence\u2010 and experience\u2010based recommendations for treatment and RTS following TASI according to age\u2010 and time\u2010specific (first time and recurrent) scenarios. By integrating recurrence status, bone loss, soft tissue injury and sport type, the consensus provides a clinically valuable framework for individualized decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70497","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:56:08Z","timestamp":1782312968000},"page":"3040-3051","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Age\u2010 and time\u2010specific management of traumatic anterior shoulder instability: The 2024 ESSKA\u2013ESA Formal Consensus. Part 2: Treatment and return to sports"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8979-8404","authenticated-orcid":false,"given":"Eduard","family":"Alentorn\u2010Geli","sequence":"first","affiliation":[{"name":"Barcelona Sports Trauma Institute Barcelona Spain"},{"name":"Trauma Unit, Unidad de Cirug\u00eda de Hombro, Rodilla y Traumatolog\u00eda deportiva, Centro M\u00e9dico Teknon, Grupo Quir\u00f3nsalud Barcelona Spain"},{"name":"Sport\u2010IT Instituto de Traumatolog\u00eda, Unidad de Medicina y Traumatolog\u00eda Deportiva, Hospital El Pilar, Grupo Quir\u00f3nsalud Barcelona Spain"},{"name":"ViuSalut, Medicina Integrativa Barcelona Spain"},{"name":"Zona Wellness, The Aquatics Medical Center, Club Nataci\u00f3 Atl\u00e8tic\u2010Barceloneta (CNAB) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Brilakis","sequence":"additional","affiliation":[{"name":"Brilakis Orthopaedics Athens Greece"},{"name":"Orthopaedic Department of Modern Arthroscopic and Robotic Surgery Athens Medical Group Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Catarina","family":"\u00c2ngelo","sequence":"additional","affiliation":[{"name":"Hospital SAMS I Mais Sindicato Lisbon Portugal"},{"name":"Joaquim Chaves Sa\u00fade I Cl\u00ednica Cir\u00fargica, Praia de Carcavelos  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berte","family":"B\u00f8e","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery Oslo University Hospital Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Ru\u00edz\u2010Iban","sequence":"additional","affiliation":[{"name":"Unidad de Hombro y Codo Hospital Universitario Ram\u00f3n y Cajal Madrid Espa\u00f1a"},{"name":"Departamento de Cirug\u00eda, Facultad de Medicina, Universidad de Alcal\u00e1 Ciencias Sanitarias Y Medicosociales. Alcal\u00e1 de Henares, Madrid  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Dyrna","sequence":"additional","affiliation":[{"name":"Gelenkzentrum\u2010Leipzig Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maristella Francesca","family":"Saccomanno","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fondazione Policlinico Universitario A. Gemelli, IRCSS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucca","family":"Lacheta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Sports Medicine Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Housset","sequence":"additional","affiliation":[{"name":"Clinique des Maussins Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horea","family":"Benea","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy UMF \u201cIuliu Hatieganu\u201d Cluj\u2010Napoca  Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helder","family":"Fonte","sequence":"additional","affiliation":[{"name":"Hospital das For\u00e7as Armadas\u2014P\u00f3lo Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achilleas","family":"Boutsiadis","sequence":"additional","affiliation":[{"name":"Bioclinic of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frantzeska","family":"Zampeli","sequence":"additional","affiliation":[{"name":"Hand, Upper Limb and Microsurgery Department KAT Attica General Hospital Kifisia Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Milano","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy"},{"name":"Department of Bone and Joint Surgery Spedali Civili Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Beaufils","sequence":"additional","affiliation":[{"name":"ESSKA Consensus Projects Advisor Centre M\u00e9dical, Fondation Norbert Metz76 Luxembourg 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