 Finding a long-term solution for adolescents with traumatic shoulder instability remains a challenge for surgeons. Among adolescents who undergo Bankhart shoulder repair, it's estimated that up to 44% are at risk of recurrent instability. One proposed predictor of this risk is the concept of whether shoulder lesions lie on or off the glenoid track. But that's in adults. A new study reported in the American Journal of Sports Medicine suggests that the same may not apply to adolescents who have undergone Bankhart shoulder repair. Shoulder dislocations often cause injury to the anterior labrum, as well as the posterior aspect of the humeral head, creating a hill sacs lesion. The location of such lesions has been reported to play a role in shoulder instability, specifically where lesions lie in relation to the glenoid track, the zone of contact between the humeral head and glenoid when the shoulder is abducted. Hill sacs lesions within the glenoid track or on-track lesions have been found less likely to cause recurrent shoulder instability than off-track lesions in adults following Bankhart repair. To determine how this feature affects adolescents, researchers examined 59 patients between the ages of 12 and 18 treated with arthroscopic Bankhart repair. In addition to the presence of off-track lesions on MRI, the team examined glenoid and humeral bone loss. They also collected patient-reported outcomes to assess shoulder function, activity level, and perceived instability. At a final mean follow-up of 49 months, 18 patients were considered a surgical failure, 10 had undergone revision surgery, while eight reported instability, but had not undergone revision surgery. No radiographic variables were statistically significantly different between the failure and non-failure groups. Four patients were found to have off-track lesions and two underwent revision, while the other two did not experience surgical failure. The same was observed for patient-reported outcomes. At final follow-up, scores were not significantly different between the two groups. There was also no difference in the rates at which patients returned to sports. One significant difference that was observed occurred among the 38 patients identified to have a Hilsax lesion. Seven of these patients had undergone revision surgery. Compared with the 31 who did not, the revision group showed a significantly greater median Hilsax interval. Despite the small sample size, the findings suggest an exception to the idea that off-track lesions may predict shoulder instability following repair in adolescence. To be sure, larger, more adequately powered studies with adolescents are needed. Understanding the anatomy and experiences of such patients following shoulder repair surgery could help researchers gain deeper knowledge about recurrent instability.