management of in-season concurrent rotator cuff tear with shoulder instability in professional contact football athletes; respect the career goals!

introduction professional sports injuries are usually all dealt with at one single operation to return the player to the sport after appropriate rehabilitation. we questioned the assumption that rotator cuff tears must be repaired concurrently with instability syndromes, and aimed to allow a professional rugby league player to achieve career goals by not correcting all pathology at one surgery. case presentation a professional rugby league player presented with acute shoulder instability on a setting of a chronic full thickness rotator cuff tear. we performed an “in season” arthroscopic stabilization on an elite rugby league player, leaving a previously diagnosed large full thickness rotator cuff tear untreated. this allowed aggressive rehabilitation and return to contact competition at 12 weeks post-surgery. the player achieved a long held career goal of winning a premiership ring before undertaking rotator cuff repair at the end of the season. latest follow up at seven years (still at elite level) demonstrated an asymptomatic shoulder. conclusions the assumption that all pathology found at surgical exploration requires correction to play at elite level is not universally correct. we postulate that whilst rotator cuff deficiency has severe long-term sequelae, it is shoulder instability alone that prevents high level contact sports participation. career goal management is an important part of managing elite level athletes. we have demonstrated that by careful management of the specific pathology preventing participation can allow elite athletes to achieve career goals without compromising long-term health.