[Surgical treatment of anterior shoulder instability]

Long-term results obtained with the procedures hitherto regarded as standard and new findings about the etiopathogenesis and biomechanics of shoulder instability allow the conclusion that there is no single technique that is suitable for all forms of instability. Rather, an optimal surgical treatment should be selected with regard to the particular pathologic anatomy. For the majority of anterior instabilities--most of which are traumatic in origin--lasting reattachment of the capsule ligamentous structures to the lower anterior glenoid rim without a change in the original anatomical conditions is indicated. This concept, first described by Perthes and made known by the publications of Bankart, has been incorporated into several operative procedures and has been subjected to various modifications and technical innovations, including adaptation for arthroscopic methods. In a small number of instabilities deformations of the bones articulating on each other in the joint are found. These should be compensated if they affect the biomechanics. Most instances of shoulder instability caused by constitutionally determined laxity of the capsule should be treated conservatively. Not until such measures have failed should an operation be carried out; depending on the extent and directions of the usually multi directional instability, different methods of tightening and strengthening of the capsule are required.