Recurrent anterior shoulder instability associated with bony defects

Mobility of the glenohumeral joint is facilitated through the complex interplay of soft tissue and osseous anatomy. Arthroscopic shoulder stabilization is commonly used in the surgical management of shoulder instability. However, the management of the unstable shoulder associated with bony defects (glenoid, humeral, or combined) can be challenging. Adequate recognition of bony defects is paramount to successful treatment and entails a careful history, clinical examination, and advanced radiographic imaging. Nonoperative methods of treatment are often insufficient for treating patients with large bony defects. Bony procedures, as opposed to soft procedures, may yield better outcomes in this patient population. However, respective surgical techniques used to address these defects are technically challenging with a significant learning curve and may lead to significant morbidity. This represents a paradigm shift in treatment and replaces the old paradigm of "open vs arthroscopic" instability surgery.