Anterior Shoulder Instability Evolution of Principles and Surgical Treatment

Anterior shoulder instability has been a common shoulder problem since the earliest of human civilizations. Over the course of thousands of years, our understanding regarding shoulder instability and treatment options have evolved tremendously. Specifically, over the past several decades we have seen a gradual but substantial development in our understanding of the natural history of anterior shoulder instability with and without surgical treatment. There is increasing recognition and improved understanding of the role of bone loss in the pathophysiology of shoulder instability, with ongoing emphasis on restoring native anatomy with minimally invasive techniques. The rich history of successes and failures of past surgical procedures forms the basis of the many innovative surgical techniques currently used, including both bony and soft tissue procedures. The purpose of this review is to highlight some of the most influential and important breakthroughs in the evolution of our understanding and management of anterior shoulder instability.