Current Approaches to Arthroscopic Management of Anterior Shoulder Instability

Operative management should be considered from the initial episode of anterior shoulder instability to prevent bone loss, minimize risk of recurrence, maximize the potential for return to sport at the preinjury level, and from a cost-effectiveness standpoint. The glenoid track concept will be examined as a crucial factor in determining whether bone loss is significant. The increasingly comprehensive understanding of the dynamic interactions between bone loss on the humeral head and glenoid rim will be further discussed as a key factor influencing both surgical management and outcomes. The indications for an isolated soft-tissue procedure in anterior shoulder instability are now narrower; the ideal candidate presents with minimal glenoid bone loss (13.5%). The indications for remplissage as an adjunct procedure continue to expand and remain an ongoing area of study; they now include arthroscopic Bankart repair with off-track and near-track Hill-Sachs lesions or subequatorial extension, and in conjunction with Latarjet, and free bone block procedures. Regarding bony stabilization, Latarjet remains the most established option, but arthroscopic anatomic glenoid reconstruction with a distal tibial allograft is a promising alternative, offering near-anatomic reconstruction and excellent short-term outcomes.