Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability

BACKGROUND: Arthroscopy has rapidly transformed the treatment of anterior shoulder instability over the past 30 years. Development of arthroscopic equipment has permitted the investigation and diagnosis of the unstable shoulder, and fixation methods have evolved to promote arthroscopy from an experimental procedure to one of first-line mainstream treatment. METHODS: Key research papers were reviewed to identify the fundamental principles in patient diagnosis and appropriate selection for arthroscopic treatment. The evolution of arthroscopy is described in this article to facilitate the understanding of current treatment. RESULTS: Accurate diagnosis of the shoulder instability subtype is essential prior to selection for surgery. Different surgical techniques are described to address different pathology within the glenohumeral joint related to instability and the appropriate method should be selected accordingly to optimise outcome. CONCLUSION: Anterior shoulder instability can be treated successfully using arthroscopic surgery, but the surgeon must treat each patient as an individual case and recognise the different subtypes of instability, the associated pathological lesions and the limitations of arthroscopy. The article concludes with a suggested algorithm for the treatment of anterior shoulder instability.