Shoulder Instability: An American Perspective.

The recognition and management of glenohumeral instability has become an increasingly important aspect of orthopaedic care. Substantial controversy exists with regard to the indications for soft-tissue stabilization versus bony augmentation in patients with glenohumeral instability, particularly among surgeons in the United States and Europe. Although bone loss procedures are frequently performed in the United States and abroad, surgical techniques and indications for bone loss procedures are different. Surgeons should understand current evidence-based indications for arthroscopic versus open soft-tissue stabilization in patients with anterior shoulder instability. Surgeons also should understand the importance of glenoid bone loss with regard to surgical decision making and the indications for Latarjet reconstruction versus allograft reconstruction. Patient-specific factors, including age, sex, sports participation (type and level of play), and the number of instability events that occur before presentation, affect surgical decision making. The technical pearls for successful arthroscopic stabilization, remplissage, open soft-tissue stabilization, and bony reconstruction of the glenoid rim that are discussed in this chapter may increase the likelihood of successful outcomes in patients with glenohumeral instability.