Current concepts review - Open operative treatment for anterior shoulder instability: When and why?

Open surgical treatment for primary anterior glenohumeral instability is reliable and time-tested and can yield excellent clinical results(1-4). With advancements in arthroscopic technique, there has been a growing trend toward arthroscopic treatment of anterior shoulder instability. In many instances, arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, obviating the need for releasing and repairing the subscapularis; because it allows better identification and treatment of associated pathological conditions; and because it decreases morbidity and facilitates an outpatient approach. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures(5-8). Despite these exciting advances, open surgery remains an acceptable method of treatment, particularly when a surgeon lacks the equipment, experience, or technical expertise needed to perform an arthroscopic repair. Furthermore, open surgery remains the preferred method of treatment in situations where even the most modern arthroscopic techniques cannot adequately address the pathoanatomy, such as anterior instability in the setting of large bone defects or soft-tissue deficiencies. We will review the indications, techniques, and complications of open surgical treatment of anterior shoulder instability, summarizing the various types of open stabilization procedures and their clinical results and highlighting the specific situations in which open surgery remains the preferred method of treatment.