Soft-Tissue Procedures: Indications

The surgical treatment of anterior shoulder instability includes various open and arthroscopic surgical techniques. Soft-tissue procedures can be successful treatment options for patients with predominant soft-tissue lesions. The results in terms of stability after the surgical procedure in these cases can be comparable to other surgical procedures such as stabilization using bone block or coracoid transfer. Identification of risk factors that can influence the outcome is of the utmost importance. Among these, the most important factor is the bony status of the glenoid and humeral head. In the absence of important bony injuries, including a bony Bankart lesion and a Hill–Sachs lesion, soft-tissue procedures are frequently successful. Additional important factors that should be taken into account in the surgeon’s decision-making process are shoulder laxity, underlying lesions, concomitant shoulder injuries, and the presence and quantity of instability events that predispose the quality of the soft tissue, especially the capsule and ligaments. To better describe and illustrate diagnostic process in the patients with anterior shoulder instability, some scenarios from clinical practice are used, showing the author’s preferred choice of treatment.