Anterior instability of the shoulder after trauma.

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B4. 15014 $2.00 J Bone Joint Surg [Br] 2004;86-B:469-79. Anterior dislocation of the glenohumeral joint is a common injury of young people playing contact sport and may progress to recurrent episodes of symptomatic instability. The usual treatment for a primary dislocation is a short period of immobilisation followed by a programme of rehabilitation and a gradual return to full activity. An open operation to stabilise the shoulder is a successful procedure for the treatment of patients who develop recurrent instability. The advent of arthroscopic surgery, initially as a diagnostic tool, but more recently to perform therapeutic intervention, has resulted in a variety of minimally-invasive techniques for the management of instability. Arthroscopic stabilisation done as day-care surgery offers attractive advantages over open repair such as improved cosmesis, less postoperative pain, reduced stiffness after operation and more rapid rehabilitation. As a consequence, this technique has been offered as initial treatment after a primary dislocation in an attempt to prevent subsequent instability. However, the results after this procedure have been much more variable than those for open repair. In this review, we examine the recent advances in the understanding of the epidemiology and pathoanatomy of anterior instability of the shoulder after trauma, and compare the relative merits of arthroscopic and open stabilisation in the management of this condition.