Chronic anterior shoulder instability with bone loss: a practical approach.

The stability of the glenohumeral joint, known for its remarkable mobility, relies on several factors, including the congruency of the joint's bones and the integrity of capsulolabral structures, encompassing the labrum, the capsule, and the glenohumeral ligaments. In cases of anterior shoulder instability, bone lesions are a common occurrence, most frequently involving glenoid bone loss and Hill-Sachs lesions. When both glenoid and humeral bone lesions coexist, the isolated Bankart procedure has exhibited a significant rate of failure. In such instances, the Latarjet procedure, especially when bone loss is present, retains its position as the gold standard, thanks to its consistent success in both short- and long-term outcomes. Recent advancements in research have explored alternative strategies to address bone loss, including the Remplissage procedure for humeral bone deficits and the use of bone block grafts to manage glenoid bone lesions, with a focus on achieving more anatomical techniques. However, it's crucial to recognize that, beyond bone loss, a multitude of intrinsic and extrinsic factors come into play when determining the most suitable treatment. The patient's profile, including factors like constitutional laxity and activity level, must be carefully considered in the decision-making process. The Latarjet procedure maintains its esteemed status as a benchmark in the field, thanks to its consistent excellence in both short- and long-term results. This article seeks to provide insights into the roles and placement of various surgical techniques within the context of chronic anterior shoulder instability, taking into account the intricate interplay of factors that influence treatment decisions.