الفهرس 
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Abstract
The glenohumeral joint is a multiaxial joint of ball and socket type between the roughly hemispherical humeral head and shallow scapular glenoid fossa, an arrangement allowing much movement but reducing stability.
Shoulder instability is one of the most important medical complications affecting the shoulder joint, which occurs due to disturbance of the anatomical stabilizing mechanisms
Sev¬eral classification systems have been proposed for instability of the glenohumeral joint, generally based on the mechanism of injury (traumatic, non-traumatic) and the direc¬tion (anterior, posterior, inferior, and multidirectional), the frequency (acute and chronic), and degree (dislocation, subluxation).
The assessment of shoulder instability can be done in several steps starting with history, physical examination which include the inspection (attitude, skin and muscle wasting), palpation (range of motion, strength tests, generalized joint laxity assessment and stability assessment), neurological examination, examination under anesthesia, X-Ray, CT, MRI, fluoroscopic imaging) but the direct visualization of the joint anatomy achieved during arthroscopy allows the final comprehension of the problem and the best strategy for its treatment.
The treatment of primary acute shoulder dislocation consists of closed reduction, immobilization in a special sling or bandage for three to six weeks, followed by a rehabilitation program, consisting of exercises to strengthen the rotator cuff and scapular stabilizers.
Operative treatment can be open or minimally invasive - through arthroscopic portals. The indications for the surgical treatment of glenohumeral instability are pain, recurrent dislocation and limitation of sporting activity.
More than a hundred operative procedures have been described for traumatic anterior instability of the shoulder. The Bankart procedure remains the procedure of choice frequently in association with the previously described techniques, as it restores normal glenohumeral anatomy and function
Traumatic anterior dislocations and subluxations of the glenohumeral joint are frequently associated with humeral head bone defects. If not properly addressed, Hill-Sachs lesions can alter normal glenohumeral biomechanics and contribute to recurrent shoulder instability.
In patients with small, nonengaging lesions, soft tissue repair alone may be indicated. For moderate-sized lesions, ‘‘remplissage’’ can be used.
Bankart repair alone was ineffective in preventing engagement and recurrent dislocation in specimens with a 30% Hill-Sachs defect. The addition of remplissage to the Bankart repair in these specimens prevented engagement and enhanced stability, which is a less demanding procedure than allograft and coracoid transfer with the added benefit of lower morbidity, and it can be performed arthroscopically at the same time as a Bankart procedure.
The slight restriction in external rotation (approximately 10O) does not significantly affect return to sports, including those involving overhead activities. The procedure, which may also be useful for revision of previous failed glenohumeral instability surgery, is not indicated for patients with glenoid bone deficiency.