Decision-making in anterior shoulder instability

The choice of operative treatment after shoulder instability depends highly on the risk of recurrent instability. Although Balg et al. has developed the instability severity index score (ISIS) to aid in the surgical decision making, including the factors contributing to a high risk of recurrent dislocation such as younger age (≤ 20 years old), participation in competitive or contact/forced overhead sport, shoulder hyperlaxity and presence of a Hill-Sachs lesion or glenoid bone loss on anteroposterior radiographs, there are still many other factors to be accounted for. The surgical decision making thus proves to be a challenging process with many factors of influence.