Subjects with shoulder instability often present with bony defects in addition to soft-tissue injuries. Humeral head injuries are found in most, if not all, subjects with recurrent anterior shoulder instability and in up to 25% of subjects with posterior instability. The importance of these injuries cannot be understated. The Hill-Sachs defect (HSD) is the most prevalent injury associated with anterior shoulder dislocation. When the defect engages with the anterior edge of the glenoid during abduction and external rotation (the so-called engaging Hill-Sachs lesion or “off-track” Hill-Sachs defects) most patients requiring surgical treatment will benefit from addressing the humeral defect. The most popular procedure is the remplissage technique, an arthroscopic capsulotenodesis of the infraspinatus into the HSD that can be easily associated with an anterior capsulolabral Bankart repair. It is a straightforward, relatively easy procedure that is associated with a very low complication rate. It has been shown to dramatically decrease the recurrence rate when used in combination with a Bankart procedure in subjects with engaging HSD and no relevant glenoid bone defects (glenoid defects smaller than 8%–10%). For subjects with critical glenoid bone defects (>20%–25%), the Latarjet procedure is still the best option, but it is not clear if for subcritical glenoid bone defects (defects that are between 8%–10% and 20%–25%), the association of Bankart-remplissage is good enough. Some subjects with massive HSD might benefit from bone grafting of the defect. Patients with posterior instability and large (>25%) anterior humeral bone defects, the so-called reverse Hill-Sachs defect, can benefit from the McLaughlin procedure, which can be performed either in an open fashion, detaching the subscapularis and reinserting it to the bone defect, or arthroscopically, suturing the subscapularis to the defect. For massive injuries (>50%), a bone graft procedure or an arthroplasty might be needed. The results of these procedures seem to be successful.