Soft tissue reconstruction or a bony procedure remains probably one of the most arguable questions in the surgery of anterior shoulder instability. The answer is still not easy and precise, but a step-by-step decision-making process is presented in this chapter. The authors believe that bone loss concerning the anterior glenoid rim and the humeral head is a crucial factor that should be evaluated first. Proper patient assessment will then allow deciding whether it is a patient “at risk” or not. The adequate shoulder stabilization procedure should then be chosen and proposed “à la carte.” The authors also believe that the patient should be aware of the potential risk of complications and recurrence, as none of these procedures has a 100% success rate.