<p>Anterior shoulder instability is the most prevalent form of instability of the glenohumeral joint and primarily affects young active patients. The decision between conservative and surgical treatment is complex and requires consideration of individual risk factors. The aim of this review article is to present the current evidence on indications, clinical outcomes of conservative and surgical treatment and recurrence rates. Furthermore, the article proposes clinical decision criteria, taking patient-specific risk factors, activity level and structural glenoid and humeral pathologies into account. Conservative treatment after the first anterior shoulder dislocation involves short-term immobilization followed by functional rehabilitation to improve muscular stabilization and shoulder mobility. This approach can result in a&#xa0;significant improvement in function and pain relief in older less active patients without substantial bony defects; however, young, physically active patients, particularly those involved in contact and overhead sports, have a&#xa0;significantly increased risk of recurrence. This risk can be reduced by early surgical stabilization, primarily using arthroscopic techniques, while considering the patient’s age, activity level, number of previous dislocations and associated bony and soft tissue pathologies. Overall, managing anterior shoulder instability requires an individualized, risk-adapted approach.</p>