Background <p>The surgical treatment of shoulder instability has undergone substantial changes over recent decades. Advances in anatomical understanding, imaging and surgical techniques have led to a&#xa0;shift in therapeutic concepts and indications.</p> Objective <p>Presentation of the historical evolution of shoulder stabilization, focusing on the transition from open standard procedures to modern, defect-oriented treatment strategies.</p> Material and methods <p>Narrative review based on key historical publications and contemporary literature on diagnostics and treatment of shoulder instability surgery.</p> Results <p>The evolution reflects a&#xa0;shift from nonanatomical, mechanically oriented procedures toward anatomical, minimally invasive and ultimately defect-oriented concepts. The description of the Bankart lesion established the anatomical reconstruction as the central principle of anterior shoulder stabilization. Advances in imaging enabled increasingly more precise assessment of labral, capsular and osseous defects. Arthroscopic approaches became the standard for soft tissue instability without relevant bone loss. With the introduction of remplissage, Latarjet procedures, and bone loss concepts, the functional relevance of bipolar osseous defects gained in importance. Decision-making tools such as the glenoid track, instability severity index score (ISIS) and glenoid track instability management score (GTIMS) now support individualized, defect-based treatment planning.</p> Conclusion <p>Shoulder instability surgery has evolved from standardized mechanical procedures to individualized concepts integrating clinical findings, imaging, and defect morphology.</p>