Anterior traumatic instability of the shoulder with glenoid bone loss is a complex condition that frequently necessitates surgical intervention to restore stability and function. This chapter provides a comprehensive review of the indications, surgical techniques, complications, and outcomes associated with the arthroscopic management of this challenging condition. The extent of glenoid bone loss plays a pivotal role in determining the appropriate surgical technique. Generally, bone loss exceeding 20% requires a bone augmentation procedure, such as the Latarjet procedure or a free bone block, which can be sourced from autologous or allograft materials. Among autologous options, the Heden Hybinette technique using the iliac crest is the most consistent, while newer autologous options, such as distal clavicle and scapular spine grafts, offer the advantage of being local grafts. However, the efficacy of these smaller grafts remains debated. Fresh frozen allografts, including the distal tibia, iliac crest, or glenoid, have been utilized, but they often suffer from excessive osteolysis, potentially resulting in less favorable outcomes compared to autografts. This chapter aims to enhance the understanding and management of anterior shoulder instability with glenoid bone loss by examining the advantages and disadvantages of various fixation methods.