Purpose: Traumatic anterior instability of the shoulder is a common condition associated with a high recurrence rate in young patients. The role of nonoperative versus operative treatment and the optimal surgical approach for this condition is debated. The purpose of this study was to review the literature for the latest evidence comparing outcomes of treatment for traumatic anterior instability of the shoulder. Methods: A systematic review of the literature was performed to identify studies com- paring operative versus nonoperative treatment for traumatic anterior shoulder instability and studies comparing open versus arthroscopic stabilization for traumatic anterior shoulder instability. Results: Surgical treatment was associated with a significantly lower rate of recurrent instability at 2 years of follow-up (7% v 46%) and at longer-term follow-up (10% v 58%) for first-time traumatic anterior shoulder dislocation, all in younger patients. The rates of recurrent instability were roughly equal after arthroscopic stabilization with suture anchors and open stabilization with anchors (open, 8.2%; arthroscopic, 6.4%). Conclusions: Rates of recurrent instability after a first-time anterior shoulder dislocation, particularly in young active male patients, are reduced by surgical intervention compared with nonoperative treatment. If surgical treatment is indicated, an arthroscopic approach using suture anchors appears to have similar results in terms of recurrent instability to an open approach using suture anchors.