Beach Chair versus Lateral Decubitus Positioning for Arthroscopic Anterior Shoulder Stabilization: A Systematic Review of Clinical Outcomes and Surgical Parameters

IMPORTANCE: Arthroscopic shoulder stabilization is widely used for treating anterior shoulder instability, yet the optimal patient positioning (beach chair (BC) vs lateral decubitus (LD)) remains controversial, with unclear implications for operative efficiency and clinical outcomes. AIM OR OBJECTIVE: To systematically compare BC and LD positioning in patients undergoing arthroscopic anterior stabilization for shoulder instability, focusing on operative parameters, surgical technique variables, and clinical outcomes. EVIDENCE REVIEW: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. PubMed, MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2026 for studies comparing BC and LD positioning in arthroscopic anterior shoulder stabilization. Studies involving rotator cuff tears or other shoulder pathologies were excluded. Study quality was assessed using the modified Newcastle-Ottawa Scale (mNOS). Data extracted included demographics, operative time, number of anchors, revision surgery, and recurrent instability. Both qualitative synthesis and comparative quantitative analysis were performed. FINDINGS: Three studies met inclusion criteria, comprising 1,649 patients (BC: 1,025; LD: 624). Two were cohort studies and one was cross-sectional, all conducted in the United States (US) between 2021 and 2023. Baseline characteristics were comparable between groups. No statistically significant differences were observed in operative time or number of anchors used. Revision surgery and recurrent instability were numerically higher in the BC group, but differences were not statistically significant. Exploratory effect size estimates numerically favored the lateral decubitus position; however, these differences were not statistically significant and were associated with wide confidence intervals. CONCLUSION: and Relevance: Current evidence does not demonstrate statistically significant differences between BC and LD positioning regarding operative parameters or early clinical outcomes following arthroscopic anterior shoulder stabilization. Given the limited number and methodological heterogeneity of available comparative studies, no conclusion regarding the superiority of either position can be drawn. Patient positioning should therefore be individualized according to surgeon experience, technical considerations, and patient-specific factors. LEVEL OF EVIDENCE (LOE): III.