196 patients with recurrent traumatic anterior shoulder instability were randomized to undergo open or arthroscopic repair to compare differences in disease-specific quality of life and recurrent instability over a period of two years. The results from this trial indicate that both procedures provided a significant improvement in disease-specific quality of life, with not differences between groups. However, open repair resulted in fewer cases of recurrent instability, especially in patients identified with a Hill-Sachs lesion, an observation that warrants further research.