Project 451836

Shoulder dislocations are a common and potentially devastating injury affecting with a global incidence that is estimated to be over 24 per 100,000 people. Dislocations primarily affect young active individuals between the ages of twenty and twenty-nine years. Anterior dislocations, the most common type of shoulder dislocation, are often complicated by recurrence with reported rates as high as 42%. The scapula (shoulder blade) has a shallow socket - the glenoid - where the end of the humerus (upper arm) rests. During the process of a shoulder dislocation the lining around the glenoid is commonly torn. When the shoulder dislocates the lining of the glenoid (labrum) can become permanently damaged and the bone underneath can begin to erode - particularly with recurrent dislocations. Surgeons disagree about whether a soft tissue repair or a bony transfer procedure is the optimal treatment in such cases. Soft tissue repair is more common and involves re attaching the torn lining (labrum) as well as often anchoring part of the rotator cuff into a bony defect to prevent further dislocation. This is called a Bankart repair with Remplissage. This has strong advocates who argue that with modern arthroscopic techniques, the rates of dislocation after surgery are acceptably low and the surgery is minimally invasive with lower risk of complications. Alternatively, a transfer of bone from another part of the shoulder to the front of the shoulder joint can be performed and anchored with screws which also functions to prevent instability - this is termed the Latarjet procedure. Surgeons who prefer the Latarjet procedure cite its reported lower failure rate as support for its use. We are conducting a randomized trial to determine which procedure has better outcomes so we can provide better care to patients with shoulder problems.