Approach to Shoulder Instability
Anterior Shoulder Instability
About this trial
This is an interventional treatment trial for Anterior Shoulder Instability focused on measuring Latarjet, Bankart
Eligibility Criteria
Inclusion Criteria:
- Recurrent anterior instability (dislocation or subluxation) with or without hyperlaxity, including a clinical history of traumatic anterior instability of the shoulder, with positive apprehension or relocation tests.
- Provide consent
Exclusion Criteria:
- Patients with a concomitant rotator cuff lesion or humeral avulsion of the anteroinferior glenohumeral ligament (HAGL)
- An acute first-time dislocation
- Previous shoulder surgery
- Surgery for a painful, unstable shoulder without true dislocation or subluxation
- Patients with active worker's compensation claims (due to the expectation of lower rates of success in this patient population)
- Active joint or systemic infection
- Patients with convulsive disorders, collagen diseases, previous shoulder surgeries, and any other conditions that might affect the mobility of the joint
- Major medical illness (life expectancy less than 2 years or unacceptably high operative risk)
- Unable to speak or read English/French
- Inability to provide informed consent and comply with requirements of participation
- Unwilling to be followed for 2 years
Sites / Locations
- Pan Am Clinic Foundation
- The Ottawa Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Arthroscopic Bankart repair
Open Latarjet procedure
After the diagnostic arthroscopy is completed, any other pathology is documented. At least 3 anchors will be used for the bankart repair for repair of the labrum with an inferior to superior capsular shift. The suture anchors used will be at the discretion of the surgeon but will be of the screw-in variety. The sutures are passed through the labrum, and the labrum is tied to the glenoid rim after the bone is prepared in the standard fashion. The surgical times will be recorded on standardized forms.
A deltopectoral approach is used. The coracoacromial ligament (CAL) is exposed and incised 1 cm from its coracoid attachment. Harvesting of a 2.5- to 3-cm coracoid graft allows use of 2 screws for fixation to the glenoid neck through a subscapularis-splitting approach. The stump of the CAL is repaired to the capsule with the arm positioned in neutral. The graft is placed in a extra-articular fashion with capsular closure to the native glenoid rim.