The Arthroscopic Treatment of Recurrent Anterior Shoulder Instability (ATRASI): A Pilot Multicentre Randomized Controlled Trial

The human shoulder has a large range of motion and as such is vulnerable to dislocations. Dislocations are commonly underestimated and are burdensome for individuals, causing pain, bone loss, stiffness, and increased risk of recurrence. Patients are commonly treated arthroscopically (surgery that uses small cameras and tiny incisions to repair the joint) but there is controversy about the best surgical option. The two most common options are Bankart repairs (soft tissue repair in the shoulder) and bone block procedures (bone grafting in the shoulder). When choosing between surgical options, bone loss of greater than 25% has previously been an indication for a bone graft procedure, yet some surgeons choose their treatment regardless of bone loss status and still report good postoperative outcomes. With conflicting arguments for the use of both procedures, it is obvious that a high-quality study is required to determine the best surgical approach. Through collaborative efforts with surgeons and other health professionals, our group has developed a new technique. An arthroscopic anatomic glenoid reconstruction (AAGR) reduces risks that are inherent to the other bone grafting procedures while allowing for bone grafting to take place. Thus far, this technique has resulted in no major complications. Our data shows that AAGR results in good restoration of native shoulder anatomy with low recurrence of shoulder dislocations. While preliminary work has been done to investigate this treatment, a randomized controlled trial has not yet been performed to compare it to the current standard of care -- the Bankart repair. The proposed surgical RCT aligns well with the research area of Musculoskeletal Health as it is an orthopaedic study looking to assess the best treatment option for patients with recurrent shoulder dislocations. We are hoping to perform a pilot RCT to help design a future larger, definitive RCT.