Evaluating the effects of shoulder stabilisation procedures on shoulder joint function

Participants in the experimental groups will undergo shoulder stabilisation either via an arthroscopic Bankart repair (Arm 1) or an open Latarjet (Arm 2) procedure. The procedures differ in the method with which the surgery is performed (i.e. arthroscopic vs. open) and the manner with which the joint is reconstructed (i.e. anatomical vs. non-anatomic). One of three fellowship trained orthopaedic surgeons will conduct each surgical procedure. The decision as to what stabilisation procedure participants in the experimental group undergoes will be determined by consultation between the individual and the acting surgeon. Fidelity of the procedures will be monitored through surgical notes, reviewing medical images post-surgery, and clinical observation. Arm 1 - Arthroscopic Bankart Repair Individuals will be evaluated under anaesthetic to determine the stability pattern of the glenohumeral joint, with clinical findings considered alongside pre-operative medical images. The joint space will be accessed with arthroscopic portals. The glenohumeral labral tear will be prepared with liberator probes and shaver, and capsulolabral reduction and fixation anteriorly and/or posteriorly will occur with anchors according to the injury pattern. Procedure duration will be approximately 60 minutes. Arm 2 - Open Latarjet An oblique three to five centimetre incision will be made under anaesthesia from the tip of the coracoid process and extending inferiorly down the deltopectoral groove to the superior portion of the axillary fold. A 22 to 27 millimetre bone graft will be harvested from the tip of the coracoid process, with harvesting and preparation of the graft performed according to standardised procedures and ensuring that the graft is shaped to be flush with the anterior face of the glenoid. The anterior portion of the shoulder will be exposed by dividing the subscapularis in line with the muscle fibres, maintaining a 50-50 split of the upper and lower portions of the muscle. A T-shaped incision will be made in the labrum at the apex of the bony deformity in preparation to set the coracoid bone graft in place. The coracoid bone graft will be positioned so that it serves as an extension of the inherent articular arc of the glenoid. Once the ideal position is identified, fixation of the bone graft to the anterior glenoid will be achieved via two surgical screws. Anchors will be placed in the native glenoid and the joint capsule repaired. The subscapularis will be repaired over the coracoid bone graft, with the conjoint tendon exiting anteriorly through the previously split segments of the subscapularis. Procedure duration will be approximately 90 minutes. Postoperative Patient Care Irrespective of the surgical procedure they undergo will follow the clinics standardised protocols and care pathways. Participants will use an immobiliser sling for at least four weeks post-surgery and then commence a rehabilitation program to improve active shoulder stability. Progressive increases to range of movement exercises, strengthening and functional restoration will be incorporated into each participant’s individualised program. Rehabilitation will be monitored by the clinic for at least three months postoperatively. In addition, the number of training sessions the individual completes during the six-month period following surgery will be monitored via an online survey. Specifically, participants will be prompted to complete an online survey detailing the number and type (i.e. range of motion, strength or functional movement) of training sessions they have completed over the past two weeks. This survey will take approximately 3-5 minutes to complete each fortnight. Return to sport will be recommended after six-months, pending the participant’s recovery. Participants in the control group will be instructed to continue their regular training over the study period.