Latarjet vs Anatomic Glenoid Reconstruction

Anterior shoulder dislocations are painful and highly prevalent. If left untreated, ratesof recurrence can be up to and greater than 90%. The risk of recurrence room is increasedwith younger age (< 40), male sex, hyperlaxity, participation in contact sports, and GBL.From these factors, GBL is the only modifiable factor and surgical intervention isrequired. Managing the bone deficiency for instances of shoulder instability has provento be a surgical challenge.Established boney procedures for shoulder instability include the open and arthroscopicLatarjet and open and arthroscopic free bone block interventions. Latarjet is consideredthe gold standard for treating anterior shoulder instability with bone loss, where thecoracoid process is cut and transferred with the conjoin tendon through thesubscapularis. The coracoid process is then fixed to the anterior glenoid increasingglenohumeral surface area and stability by the addition of the sling effect. Latarjet hasproven to result in low recurrent instability but raises concerns due to underappreciatedcomplication rates (15‐30%). The arthroscopic glenoid reconstruction (AGR) with distaltibia allograft is an arthroscopic bone block procedure that has recently garneredattention for its low rate of recurrent instability and complications, high levels ofpatient satisfaction and avoidance of splitting the subscapularis tendon. AGR with adistal tibia uses a new far medial portal, (i.e., Halifax portal) to avoid damaging theneurovascular or musculature while allowing for anatomic repair of the glenoid.This randomized control trial will compare the gold standard Latarjet to the AGR. Thisstudy aims to randomize 68 individuals who experience anterior shoulder instability withGBL. Through a series of clinical and radiographic outcome measures, the studyinvestigators hypothesize the AGR group will demonstrate smaller complication rates, butremain a similar post‐operative recurrence rate, and patient reported outcomes. Thistrial will be the first multi‐centre control trial evaluating the Latarjet to the AGR forpatients with critical bone loss (>20%). This research has the potential to demonstrateclinical efficacy of a procedure that is safer, more anatomic, with less damage to thesubscapular muscle, and an easier revision surgery.