Military personnel are the most at-risk population for shoulder instability and more than 80% of these individuals have recurrent instability with non-operative treatment. Traumatic and recurrent shoulder instability produces progressive bone loss to the stabilizing structures of the glenoid and humerus, which contributes to failure following surgery, impairments of physical performance, and prolongs limited duty/disability. To date, there are no prospective comparative studies to determine optimal surgical treatment for shoulder instability with subcritical glenoid bone loss (10-20%). Further, there are no studies to assess functional recovery and return to military duty, work, and sports after the most common stabilization procedures. Therefore, this clinical trial will investigate the effects of three surgical procedures and the associated post-operative rehabilitation to mitigate the risk of re-injury, minimize time away from duty, and optimize military readiness.

This study will recruit military personnel and civilians between 17 and 45 with a traumatic anterior shoulder dislocation with associated 10-20% bone loss and randomize to one of three surgeries and their associated rehabilitation, with progressive-individualized strengthening and functional training in a 1:1:1 allocation. Participants will be followed for 24 months, with primary outcomes consisting of patient-reported physical function and time to return to pre-injury military duty, work, and sports. Secondary outcomes will include shoulder-specific and generic patient-reported measures of physical function, health/quality of life, and recurrent instability.