Arthroscopic Stabilization of Anterior Shoulder Instability With Subcritical Glenoid Bone Loss (SHIELD)

July 15, 2026 updated by: Clinique Générale dAnnecy

Arthroscopic Stabilization of Anterior Shoulder Instability With Subcritical Glenoid Bone Loss: A Comparison Between Dynamic Anterior Stabilization and the Latarjet Procedure

Recurrent anterior shoulder instability is a common condition among young and active patients, with a significant impact on function and a high risk of recurrence in the absence of appropriate management. Quantifying glenoid bone loss has become a central component of the treatment strategy, with losses exceeding 20 % traditionally considered critical and requiring a coracoid transfer according to the Latarjet procedure. Recent data have, however, shown that so-called "subcritical" bone loss, ranging from 13.5 to 20%, may already be associated with unfavorable clinical outcomes, particularly in highly active patients. These patients most often present with associated humeral lesions, such as Hill-Sachs lesions, and sometimes other concomitant lesions such as Humeral Avulsion of the Glenohumeral Ligament, underscoring the need for a comprehensive therapeutic approach.

Two arthroscopic techniques are currently used for this indication. The arthroscopic Latarjet procedure restores glenoid bone stock and improves dynamic stability through the combined effect of the bone block and the sling, while offering reduced morbidity compared to the open approach. Dynamic anterior stabilization (DAS), on the other hand, involves transferring the long biceps tendon to the anterior glenoid rim to replicate the sling effect in a less invasive manner, while preserving the pectoralis minor and the thoracoacromial pedicle and reducing the risk of neurological complications.

Although both techniques have shown low recurrence rates and functional improvement in the short and medium term, no Level I randomized prospective study has directly compared their outcomes in patients with subcritical glenoid bone loss and combined lesions, as the available data are primarily derived from retrospective studies or case series.

Due to the biomechanical differences between the two techniques, the associated rehabilitation protocols also differ. Thus, this study compares not only the surgical procedures themselves, but two comprehensive therapeutic strategies that include both surgery and rehabilitation.

This project aims to determine whether, in these patients, treatment with DAS yields functional outcomes comparable to those of treatment with arthroscopic Latarjet surgery while reducing morbidity and the risk of overtreatment. The evaluation will be based on validated functional and quality-of-life scores. The primary outcome measure will be the WOSI score. The results of this study could help refine surgical indications and optimize care for a population that is predominantly young and active.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

84

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • aged 18 or older
  • with symptomatic recurrent anterior shoulder instability indicating the need for surgical stabilization
  • whose glenoid bone loss must be classified as subcritical, approximately between 13.5% and 20%, according to the criteria defined in the protocol
  • with HAGL lesions
  • with bone lesions
  • capable of providing informed consent and complying with the planned 24-month follow-up

Exclusion Criteria:

  • with glenoid bone loss exceeding 20%
  • with a clear indication for another procedure not covered by the protocol (particularly if routine bone grafting is required and incompatible with the study)
  • with a history of bone stabilization of the affected shoulder
  • with a transfixing rotator cuff tear or a neurological condition impairing shoulder function
  • unable to guarantee adequate follow-up
  • under legal guardianship (curatorship, guardianship, or judicial protection)
  • deprived of liberty by judicial or administrative order
  • receiving psychiatric care
  • not enrolled in a social security program

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Arthroscopic Treatment of Latarjet Syndrome
Procedure: Arthroscopic Latarjet procedure
The arthroscopic Latarjet procedure restores the glenoid bone stock and improves dynamic stability through the combined effect of the bone block and the band, while offering reduced morbidity compared to the open approach
Experimental: Treatment Using Dynamic Anterior Stabilization (DAS) via Arthroscopy
Procedure: Dynamic anterior stabilization (DAS)
Dynamic anterior stabilization (DAS), on the other hand, involves transferring the long biceps tendon to the anterior glenoid rim in order to replicate the sling effect in a less invasive manner, while preserving the pectoralis minor and the thoracoacromial pedicle and reducing the risk of neurological complications.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
WOSI (Western Ontario Shoulder Instability Index) score. The WOSI is a validated score specific to shoulder instability that assesses the impact of the condition on quality of life and daily activities.
Time Frame: Month 24
To compare the impact of recurrent anterior shoulder instability associated with subcritical glenoid bone loss on quality of life and activities of daily living between DAS and arthroscopic Latarjet procedure
Month 24

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Clinique Générale dAnnecy

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 20, 2026

Primary Completion (Estimated)

November 1, 2030

Study Completion (Estimated)

November 1, 2030

Study Registration Dates

First Submitted

July 8, 2026

First Submitted That Met QC Criteria

July 15, 2026

First Posted (Actual)

July 20, 2026

Study Record Updates

Last Update Posted (Actual)

July 20, 2026

Last Update Submitted That Met QC Criteria

July 15, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 2026-19-CGA

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Anterior Shoulder Instability

Clinical Trials on Arthroscopic Latarjet procedure

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Albania

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe