Every year, around 8,000 young adults in the UK dislocate their shoulder for the first time, and current treatment is a gamble between immediate surgery or rehabilitation alone—with no clear evidence which is better. This matters because a first-time dislocation often damages ligaments and bone, leaving the joint unstable and prone to repeat dislocations throughout life. Surgeons have only recently standardised the keyhole repair technique across the NHS, which for the first time makes a fair comparison possible. Without a definitive trial, patients and clinicians are making this decision in the dark. The SORTED trial will randomly assign 16-to-30-year-olds to either arthroscopic stabilisation plus rehabilitation, or rehabilitation alone. It will measure shoulder function, re-dislocation rates, costs, and quality of life over 15 months. If surgery proves superior, the NHS can immediately shift treatment pathways for those 8,000 patients each year—and tens of thousands globally—using procedures already available. If rehabilitation alone works as well, it will spare many young people unnecessary surgery and recovery time. Either result will end the current uncertainty.
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- Research question: What is the clinical and cost-effectiveness of adding surgery to a patient’s treatment pathway, compared to non-operative rehabilitation alone for adult patients with a first-time shoulder dislocation. - Background The shoulder is the most frequently dislocated joint and 1.7% of the population will dislocate their shoulder in their lifetime. The highest incidence of dislocations occurs in those aged 16-20 years, equating to approximately 8000 young-adults per year in the UK. First-Time Shoulder Dislocations (FTSDs) usually occur due to sporting activities or accidents. When a FTSD occurs, there is associated damage to the nearby ligaments and bones. This damage predisposes someone to ongoing instability and further dislocations throughout their life. There are two treatment options to reduce the risk of future dislocations; (a) immediate surgical intervention (usually an ‘arthroscopic stabilisation’) followed by rehabilitation or (b) rehabilitation alone. Until recently, there was considerable variation in the surgical technique used to stabilise the shoulder after a FTSD and therefore research in this area has been heterogeneous and lacked impact on patient care. However, our national survey of current practice shows that surgery is now standardised across the UK, with all units using arthroscopic (‘key-hole’) techniques. This creates the opportunity for a pragmatic study which incorporates comparable treatments across sites. - Aims and objectives Primary objective: To compare shoulder function 15 months after randomisation following FTSD, as measured on the Oxford Shoulder Instability Score, between two trial treatment groups; Intervention: Arthroscopic shoulder stabilisation + Shoulder stability rehabilitation Control: Shoulder stability rehabilitation Secondary objectives: This trial will compare the following between the two trial treatment groups, within 15 months of randomisation; rate of re-dislocation, resource use, costs and comparative cost effectiveness, arm function, patient satisfaction, fear of movement and rates of return to sport, health-related quality of life, rate of complications. - Methods SORTED is a multicentre, parallel group, randomised controlled superiority trial with shoulder function within 15 months of randomisation being the primary endpoint. Inclusion Criteria: Patients aged between 16 and 30 years old with medical imaging confirming dislocation. Patient-reported outcomes, resource use and health-related quality of life and complications data will be collected after 3, 6, 9, 12 and 15 months. The primary outcome will be the patient-reported Oxford shoulder instability score (OSIS). Results will be reported in accordance with the CONSORT statement using extensions for non-pharmacological treatment interventions and patient-reported outcomes. - Timelines for delivery The proposed project will start in July 2025. We will conduct a 6-month internal pilot phase and a stop/go assessment of trial viability will be conducted. Submission of main results is planned in autumn 2029. - Anticipated impact and dissemination Immediately following the delivery of this programme of work the SORTED intervention will change treatment pathways for approximately 8000 patients per year in the UK and tens-of-thousands around the world. As the treatments under investigation are currently available in the NHS the impact of the trial will be immediate, following dissemination of results.
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