Advancement in Care Through Applied Translational and Clinical Research in Anterior Shoulder Instability: Military Contribution Over 25 Years

Anterior shoulder instability represents one of the most common causes of shoulder dysfunction, particularly among young active individuals. Its prevalence is markedly elevated in the United States military, where incidence rates are up to 18 times higher than in the general population. Over the past 25 years, military orthopaedic surgeons have leveraged this unique population to advance the understanding, diagnosis, and treatment of shoulder instability through a systematic, translational research framework spanning epidemiology, biomechanics, imaging, and surgical innovation. Early studies identified the dramatically increased risk of recurrence after nonoperative management and established evidence-based guidelines for first-time dislocators, shifting global treatment paradigms toward early surgical intervention for high-risk patients. Subsequent investigations defined the critical and subcritical thresholds of glenoid bone loss, demonstrating that even modest loss (>13.5%) compromises outcomes after soft-tissue stabilization. Through extensive biomechanical and imaging research, this team validated the glenoid track concept, developed the Glenoid Track Instability Management Score (GTIMS), and demonstrated that bipolar bone loss involving both the glenoid and humeral head is additive and functionally significant. Advances in imaging led to the validation of three-dimensional MRI as a radiation-free alternative to CT for quantifying glenoid bone loss. To address the limitations of existing reconstructive options, the group developed the distal tibia allograft (DTA) as a novel osteochondral solution for glenoid bone loss, achieving comparable outcomes to the Latarjet with lower complication and revision rates. These clinical and translational advances were supported by the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION). Collectively, this body of work has transformed the management of anterior shoulder instability, establishing new diagnostic standards, surgical techniques, and treatment algorithms that emphasize the right surgery for the right patient, done right the first time, benefiting both military service members and the broader orthopaedic community.