ensuring the results obtained are valid and reliable. To counter this researchers decided to recruit subjects at the emergency room of participating hospitals who met inclusion criteria. Radiographic evidence on anterior dislocation was performed identically for each recruited subjects, using standard anteroposterior and lateral radiographs as well as the West Point view. Furthermore, the researchers used one surgeon exclusively from each participating hospital to preform the arthroscopic evaluation and surgical repair and required these same surgeons to gather together and standardize surgical technique, evaluation of the injury and implementing the Constant shoulder score at the 24mo follow- up. Researchers had potential subjects agree to random allocation where all underwent arthroscopic evaluation to diagnose lesion and severity. It is important to note that the subjects were randomized during the arthroscopic procedure but after the surgeon’s diagnosis, blinding him/her regarding CT or PR group allocation of the subject. Following randomization, surgeons were able to complete the procedure accordingly and thus, the researchers achieved excellent between group homogeneity regarding time elapsed from initial injury to surgical evaluation/procedure (1-week) and subsequent duration of the studies standardized protocol including periods of immobilization (2 days fixed sling + 1- week non-fixed sling) as well as initiation of standardized rehabilitation protocol and progressions for 6 months until the follow-up periods at 24 months and ten years. The researchers present a large amount of evidence that strongly support primary repair over conservative treatment upon incurring capsular or labral lesions following first time traumatic anterior shoulder dislocation. The study also achieve excellent patient adherence with no patient attrition at the 24 month follow-up period and able to gather subjective outcomes information from all but one of the initial total patient population (98%). This along with good practice of standardization mentioned previously ensures that the results that were obtained were most likely valid across the entire course of the study. However, this evidence is almost exclusively expressed by percentages and statistical significance. The researchers only state the number of recurrent dislocations in each group and neglect to provide any written record of subjective or objective information regarding subject/group mean scores, standard deviations, confidence intervals, effect sizes on follow-up outcome measures. The authors also show that groups CT and PR were homogeneous regarding size, mean age and male to female ratios but neglect to show the relative distribution of number of patients recruited from each participating hospital (first come-first serve selection), patient age or type/severity of lesion across both groups. This lack of information proves to be very significant, leaving the reader unable to identify trends between positive/negative outcomes and the respective hospitals in which subjects are recruited as well as possible sources for these trends (ie:socio-economic status, adequate/inadequate recourses outside study, poor practice by therapist/surgeon etc.). More importantly, the studies results showed over 95% of recurrent dislocations incurring in those under 25 yo and with type II/III lesions and thus, the distribution of which could predispose a group for re-dislocation or poor overall outcome.(see interpretation section) The researchers also state that the majority of injuries occurred during sports participation (49%) with 10.5% due to MVA but neglect to divulge the mechanism of injury for the remaining 40% of patients (N=31) which also decrease the overall information to take into account with interpreting the results. The authors do not mention an attempt to blind as well as neglect to identify examiners and/or those scoring/conducting the Constant score nor OSS at the 24mo and 10-year follow- up, respectively. Due to the Constant score being discussed prior to the start of the study between respective surgeons the reader is left to assume they at least carried out the objective and subjective portions of the Constant score outcome measure at 24 months. The surgeons being unmasked for the Constant Score and potentially also the OSS present them with the opportunity to show results which favour their technique presenting a large potential source of bias and personal questioning of the research validity. I also believe the authors should have used a clinician administered outcome measure other than the Contestant score as well as objective measures (load and shift; apprehension at 24 months. The Constant score has been validated and shown as reliable regarding test-retest reliability however evidence shows that the outcome is most valid regarding shoulder dysfunction other than post-stabilization procedures. Furthermore, there is deficit or a total lack of current evidence of neither test quality nor psychometric properties regarding the load and shift or Apprehension tests. Also these stability tests are more abrupt and forceful which lend the patient to be more apprehensive and