Introduction The value of collecting continuous prospective patient data, including operation records and outcome scores, is well known. In 1994, a systematic prospective patient data collection was initiated on all patients attending the Reading Shoulder Unit (RSU). Initially this was done with hand written records. In 1995 a Windows Access ® database was formulated on a portable laptop. This was used continuously through until September 2005 when an Internet web-based database was introduced. We present this collective data and trends in practice from a busy shoulder unit over this decade. Results Between 1995 and 2005, 10005 entries were made to the Reading Shoulder Unit database. 3233 patient visits to outpatient clinics were recorded. 6772 operations were recorded – this includes: arthroscopic decompressions (ASD) + AC joint excisions − 3514, MUA for frozen shoulder 842, shoulder arthroplasty 432, open stabilisation 356, arthroscopic stabilisation 192, arthroscopic rotator cuff repair (RCR) 402, open cuff repair 290, arthroscopic capsular release 78 and 248 trauma cases. Changes in the unit practice include the move from open to arthroscopic reconstructive surgery (RC and stabilisation), RCR rather than ASD alone in elderly patients with impingement and cuff weakness, and repairing partial rotator cuff tears when previously we did not. Conclusions With over 10000 continuous and prospective entries – the RSU database is invaluable for continuous audit of practice and assessment of outcomes of the different procedures. Several practices have changed through the decade; most notably from predominately open reconstructive surgery through to arthroscopic reconstructive surgery. We would recommend to every surgeon and unit to collect his own data prospectively to enable him to analyse and assess his results.
To report the results of the vertical apical suture Bankart lesion repair. Fifty-nine patients (52 men and 7 women) with a mean age of twenty-seven years (range, 16 to 53 years) were studied. The mean duration of instability was 4. 1 years and mean follow-up was 42 months (range 24 to 58 months). A laterally based T-shape capsular incision was performed with the horizontal component directed towards the glenoid neck and into the Bankart lesion. A vertical apical suture through the superior and inferior flaps of the Bankart lesion, tightens the anterior structures to allow them to snug onto the convex decorticated surface of the anterior glenoid. The inferior flap of the capsule was then shifted superiorly and the superior flap shifted inferiorly to augment the anterior capsule, with the shoulder in 20 degrees of abduction and 30 degrees of external rotation. At final review, according to the system of Rowe et al., 94. 9% (56 patients) had a rating of good or excellent. Three patients had a recurrent dislocation due to further trauma. The mean loss of forward elevation was 1 degree, external rotation with the arm at the side was 2. 4 degrees and external rotation in 90 degrees abduction was 2. 2 degrees. Of forty-four patients participating in sport, thirty-five (79. 5%) returned to the same sport at the same level of activity, seven returned to the same sport at a reduced level of activity and two patients did not return to sport. The vertical apical suture repair offers a 94. 9% stability rate, a maintained range of motion and a 79. 5% return to pre-injury level of sporting activity. It is technically less demanding than the Bankart procedure. All sutures used are absorbable. Complications related to non-absorbable implants and absorbable anchors and tacks are avoided.
