Purpose of the study: The purpose of this paper was to report our experience with arthroscopic treatment of tendon-related epicondylalgia resistant to well-conducted medical treatment and the long-term outcomes. From September 2000 to January 2008, 25 consecutive patients underwent arthroscopic treatment performed by the same surgeon. Twenty-two patients were available for follow-up. We reviewed 26 interventions.

Material and methods: An endoarticular technique was used, with section of the lateral capsule then the extensor carpi radialis brevis and the extensor digitorum communis. Mean patient age was 45 years (36–55); five patients had work accidents (one bilateral case). Patients were assessed clinically using the Mayo Clinic Elbow Performance Score (MEPS) and for pain at rest, during daily life activities and during exercise (scale 0–10).

Results: Mean follow-up was 51 months (17.6–88.7). Pain was scored 0.38 at rest, 0.81 for daily life activities, and 4.11 for exercise. Mean function score was 90/100. Two patients underwent revision. Sixteen patients (62%) stated they were « much better », six « better » (23%) and four unchanged (15%). Twenty-one patients (81%) were satisfied, 23 would request the same procedure (88%). There was no statistically significant difference in the subgroup of work accidents versus the other patients with p=1.35 for pain at rest; p=0.51 for pain during daily life activities, p=0.37 for pain during exercise. Two minor complications (skin burn, subcutaneous infection) were observed.

Discussion: The results show improvement postoperatively. Patient satisfaction was correlated with the clinical results and the function score. Treatment of resistant epicondylalgia remains a very controversial issue; several surgical techniques have been described with good or even excellent results. Arthroscopic treatment, inspired by the work of Kuklo, was adopted by Baker, Owens and Jerosch. Our results are equivalent to those of other arthroscopy series. Longer time before resumption of occupational activities can be explain in our opinion by the greater number of patients with an occupational accident in our series.

Conclusion: Arthroscopic resection yields satisfactory results which are sustained over time, for the treatment of resistant epicondylalgia. It is an alternative to open surgery.

Purpose of the study: Treatment of irrepable massive rotator cuff tears remains a controversial issue. The purpose of this study was to assess clinical and radiological outcome in patients with a reversed shoulder prosthesis used for the treatment of irreparable massive rotator cuff tears with or without associated glenohumeral osteoarthritic degeneration.

Material and methods: Between 1996 and 2002, 55 reversed shoulder prostheses were implanted via a superolateral approach. Mean follow-up of the 15 men and 40 women (mean age 73 years, age range 57–86 years) was 34.8 months (range 24–84 months). The supraspinatus and infraspinatus tendons were retracted to the glenoid and ruptured in 100% of the patients: 27 shoulders (49%) also presented a infrascapularis tear. Glenohumeral osteoarthritis (Fukuda IV and V) was persent in 29 patients. Postoperatively, patients were assessed with the Constant score and radiographically on plain x-rays.

Results: Three patients were excluded from the analysis because of implant infection and removal before review. Subjectively, 90% of patients were satisfied or very satisfied. All items of the Constant score improved significantly (p< 0.0001). Active elevation improved from 65° to 123°. External rotation was not improved. Radiographically, there wre 41 shoulders with a grade 0, 1 or 2 notch (Nerot system), and 11 with a grade 3 or 4 notch. Thirteen patients (25%) presented heterotopic ossifications.

Discussion and conclusion: In this context, the clinical results obtained with this prosthesis are much better than with any other type of arthroplasty. Radiographically, heterotopic ossifications have a significant impact on the Constant score (p=0.015). Presence of ta glenoid notch is signifiantly associated with use of a medialized or retaining polyethylene cup (p< 0.0001). For us, loosening of the metaglenoidglenosphere bloc is related to the progression of the glenoid notch. For these reasons, it would be preferable to reserve this type of arthroplasty for patients aged over 70 years presenting an irreparable massive cuff tear with satisfactory glenoid bone stock sufficient for obtaining a good anchor for the metaglen. We recommend only using lateralized polyethylene cups.

Purpose of the study: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block.

Material and methods: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit.

Results: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15°. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level.

Discussion: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.