Aims. The open Latarjet procedure is a widely used treatment for recurrent anterior instability of the shoulder. Although satisfactory outcomes are reported, factors which influence a patient’s experience are poorly quantified. The aim of this study was to evaluate the effect of a range of demographic factors and measures of the severity of instability on patient-reported outcome measures in patients who underwent an open Latarjet procedure at a minimum follow-up of two years. Methods. A total of 350 patients with anterior instability of the shoulder who underwent an open Latarjet procedure between 2005 and 2018 were reviewed prospectively, with the collection of demographic and psychosocial data, preoperative CT, and complications during follow-up of two years. The primary outcome measure was the Western Ontario Shoulder Instability Index (WOSI), assessed preoperatively, at two years postoperatively, and at mid-term follow-up at a mean of 50.6 months (SD 24.8) postoperatively. The secondary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. The influence of the demographic details of the patients, measurements of the severity of instability, and the complications of surgery were assessed in a multivariate analysis. Results. The mean age of the patients was 25.5 years (22 to 32) and 27 (7.7%) were female. The median time to surgery after injury was 19 months (interquartile range (IQR) 13 to 39). Seven patients developed clinically significant complications requiring further intervention within two years of surgery. The median percentage WOSI deficiency was 8.0% (IQR 4 to 20) and median QuickDASH was 3.0 (IQR 0 to 9) at mid-term assessment. A minority of patients reported a poorer experience, and 22 (6.3%) had a > 50% deficiency in WOSI score. Multivariate analysis revealed that consumption of ≥ 20 units of alcohol/week, a pre-existing affective disorder or epilepsy, medicolegal litigation, increasing time to surgery, and residing in a more socioeconomically deprived area were independently predictive of a poorer WOSI score. Conclusion. Although most patients treated by an open Latarjet procedure have excellent outcomes at mid-term follow-up, a minority have poorer outcomes, which are mainly predictable from pre-existing demographic factors, rather than measures of the severity of instability. Cite this article: Bone Joint J 2023;105-B(4):389–399

The aim of this study was to determine if the extent of the glenoid and humeral bone loss affects the rate of recurrent instability and the functional outcome following the Latarjet procedure. 161 patients underwent open Latarjet procedure during the period 2006–2015 (Mean age 30.0 years, 150t (93.2%) Male, 118 (73.3%) primary procedure). Functional outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDash) score at a mean of 4.7 years post-operatively. All patients underwent computed tomographic (CT) imaging pre-operatively. Using three-dimensional reconstruction, the glenoid bone loss, Hill-Sachs lesion and ‘Glenoid Track’ status was recorded. Radiographically-confirmed redislocation was rare (1.2%), but 18.5% (n=23/124) reported ongoing subjective shoulder instability. Fifty-two shoulders (32.3%) were classified as “Off-Track”. The median Quick DASH and WOSI scores were 2.27 (IQR 9.09; range 0–70.45) and 272.0 (IQR 546.5; range 0–2003), respectively. There were no significant differences observed between overall Quick DASH scores or WOSI scores for either On-Track or Off-Track groups (p=0.7 and 0.73, respectively). Subjective instability was not influenced by the degree of glenoid bone loss (p=0.82), the overall size of the Hill-Sachs lesion (p=0.80), or the presence of an ‘Off-Track’ lesion (p=0.84). Functional outcome and recurrent instability following the Latarjet procedure do not appear to be influenced by the extent of glenohumeral bone loss prior to surgery

Purpose:. We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups. Method:. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group. Results:. Complications were seen in 27 patients in the Latarjet group. These included: 5 nerve injuries (3 axillary nerves, 1 musculocutaneous nerve, 1 possible suprascapular nerve) 4 of which resolved; 6 screw related complications and 7 early recurrences of the instability. There was a total reoperation rate of 8%. Patients who developed complications had an average post op Oxford score at last follow up of 36.1, while those without complications had an average score of 14.8. In the group of patients who underwent Bankhart procedures there were no recorded short or medium term complications. We specifically did not look at recurrence rates in either group as we felt our follow up times would not reflect this adequately. Conclusion:. Modified Latarjet procedure appears to have a higher short and medium term complication rate compared to the open Bankhart procedure. Once a complication occurs following a Latarjet reconstruction outcomes are significantly worse

A total of 12 epileptic patients (14 shoulders) with recurrent seizures and anterior dislocations of the shoulder underwent a Latarjet procedure and were reviewed at a mean of 8.3 years (1 to 20) post-operatively. Mean forward flexion decreased from 165° (100° to 180°) to 160° (90° to 180°) (p = 0.5) and mean external rotation from 54° (10° to 90°) to 43° (5° to 75°) (p = 0.058). The mean Rowe score was 76 (35 to 100) at the final follow-up. Radiologically, all shoulders showed a glenoid-rim defect and Hill-Sachs lesions pre-operatively. Osteo-arthritic changes of the glenohumeral joint were observed in five shoulders (36%) pre-operatively and in eight shoulders (57%) post-operatively. Re-dislocation during a seizure occurred in six shoulders (43%). Five of these patients underwent revision surgery using a bone buttress from the iliac crest and two of these patients re-dislocated due to a new seizure. . Due to the unacceptably high rate of re-dislocation after surgery in these patients, the most important means of reducing the incidence of further dislocation is the medical management of the seizures. The Latarjet procedure should be reserved for the well-controlled patient with epilepsy who has recurrent anterior dislocation of the shoulder during activities of daily living

The Latarjet procedure utilises the coracoid as a vascularised bone autograft to augment the glenoid in patients with shoulder dislocation, especially where there is a bony lesion affecting the glenoid. A modification of the Latarjet procedure, pioneered in Cape Town, South Africa, rotates the coracoid so that its curved under-surface matches that of the glenoid. The aim of this study was to measure the radii of curvature of the glenoid and the coracoid to see how well the curved under-surface of the coracoid matches the glenoid’s surface curvature. An initial study of 210 cadaveric scapulae was performed in which the radii of curvature of the surface of the glenoid and the curved under-surface of the coracoid were measured. We found that the curves are very similar. The glenoid’s surface had a median curvature of 30mm (inter-quartile range from 25mm to 30mm) and the coracoid had a median curvature of 22.5mm (inter-quartile range from 20mm to 25mm). The curvature of the glenoid in these dry specimens was slightly larger than the corresponding coracoid curvature. In life this difference would be minimised by articular cartilage, labrum and the attachment of capsule (another Cape Town modification). A further parallel CT based study was set up at Derbyshire Royal Infirmary in England. The same radii of curvature where measured and compared using 3D CT reconstruction on a further 20 scapulae from living patients. These measurements also support the cadaveric similarities with a mean glenoid curvature of 23.9mm and coracoid of 25.4mm respectively. Using a paired t-test no statiscally significant difference was found between the corresponding data (p=0.2488). This study confirms the native anatomy of the coracoid is perfectly suited for this modification of the Latar-jet procedure

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively (p< 0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively (p<0.001). The mean SSV increased from 46% to 89% (p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. Five experienced transient neurological symptoms all of which resolved within three months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively(p<0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively(p<0.001). The mean SSV increased from 46% to 89%(p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. 5 experienced transient neurological symptoms all of which resolved within 3 months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

To evaluate the efficacy of using a novel button-suture construct in place of traditional screws to provide bone block fixation for the Latarjet procedure. Four paired cadaveric shoulders (n=8) were denuded, with the exception of the conjoint tendon on the coracoid, and were potted. A 15% anterior glenoid bone defect was simulated. Right and left specimens were randomised into two groups: double-screw versus quadruple-button Latarjet reconstruction techniques. A uniaxial mechanical actuator loaded the Latarjet reconstructed glenoid articular surface via a 47mm diameter metallic hemisphere. Cyclic loading between 50–200N was applied to the glenoid at a rate of 1Hz for 1000 cycles. Testing was repeated three times for conjoint tendon loads of 0N, 10N and 20N. The relative positions of three points on the inferior, central and superior edges of the coracoid bone fragment were optically tracked with respect to a glenoid coordinate system throughout testing. Screw and button constructs were compared on the basis of maximum relative displacement at these points (RINF, RCENT, RSUP). Statistical significance was assessed using a paired-samples t-test in SPSS. When conjoint tendon loading was not present the double screw and quadruple button constructs were not significantly (P>0.779) different (0N: RINF: 0.11 (0.05)mm vs. 0.12 (0.03)mm, RCENT: 0.12 (0.04)mm vs. 0.12 (0.03)mm, RSUP: 0.13 (0.04)mm vs. 0.12 (0.03)mm). Additionally, the double screw construct was not found to differ (P>0.062) from the quadruple button in terms of resultant coracoid displacement for all central and superior points, regardless of conjoint loading (10N: RCENT: 0.11 (0.03)mm vs. 0.19 (0.05)mm, RSUP: 0.11 (0.01)mm vs. 0.18 (0.04)mm; 20N: RCENT: 0.13 (0.01)mm vs. 0.30 (0.13)mm, RSUP: 0.13 (0.03)mm vs. 0.26 (0.14)mm). It was only for the inferior point with conjoint loading of 10N and 20N that the double screw construct began to produce significantly lower displacements than the quadruple button (10N: RINF: 0.11 (0.03)mm vs. 0.23 (0.05)mm, P=0.047; 20N: RINF: 0.12 (0.02)mm vs. 0.39 (0.15)mm, P=0.026). The results of the screw and button constructs when conjoint tendon loading was absent suggest that the button may be a suitable substitute to the screw when the coracoid is used as a bone block. Due to the small resultant displacements (max: screw = 0.19mm, button = 0.52mm), it is suggested that buttons may also act as a substitute to screws for Latarjet procedures, provided conjoint tendon overloading is minimised during the post-operative graft healing period. These in-vitro results support the in-vivo results of Boileau et al (2015) that demonstrated the suture-button technique to be an excellent alternative to screw fixation Latarjet, with graft healing in 91% of their subjects

Between 1996 and 2001 we used a modification of the Latarjet procedure to treat 70 patients with bony insufficiency of the glenoid. Our modification involves detaching a long piece of coracoid and rotating it to match its concave inferior surface with the surface of the glenoid. The coracoid graft is placed extra-articularly and the capsule repaired with bone anchors to the edge of the glenoid. Postoperatively no sling is applied and rehabilitation is started early. At a mean of 24 months (9 to 72) patients were clinically reviewed and assessed on the Walch-Du Play score. The results were excellent in 68%, moderate in 6% and poor in 1%. There were no redislocations. The results were most satisfactory in this group of patients, most of whom participated in contact sports, where soft tissue procedures (e.g., open and arthroscopic Bankarts) carry unacceptable failure rates

Over a six-year period, one surgeon operated on 46 men with instability associated with antero-inferior glenoid loss. Thirty-three of them played rugby at a competitive level. The mean number of preoperative dislocations was five (2 to 22). Modifications included a change in orientation of the coracoid bone block and the addition of capsular closure. A Walch-Duplay score for instability was calculated at follow-up. The mean follow-up was 38 months with a minimum of 6 months. Only one patient had recurrent instability. Thirty-one returned to sport at the same level. Walch-Duplay scores were excellent in 70%, good in 25%, mild in 3.75% and poor in 1.25%. Complications included two fibrous unions (excellent outcome), three broken screws (excellent outcome) and two fixation failures owing to patient non-compliance. There was no decrease in the range of internal rotation. Eight patients had mild restriction in forward flexion (mean 5°) and 20 patients had mildly reduced external rotation at 90° abduction (mean 5°). All but one patient with recurrent dislocation rated the outcome excellent and would have the operation again. The Latarjet procedure confers outstanding stability and gives excellent subjective and objective outcomes

Aim: The aim of the present study was to evaluate the functional results of the Latarjet procedure. Moreover we analysed the prevalence of glenohumeral OA after this intervention. Patients and Methods: Forty patients were included in the study. All the patients were clinically evaluated according to the system of Rowe, Duplay and Constant. X-ray evaluation was useful to detect bony lesions, to evaluate the position and the evolution of the graft, and according to the system of Samilson the grade of glenohumeral OA. Results: At follow-up none of the patients had recurrent dislocation. Only two patients reported occasional subluxation, and 1 case had a positive apprehension test. The average score for strenght according to the system of Constant was 16 points (min/max: 9/22) for the operated shoulder and 19 points (min/max: 12/24) for the uninvolved side. Pre-op radiographs demonstrated a bony lesion in 37 cases (90%): in 35 cases was discovered a lesion of the glenoid rim and in 36 shoulder was detected an Hill-Sachs lesion. In only one case was detected a Samilson grade 1 degeneration. Post-op radiographs showed a correct positioning of the coracoid graft in 32 cases, too lateral in 5 cases and too medial in 3 cases. Glenohumeral OA: 2 cases Samilson grade 2; 1 case Samilson grade 1. Conclusion: Our data confirm that Latarjet technique is an efficient procedure in chronic anterior shoulder instability in sportsmen so to allow to more than 80% of our patients to return to sport activities

Latarjet procedure (transfer of coracoid process to the anterior glenoid rim) has been widely used for severe anterior shoulder instability. The purpose of the present study was to investigate the intraarticular stress distribution after this procedure to clarify the pathomechanism of its postoperative complications. CT-DICOM data of the contralateral healthy shoulder in 10 patients with unilateral anterior shoulder instability (9 males and 1 female, age: 17–49) was used for the present study. Three-dimensional finite element models of the glenohumeral joint was developed using software, Mechanical Finder (RCCM, Japan). In each shoulder, a 25% bony defect was created in the anterior glenoid cavity, where coracoid process was transferred using two half-threaded screws. The arm position was determined as 0-degree and 90-degree abduction. While medial margin of the scapula was completely constrained, a standard compressive load (50 N) toward the centre of the glenoid was applied to the lateral wall of the greater tuberosity. A tensile load (20N) was also applied to the tip of coracoid process along the direction of conjoint tendon. Then, elastic analysis was performed, and the distribution pattern of Drucker-Prager equivalent stress was investigated in each model. The proximal half of the coracoid represented significantly lower equivalent stress than the distal half (p < 0.05). In particular, the lowest mean equivalent stress was seen in its proximal-medial-superficial part. On the other hand, a high stress concentration newly appeared in the antero-inferior aspect of the humeral head exactly on the site of coracoid bone graft. We assumed that the reduction of mean equivalent stress in the proximal half of the coracoid was caused by the stress shielding, which may constitute one of the pathogenetic factors of its osteolysis. A high stress concentration in the humeral head may eventually lead shoulder joint to osteoarthritis

The April 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic Bankart repair in athletes: in it for the long run?; Functional outcomes and the Wrightington classification of elbow fracture-dislocations; Hemiarthroplasty or ORIF intra-articular distal humerus fractures in older patients; Return to sport after total shoulder arthroplasty and hemiarthroplasty; Readmissions after shoulder arthroplasty; Arthroscopic Bankart repair in the longer term; Bankart repair with(out) remplissage or the Latarjet procedure? A systematic review and meta-analysis; Regaining motion among patients with shoulder pathology: are all exercises equal?

The proximity of neural structures to the coracoclavicular ligaments limits the amount of coracoid process that can be harvested. The purpose of this study of 100 dry human scapulae was to define the anatomic limitations.

We found the mean measurement of the horizontal arm of the coracoid process anterior to the conoid tubercle was 21.5 mm (SD 0.9 mm). In 10% of the scapulae, it was larger than 30 mm. In 66%, the posterior aspect of the conoid fused with the vertical ramus and the lateral lip of the suprascapular notch.

This amount of coracoid appears to be large enough to expand the glenoid vault, and to hold two AO small fragment screws. It can be safely harvested if the conoid ligament is respected. Partial sacrifice of the trapezoid ligament is unavoidable, but does not compromise coracoclavicular stability. If the coracoid osteotomy is extended medial to the conoid tubercle it encroaches on the vertical ramus of the coracoid and can damage the suprascapular nerve. Posterior advancement of the osteotomy can extend onto the anterosuperior glenoid.

Aims. To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. Methods. This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included “allograft”, “shoulder”, “humerus”, and “glenoid”. The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results. Results. A meta-analysis of primary outcomes across 17 studies revealed a dislocation rate of 5.1% and an increase in reoperation rates from 9.3% to 13.7% post-publication bias adjustment. There was also a noted rise in conversion to total shoulder arthroplasty and incidence of osteoarthritis/osteonecrosis over longer follow-up periods. Patient-reported outcomes and functional tests generally showed improvement, albeit with notable variability across studies. A concerning observation was the consistent presence of allograft resorption, with rates ranging from 33% to 80%. Comparative studies highlighted similar efficacy between distal tibial allografts and Latarjet procedures in most respects, with some differences in specific tests. Conclusion. OCA transplantation presents a promising treatment option for shoulder instability, effectively addressing both glenoid and humeral head defects with favourable patient-reported outcomes. These findings advocate for the inclusion of OCA transplantation in treatment protocols for shoulder instability, while also emphasizing the need for further high-quality, long-term research to better understand the procedure’s efficacy profile. Cite this article: Bone Jt Open 2024;5(7):570–580

Aims. The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents. Methods. We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed. Results. A total of 51 adolescents were included, of whom 46 (92%) were male, with 17 (33%) in the Latarjet group and 34 (66%) in the Bankart group. The mean age at time of surgery was 18 years (15 to 19). There were no intraoperative complications. At a median follow-up of nine years (IQR 2 to 18), recurrence was observed in 12 patients in the Bankart group (35.3%) and one patient in the Latarjet group (5.9%) (p = 0.023). Satisfactory postoperative outcomes were obtained, with mean Rowe, WOSI, and SANE scores noted at 95 (10 to 100), 325 (25 to 1,975), and 87.5 (10 to 100), respectively. Most patients (29 in the Bankart group (85.3%) and 16 in the Latarjet group (94.1%)) were able to return to sport (p = 0.452). Conclusion. The ABR and AL procedures both obtain satisfactory clinical and functional outcomes in the treatment of anterior glenohumeral instability in adolescents with a low complication rate. However, the ABR is associated with a significantly higher recurrence rate. Cite this article: Bone Jt Open 2024;5(11):1041–1048

Aims. The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR). Methods. This retrospective study included 133 consecutive patients with a mean age of 30 years (14 to 69) who underwent ABR-HSR; 103 (77%) practiced sports before the instability of the shoulder. All had large/deep, engaging Hill-Sachs lesions (Calandra III). Patients were divided into two groups: A (n = 102) with minimal or no (< 10%) glenoid bone loss, and B (n = 31) with subcritical (10% to 20%) glenoid loss. A total of 19 patients (14%) had undergone a previous stabilization, which failed. The primary endpoint was recurrent instability, with a secondary outcome of the ability to return to sport. Results. At a mean follow-up of four years (1.0 to 8.25), ten patients (7.5%) had recurrent instability. Patients in group B had a significantly higher recurrence rate than those in group A (p = 0.001). Using a multivariate logistic regression, the presence of glenoid erosion of > 10% (odds ratio (OR) = 35.13 (95% confidence interval (CI) 8 to 149); p = 0.001) and age < 23 years (OR = 0.89 (0.79 to 0.99); p = 0.038) were associated with a higher risk of recurrent instability. A total of 80 patients (78%) could return to sport, but only 11 athletes (65%) who practiced high-risk (collision or contact-overhead) sports. All seven shoulders which were revised using a Latarjet procedure were stable at a mean final follow-up of 36 months (11 to 57) and returned to sports at the same level. Conclusion. Patients with subcritical glenoid bone loss (> 10%) and younger age (≤ 23 years) are at risk of failure and reoperation after ABR-HSR. Furthermore, following this procedure, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level, despite having a stable shoulder. Cite this article: Bone Joint J 2021;103-B(4):718–724

The Latarjet procedure is a well described method to stabilize anterior shoulder instability. There are concerns of high complication rates, one of these being a painful shoulder without instability due to screw irritation. The arthroscopic changes in the shoulder at time of screw removal compared to those pre-Latarjet have not been described in the literature. We conducted a retrospective review of arthroscopic videos between 2015 and 2022 of 17 patients at the time of their Latarjet screw removal and where available (n=13) compared them to arthroscopic findings at time of index Latarjet. Instability was an exclusion criterion. X-rays prior to screw removal were assessed independently by two observers blinded to patient details for lysis of the graft. Arthroscopic assessment of the anatomy and pathological changes were made by two shoulder surgeons via mutual consensus. An intraclass correlation coefficient (ICC) was analyzed as a measure for the inter-observer reliability for the radiographs. Our cohort had an average age of 21.5±7.7 years and an average period of 16.2±13.1 months between pre- and post-arthroscopy. At screw removal all patients had an inflamed subscapularis muscle with 88% associated musculotendinous tears and 59% had a pathological posterior labrum. Worsening in the condition of subscapularis muscle (93%), humeral (31%) and glenoid (31%) cartilage was found when compared to pre-Latarjet arthroscopes. Three failures of capsular repair were seen, two of these when only one anchor was used. X-ray review demonstrated 79% of patients had graft lysis. Excellent inter-rater reliability was observed with an ICC value of 0.82. Our results show a high rate of pathological change in the subscapularis muscle, glenoid labrum and articular cartilage in the stable but painful Latarjet. 79% of patients had graft lysis with prominent screws on X-ray

The function of the upper extremity is highly dependent on correlated motion of the shoulder. The shoulder can be affected by several diseases. The most common are: rotator cuff tear (RCT), shoulder instability, shoulder osteoarthritis and fractures. Rotator cuff disease is a common disorder. It has a high prevalence rate, causing high direct and indirect costs. The appropriate treatment for RCT is debated. The American Academy Orthopaedic Surgeons guidelines state that surgical repair is an option for patients with chronic, symptomatic full-thickness RCT, but the quality of evidence is unconvincing. Thus, the AAOS recommendations are inconclusive. We are performing a randomized controlled trial to compare surgical and conservative treatment of RCT, in term of functional outcomes, rotator cuff integrity, muscle atrophy and fatty degeneration. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The Thomas and Matsen classification, which is currently the most commonly utilized classification, divides shoulder instability events into the traumatic, unidirectional, Bankart lesion, and surgery (TUBS) and the atraumatic, multidirectional, bilateral, rehabilitation, and capsular shift (AMBRI) categories. The acquired instability overstress surgery (AIOS) category was then added. Surgical procedures for shoulder instability includes arthroscopic capsuloplasty, remplissage, bone block procedure or Latarjet procedure. Reverse total shoulder arthroplasty (RTSA) represents a good solution for the management of patients with osteoarthritis or fracture of the proximal humerus, with associated severe osteoporosis and RC dysfunction

Coracoid fractures during screw insertion and graft osteolysis are serious concerns with standard screw fixation techniques in Latarjet procedure. This study tends to evaluate the outcome of mini open Latarjet using Arthrex mini-plate for coracoids graft fixation. We did retrospective analysis of 30 patients with recurrent anterior shoulder instability after arthroscopic Bankart's repair. A low profile wedge plate (Arthrex) with two low profile screws was used for fixation of the coracoid graft. CT analysis was performed at final follow up to see graft union and results were evaluated using American shoulder and elbow score (ASES) and Western Ontario shoulder instability score (WOSIS). Mean follow up time was 24 months. Postoperatively, mean forward elevation was 162.8 degrees and external rotation was 44.6 degrees. All patients returned to their previous occupation. None reported to be having any recurrent subluxation post-surgery. The mean ASES score was 92.5 while the mean WOSIS score was 76.84%. Only one patient had screw backing out from the plate. There was no case of coracoid graft osteolysis. The mini-open Latarjet procedure with graft fixation with Arthrex mini-plate provides satisfactory outcome and stabilization in patients who present with dramatic bone loss and failed soft tissue reconstruction. It not only ensures early rehabilitation but also minimum loss of external rotation. The only drawback is the relatively high cost of the implant