Aims. The aims of this study were to validate the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds for Western Ontario Shoulder Instability Index (WOSI), Rowe score, American Shoulder and Elbow Surgeons (ASES), and visual analogue scale (VAS) scores following arthroscopic Bankart repair, and to identify preoperative threshold values of these scores that could predict the achievement of MCID and PASS. Methods. A retrospective review was conducted on 131 consecutive patients with anterior shoulder instability who underwent arthroscopic Bankart repair between January 2020 and January 2023. Inclusion criteria required at least one episode of shoulder instability and a minimum follow-up period of 12 months. Preoperative and one-year postoperative scores were assessed. MCID and PASS were estimated using distribution-based and anchor-based methods, respectively. Receiver operating characteristic curve analysis determined preoperative patient-reported outcome measure thresholds predictive of achieving MCID and PASS. Results. MCID thresholds were determined as 169.6, 6.8, 7.2, and 1.1 for WOSI, Rowe, ASES, and VAS, respectively. PASS thresholds were calculated as ≤ 480, ≥ 80, ≥ 87, and ≤ 1 for WOSI, Rowe, ASES, and VAS, respectively. Preoperative thresholds of ≥ 760 (WOSI) and ≤ 50 (Rowe) predicted achieving MCID for WOSI score (p < 0.001). Preoperative thresholds of ≤ 60 (ASES) and ≥ 2 (VAS) predicted achieving MCID for VAS score (p < 0.001). A preoperative threshold of ≥ 40 (Rowe) predicted achieving PASS for Rowe score (p = 0.005). Preoperative thresholds of ≥ 50 (ASES; p = 0.002) and ≤ 2 (VAS; p < 0.001) predicted achieving PASS for the ASES score. Preoperative thresholds of ≥ 43 (ASES; p = 0.046) and ≤ 4 (VAS; p = 0.024) predicted achieving PASS for the VAS. Conclusion. This study defined MCID and PASS values for WOSI, Rowe, ASES, and VAS scores in patients undergoing arthroscopic Bankart repair. Higher preoperative functional scores may reduce the likelihood of achieving MCID but increase the likelihood of achieving the PASS. These findings provide valuable guidance for surgeons to counsel patients realistically regarding their expectations. Cite this article: Bone Joint J 2024;106-B(10):1118–1124

Aims. We report the clinical results of glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Patients and Methods. The study reports results in 211 patients (249 shoulders) with atraumatic posteroinferior instability. The patients comprised 63 men and 148 women with a mean age of 20 years. The posteroinferior glenoid surface was elevated by osteotomy at the scapular neck. A body spica was applied to maintain the arm perpendicular to the glenoid for two weeks postoperatively. Clinical results were evaluated using the Rowe score and Japan Shoulder Society Shoulder Instability Score (JSS-SIS); bone union, osteoarthrosis, and articular congruity were examined on plain radiographs. Results. The Rowe score improved from 36 to 88 points, and the JSS-SIS improved from 47 to 81 points. All shoulders exhibited union without progression of osteoarthritis except one shoulder, which showed osteoarthritic change due to a previous surgery before the glenoid osteotomy. All but three shoulders showed improvement in joint congruency. Eight patients developed disordered scapulohumeral rhythm during arm elevation, and 12 patients required additional open stabilization for anterior instability. Conclusion. Good results can be expected from glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Cite this article: Bone Joint J 2018;100-B:331–7

Purpose: The purpose of this study is to examine the rate of Buford complex in a consecutive series of patients with arthroscopic Bankart repair and to evaluate the postoperative outcome compared to a group of patients without this anatomical variation. Material and Method: The surgical findings of 138 consecutive shoulder arthroscopies for Bankart lesions were prospective evaluated between January 2005 and January 2007; the mean of age was 25 years old (range 14–52). The criteria used to establish the diagnosis of Buford Complex included: cordlike middle glenohumeral ligament inserted in the superior labrum and attached to the biceps tendon, and complete absence of anterosuperior labrum. Postoperative outcomes were evaluated with Rowe score. Results: Five out of 138 patients (3.6%) presented a Buford complex associated to a Bankart lesion. Four of these patients (80%) presented a type II SLAP lesion. The follow up was 28 months (range 19–40 months). In the group of patients with the Buford complex the Rowe score had a mean of 75 points (range:45–95), 2 patients (40%) presented re-dislocation whereas in the other group the Rowe score had a mean 88 points (range: 25–100) and 9 cases (6.5%) had re-dislocation (P< 0.05). Conclusion: The rate of complex of Buford associated to Bankart lesion was of 3.6%. The presence of complex of Buford in our series was associated to worse functional postoperative outcomes

We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years’ follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations

We report the outcome of a modified Bankart procedure using suture anchors in 31 patients (31 shoulders) with a mean follow-up of 11 years (10 to 15). The mean age of the patients was 28 years (16 to 39). At follow-up, the mean Rowe score was 90 points (66 to 98) and the Constant score was 96 points (85 to 100). A total of 26 shoulders (84%) had a good or excellent result. The rate of recurrence varied between 6.7% and 9.7% and depended on how recurrence was defined. Two patients had a significant new injury at one and nine years, respectively after operation. The overall rate of instability (including subluxations) varied between 12.9% and 22.6%. All patients returned to work, with 29 (94%) resuming their pre-operative occupation and level of activity. Mild radiological osteoarthritis was seen in nine shoulders (29%) and severe osteoarthritis in one. We conclude that the open modified Bankart procedure is a reliable surgical technique with good long-term results

Aims. Our aim was to investigate the outcomes of patients with a displaced fracture of the glenoid fossa who are treated conservatively. There is little information in the literature about the treatment of these rare injuries non-operatively. Patients and Methods. We reviewed 24 patients with a mean age of 52 years (19 to 81) at a mean of 5.6 years (11 months to 18 years) after the injury. Results. At final follow-up, the mean Constant and Murley score was 79 points (18 to 98); the mean Western Ontario Shoulder Instability Index score (WOSI) was 77% (12 to 100) and the mean Rowe score was 93 points (50 to 100). Fractures with little intra-articular displacement (≤ 3 mm) had an uneventful outcome. Those with intra-articular displacement of ≤ 3 mm had a significant better mean Constant and Murley score than those with displacement of ≥ 5 mm and/or a fracture gap of ≥ 5 mm. Poor clinical results such as nonunion and post-traumatic osteoarthritis were associated with displaced or angulated glenoid fragments and significant intra-articular displacement. Conclusion. Glenoid fossa fractures with displacement of ≥ 5 mm should be treated surgically if the patient’s condition allows. Displacement and angulation can lead to nonunion and a poor outcome if the degree of displacement results in a persistent fracture gap in the glenoid fossa or if the angulation of fragments leads to malunion. Cite this article: Bone Joint J 2016;98-B:1074–9

The laterjet procedure is an important option in both primary and revision surgeries, especially in anterior shoulder instabilities that progress with glenoid bone loss. 12 patients who had a history of unsuccessful arthroscopic bankart repair and who underwent laterjet procedure in Ankara Atatürk Research and Training Hospital between 2013 and 2017 were included in the study and the patients were evaluated retrospectively. The mean age of the patients was calculated as 27.7 (range 21 to 38 years). Rowe and Walch-Duplay scores and operated shoulder (OS)-healthy shoulder (HS) range of motion (ROM) measurements were used to evaluate patients clinically and functionally. The mean follow-up time of the patients was calculated as 5.5±1.8 years. Firstly, no dislocation history was recorded in any patient afer the laterjet procedure. The mean Rowe score was calculated as 82.5 (range 60–100). Accordingly, 8 patients had excellent result, 3 patients had good result and 1 patient had fair result. The mean Walch-Duplay score was 81.4 (range 55–100). It was determined as excellent result in 6 patients, good result in 4 patients and fair result in 2 patients. Another data, joint ROM of the OS-HS of patients are shown in the table. There was some limitation in OS compared to the HS. p<0.05 value was accepted as statistically significant. While there was a statistically significant difference in external rotation (OS:35.2º, HS:56.4º)(p=0.003), internal rotation (OS:65.7º, HS:68.1º)(p=0.008) and flexion (OS:171.2º, HS:175.9º)(p=0.012) degrees but there was no statistically significant difference in abduction degrees (OS:164.3º, HS:170.4º) (p=0.089). In radiological evaluation, partial graft resorption was detected in 1 patient, but it was asymptomatic. The osteoarthritis which is one of the complications of laterjet procedure, was not detected radiologically. There are some limitations of the study. Firstly, it is a retrospective study. Secondly, the demographic features of the patients such as age, gender, profession and dominant hand are excluded. Thirdly, the mean follow-up time is not too long. Finally, some of the scales filled in are based on the patient's declaration, which may not yield sufficient objective results. In conclusion, the laterjet procedure is a suitable and reliable technique even for revision surgery in the treatment of anterior shoulder instability. It gives positive results in terms of shoulder stability and function. The major disadvantage was found to be the limitation of external rotation. Longer follow-up is needed for another outcomes and late complications, such as osteoarthritis. For any figures or tables, please contact the authors directly

Introduction: The incidence of early osteoarthritis after the modified Bristow procedure for recurrent anterior shoulder dislocation has been the subject of several articles during the last decade. Recurrent dislocation, recurrent subluxation after surgery or the procedure itself have been suggested as the main causes of degenerative changes. Materials and Methods: Thirty-four patients with recurrent anterior dislocation of the shoulder were treated by the same surgeon between May 1989 and April1999. Nineteen patients were allocated for long term follow-up assessment. Patients filled in a questionnaire in which they scored mobility, strength, stability and satisfaction. A Rowe score was established in each patient and radiographs in two directions (AP and axial) were taken. Results: Twenty shoulders (6 women and 13 men) with an average follow-up of 7.7 years were seen. Seventeen patients had an history of more than 3 dislocations. The mean interval between the first dislocation and surgery was 6.8 years. In all patients a substantial improvement of stability was recorded after surgery. Redislocation occurred in only one patient. The overall satisfaction rate was 6.2. The mean Rowe score at follow-up was 92. There was no limitation in abduction while external rotation was slightly limited in 7 patients. Three patients showed arthritic changes (2 mild, 1 moderate), which, surprisingly, were also seen in the opposite shoulder. Conclusion: The occurrence of arthropathic changes in a shoulder after surgical stabilisation is based on multiple factors. The recurrent dislocation that has taken place before any surgical procedure plays a predominant role

We review our results of arthroscopic capsular plication in patients with ligamentous laxity that had developed symptoms of instability after a traumatic event. Between 2004 and 2005, 115 patients with traumatic injury to their shoulder underwent arthroscopic stabilization and repair of their shoulder. Of these, twelve patients had ligamentous laxity and had their capsule plicated as a means to stabilize their shoulder. All had failed three months of biofeedback physiotherapy. The mean age of the patients was 29 years (range 17 to 46). The average time interval between date of injury and surgery was 21 months. They were reviewed retrospectively with a minimum follow up of 2 yeats. The functional outcome was assessed by Constant scoring system and Rowe score. At arthroscopy, capsular plication with a south to north direction would be fashioned with #1 PDS sutures. In multidirectional instability, the inferior and posterior capsule would be plicated as well. If the labrum was torn, this and the capsule would be repaired together. The repair was reinforced with rotator interval closure. Postoperatively the arm was rested in sling for four weeks followed by gradual mobilization. At a minimum follow up of two years, all twelve shoulders became stable. There were 8 excellent, 3 good and one fair result as graded by modified Rowe score. Re-arthroscopy in the patient with fair result showed good capsular repair and presence of scar tissue in the subacromial space. All patients rated their shoulder as normal. Ten patients returned to their preinjury level of competitive sport. Two patients returned to sport but at a lower level voluntarily. Arthroscopic capsular plication appears to be a safe and reliable technique in stabilizing shoulders in patients with ligamentous laxity. This form of repair should be offered to this group of patients if treatment with biofeedback physiotherapy fails

Purpose of the study: The purpose of this study was to assess at more than twenty years follow-up, the results achieved with the Bankart operation, focusing on functional and radiographic outcome of the glenohumeral joint in patients operated on when they were young. Materials and Methods: This retrospective analysis reviewed clinically and radiographically patients who underwent shoulder surgery for instability between 1971 and 1986. The Bankart operation was performed in all patients followed systematically by immobilisation. Self-controlled rehabilitation was the rule. The clinical assessment used thed Duplay and Rowe scores. The Prieto and Samilson radiographic score (four stages) was noted. Results: Mean follow-up was 26 years for 49 patients (50 shoulders). There were three women and 46 men (sex ratio = 15.3), mean age 25 years at surgery. Eighty percent practiced competition sports (a contact sport for 72%). The time from the first dislocation to surgery was four years on average. The rate of recurrence was 16%. All recurrences were provoked by a violent accident. 94% of patients returned to sports activities (on average 4.6 months after surgery), 80% at the same level. 86% of patients were satisfied. Mean Duplay and Rowe scores were 81.3 and 82.2 respectively. Average deficiency of external rotation was 9° compared with the contralateral side. Normal radiographs were noted for 13 shoulders (26%). The Prieto and Samilson classification was: stage I (n=18), stage II (n=5), stage III (n=5) and stage IV (n=1). Discussion: In this cohort with 80% competition sports athletes and 94% return to sports activities after surgery, the Bankart operation demonstrated its efficacy for contact sports. The rate of osteoarthritis after this operation is comparable with that observed with other types of bone blocks, but the follow-up here was twice as long. The deficit in external rotation was not greater than with non-anatomic operations

Traumatic shoulder dislocations at young age result in a significant re-dislocation rate and lead to chronic instability. Conservative treatment fails in 25–96% of cases especially in young active patients. The accepted standard treatment is the classical open Bankart repair which almost always results in loss of motion. The development of new techniques and devices has lead to an increase in arthroscopic techniques for shoulder stabilisations. Between September 1996 and October 2000 262 arthroscopic shoulder stabilisations were performed by the senior author: 159 cases FASTak® titanium anchors, 26 Panalok® anchors and 57 cases Suretac® anchors were used. Minimum follow up was 12 months with a mean follow up of 24.9 months (12–50). Rowe score and a visual analogue scale was used to measure patient satisfaction. The Rowe score increased to 83,1 +/− 20,9. The visual analogue score demonstrated overall patient satisfaction. Complications included redislocations(4.7%) sub-luxations (6.3%) and ongoing instability (6.3%). Return to sports occurred in 89.1% of patients with 68.4% being able to return to their previous sports activity level. This study demonstrates that arthroscopic shoulder stabilisation is comparable to the gold standard open Bankart repair. It is associated with a high patient satisfaction, lower morbidity, faster return to the previous activity level, better range of motion and less postoperative pain. The disadvantage of the technique is a long learning curve and the potentially longer operating times

Posttraumatic shoulder instability is a common problem in the field of sports medicine. Especially overhead athletes need intact stabilisers to meet the functional requirements. Open procedures often result in limitations of movement postoperatively. Arthroscopic techniques offer potential advantages such as better range of motion and shorter rehabilitation times. Between September 1996 and October 2000 159 arthroscopic shoulder stabilisations were performed with FASTak® anchors. The mean follow up was 24.9 months (12–50). Rowe score and a visual analogue scale were used to measure patient satisfaction. 72 patients (m=57, f=15)with a mean age of 27.6 years (17–65) were included and clinically examined. The Rowe score increased to 83.1 after primary stabilisation and 68.1 after revision procedures. The visual analogue score demonstrated overall patient satisfaction. 89.1% (n=64) of the patients could return to sports with 68,4% (n=49) being able to return to their previous sports activity level. Overhead athletes returned to sports in 89.4% of cases and 63.3% to their pre-injury level. In the non-overhead athletes 86% returned to sports with 60% to their pre-injury level. This study demonstrates that arthroscopic shoulder stabilisation with FASTak® anchors may be offered to the athlete regardless of the sports activity. It allows return to sports in a high percentage and does offer the potential advantages of a faster return to the previous activity level, better range of motion and less postoperative pain. Disadvantages of the technique is a long learning curve and should therefore only be performed by dedicated and experienced shoulder surgeons

The benefit of open stabilization for recurrent shoulder instability is well known, however there have been recent reports of postoperative dysfunction of the subscapularis tendon following open shoulder surgery (Habermeyer et al, Scheibel et al). We present our findings in patients who have undergone an open anterior stabilization using a subscapularis split approach. We reviewed 48 patients (49 shoulders), who were treated by the senior author (SB) from 2003–2005. They all underwent an open anterior stabilization of shoulder through a deltopectoral approach, with a subscapularis split technique, without any lateral tendon detachment. The minimum follow-up was 2 years, with average 34 months. Thirty-eight shoulders underwent an isolated anterior stabilization (1 bilateral) and 11 patients had additional procedures (8 bone grafts, 1 SLAP repair, 1 cuff repair, 1 anterior and posterior repair). There were 41 male and 7 female patients, and the mean age was 23.9 years (range 15–47 years). All patients were involved in sports and 45 had presented with recurrent dislocations. Patients were followed up using the Oxford instability score and the Rowe score questionnaires. All had a clinical examination for range of movement, stability, subscapularis muscle function, or signs of dysfunction. All had a MRI to assess the quality of the subscapularis muscle and tendon. Mean postoperative Oxford instability score was 22.5 and the Rowe score was 69.38. Two patients had redislocated following re-injury. There was no evidence clinically of subscapularis dysfunction and the muscle and tendon were normal on all MRI scans. External rotation was reduced by a mean of 15.6 degrees. There was no significant loss of flexion or abduction. 81% of patients returned to their previous level of sport. With a subscapularis split technique for anterior shoulder stabilization there is no significant postoperative dysfunction or damage to the subscapularis muscle, and most patients return to their previous level of sport

Aim: In this work we report mild term clinical results of a consecutive series of 104 arthroscopic stabilizations for traumatic or non traumatic anterior-inferior shoulder instability treated using for the stabilization always poly- L-lactic acid Bioknotless anchors (Mitek, Nor-wood, Mass., USA) and surgical technique described by Thal, and the clinical results of 74 patients reviwed. Methods: From 2000 to 2005, 104 consecutive patients underwent arthroscopic capsuloplasty repair using bio-knotless anchors.14 cases were performed SLAP II by original reconstruction with bioknotless anchors. All the patient underwent preoperative a clinical examination and valued Constant and Rowe score, and subjected a X-Ray study and MRI o TC\ arthroTC scan. All patients were operated by same surgical team. 74 patients (55 male, 19 female) were reviewed with at least 20 months follow-up (20 – 60 months). Average age was 25 (18–45). Results: Recurrence rate for instability was 6,7% (5/74). All recurrence, was associated with a large Hill-Sachs lesion and poor quality of capsular tissue. Overall, the results were good or excellent in 91,5% using the Rowe score. At X-ray study 28 cases have not show Samilson’s arthrosis, in 4 (14,7%) cases we observed geoid on glenoid side. Conclusion: The improvement in the results, to use absorbable anchor, obtained could be related to the development of materials and in particular at use of PLLA (poly-L- lactic polymer) and PGACP (polygluconate co-polimer), at surgical techniques carried out, to the different fixation methods and not least to the different inclusion criteria used for the selection of patients. Arthroscopic capsulolabral stabilization for the treatment of recurrent anterior shoulder instability repair using absorbable Knotless offers reliable results with respect to failure rate, range of motion, and shoulder function also at 4 years follow-up. The percentage of rate for instability is 6,7% and is in accord with the International Literature on non resorbable anchors

Introduction Traumatic shoulder dislocations at a young age result in a significant re-dislocation rates and lead to chronic instability. Conservative treatment fails in 25% to 96% of cases especially in young active patients. The accepted standard treatment is the classical open Bankart repair. Re-dislocation rate could be decreased to 3.5% to 14.9% but almost always results in loss of motion. The development of new techniques and devices has lead to an increase in arthroscopic techniques for shoulder stabilisations. Methods Between September 1996 and October 2000, 262 arthroscopic shoulder stabilisations were performed by one surgeon (ABI). For the refixation of the injured labrum suture anchors were used. In 159 cases FASTak (Arthrex) titanium anchors, in 26 cases Panalok (Mitek) and in 57 cases Suretac (Smith and Nephew) were used. The minimum follow-up was 12 months with a mean follow-up of 24.9 months (12 to 50). Exclusion criteria were SLAP and HAGL lesions, glenoid fractures, the inverted pear sign and hooked or posterior dislocations. Rowe score and a visual analogue scale were used to measure patient satisfaction. Results The Rowe score increased to 83.1 +/− 20.9. The visual analogoue score demonstrated overall patient satisfaction. The redislocation rate was five percent, three percent having a history of adequate trauma. Complaints of subluxations and ongoing instability occured in six percent. Eighty-nine percent of the patients could return to sports with 68% being able to return to their previous sports level. Conclusions This study demonstrates that arthroscopic shoulder stabilisation is comparable to the golden standard of open Bankart repair

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

Objectives: The aim of this study was a clinical and radiological evaluation of 68 shoulders operated with the Delta reverse-ball-and-socket total shoulder prosthesis by the senior author with a mean follow-up of 42 months. Methods: This is a retrospective study in one consecutive series of 68 shoulders, operated by the senior author, which were clinically assessed using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. Radiological evaluation was graded by the classification according to Nerot et al. and complications were analysed according to Goslings and Gouma. Patients were evaluated before surgery and at a mean clinical follow-up of 42 months. Results: There was a significant improvement in all clinical and stability scores. On the average, the Constant score for pain increased from 4.62 to 11.08 points (p< 0.05); the Constant Shoulder Score from 32.65 to 60.31 (p> 0.05); the Oxford Shoulder Score increased from 32.65 to 60.31 (p< 0.05) and the UCLA Shoulder rating scale increased from 15.08 to 27.42 (p< 0.05). The evaluation of stability showed an increase from 49.42 to 80.19 points in the Rowe Score for Instability and from 22.04 to 37.62 in the Oxford Instability score (p< 0.05). According to the Nerot classification, 65 percent of patients were graded as “0”, 20 percent as “1”, 3 percent as “2”, 6 percent as “3” and 6 percent as “4”. Eight complications occurred in terms of a nerve lesion which was graded according to Goslings and Gouma as “1” once, loosening of the humeral stem which was graded as “2” three times and loosening or fracture of the glenoid component which was graded as “2” in five times. At mean follow-up of 42 months, one patient of this series had died of decrepitude which was graded as “4” and one patient was lost of follow-up. Conclusions: We summarize, that there were significant advantages identified in terms of the Constant score for pain, all clinical scores and the instability scores. Radiological analyses showed 85 percent of patients without or with a small notch only. On the other hand, the rate of complications should be taken into account. We conclude that shoulder arthroplasty with the Delta prosthesis shows significant benefits in terms of less shoulder pain, a higher stability and a gain of range of motion but on the other hand, we emphasize that this treatment remains a salvage procedure in the elderly only

Purpose: We examined the long-term effect of the Latarjet-Patte procedure on subscapularis function and trophicity. Material and methods: The series included 102 patients (106 shoulders) reviewed at a mean follow-up of 7.5 years. The subscapularis was opened by dissection along the direction of the fibres in 27 shoulders (group I) and via inverted-L tenotomy in 69 (group II). Duplay and Rowe scores were used to assess clinical outcome. Subscapularis function was measured with the hand-back distance and the Gerber lift-off test in comparison with a control group composed of healthy subjects in order to account for limb dominance. Computed tomography was used to measure fatty degeneration and muscle atrophy. Results: The Duplay and Rowe scores gave 76.4% and 87.7% satisfactory results. The Duplay score was 89.9/100 in group I and 82.1 in group II (p = 0.02). The hand-back distance and muscle force as judged by the lift-off test were statistically different between the dominant and non-dominant sides (p = 0.001). Loss of muscle force was greater for dominant sides in the operated shoulders. The mobility score, the lift-off test, and the hand-back distance were significantly altered in group II patients. Fatty degeneration of the sub-scapularis was greater on the operated side (0.76 vs 0.054) (p = 0.001). It increased with age at surgery and at review (p = 0.0001), for dominant shoulders in group II (1.18 vs 0.12). It affected the Duplay score (p = 0.006), the hand-back distance, and the lift-off test (p = 0.01). Fatty degeneration was greater than 2 in 66% of the shoulders with a poor outcome and persistent apprehension in 35.3%. Subscapular atrophy was greater on the operated side (0.91 vs 1.17) (p = 0.0001) and was statistically correlated with fatty degeneration, the Duplay score, the lift-off test, and the hand-back distance. It was greater in group II (0.71) than in group I (0.2). Discussion: Recovery of muscle force is better for dominant shoulders. Muscle trophicity and function are influenced by subscapular tenotomy that leads to significant loss of internal rotation force, atrophy, and fatty degeneration affecting final long-term outcome. Conclusion: We recommend discission of the subscapularis for coracoid bone block procedures

Traumatic anterior shoulder dislocation and sub-luxation are common injuries. But few studies have compared arthroscopic and open stabilization of the shoulder at long-term follow up. The purpose of our study is to show whether an arthroscopic approach to repair Bankart lesion can obtain the same results at long follow up as an open procedure. We analyzed 110 non-randomized consecutive shoulders in 110 patients who underwent a surgical repair of recurrent anterior shoulder instability between 1990 and 1999. Eighty-two patients were available at long term follow up (74,5% retrieval rate). In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid suture (modified Caspari) between 1990 and 1995 (mean 15,7 year FU), whereas, 33 patients (40.2%) (group B) were treated with open repair between 1995 and 1999 (mean 12,7 year FU). We evaluated the patients in terms of failure rates, Rowe and UCLA scores. The failure cases in the forty-nine patients treated with arthroscopic suture were 13, six dislocations and seven subluxations. The group A had also a Rowe score: function 24.2+8.2, stability 42.4+13.9, range of movement 18.6+3.8, total score 85.0+22.46. The UCLA score was: pain 8.8+1.7, function 8.6+2.1, muscle power 9.2+1.6, total score 26.4+4.8. Of the thirty-three patients treated with open repair, three had at least one post-op dislocations and four felt sometimes subluxations. The Rowe score in group B was: function 23.6+9.7, stability 41.2+14.9, range of movement 18.3+3.9, total score 83.2+24.4. Moreover the UCLA score was: pain 8.8+1.9, function 8.8+1.9, muscle power 9.2+1.2, total score 26.9+4.2. We showed that both techniques were fairly good in treatment of shoulder instability. In our series no significant difference was observed in redislocation rate and in Rowe and UCLA scores between the two groups. The recurrence rate (subluxations and dislocations) was high in both groups: the arthroscopic group had 26.5% and the open one had 21.2%. Our recurrence rate following open repair was higher than in many studies, while the rate after arthroscopic transglenoid procedure was almost equivalent. We hypothesize that one of the reasons for these higher recurrence rates may be the long term follow up. Another cause could be our decision to include subluxation as a failure value, even if there is no agreement about. In fact we believe it to be an important disability factor in sport as in life activities. After surgery, most of the patients returned to their preinjuried activities. But at long term follow up almost all patients have stopped high level sport activity. Moreover, at this long term follow up, some patients told us a feeling of muscle weakness in the last years. In conclusion patients had good impressions about their shoulders thanks to surgery, but also because of lower functional demand

We prospectively evaluated 61 patients treated arthroscopically for anterior instability of the shoulder at a mean follow-up of 44.5 months (24 to 100) using the Rowe scale. Those with post-operative dislocation or subluxation were considered to be failures. Logistic regression analysis was used to identify patients at increased risk of recurrence in order to develop a suitable selection system. The mean Rowe score improved from 45 pre-operatively to 86 at follow-up (p < 0.001). At least one episode of post-operative instability occurred in 11 patients (18%), although their stability improved (p = 0.018), and only three required revision. Subjectively, eight patients were dissatisfied. Age younger than 28 years, ligamentous laxity, the presence of a fracture of the glenoid rim involving more than 15% of the articular surface, and post-operative participation in contact or overhead sports were associated with a higher risk of recurrence, and scored 1, 1, 5 and 1 point, respectively. Those patients with a total score of two or more points had a relative risk of recurrence of 43% and should be treated by open surgery