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

Combined glenoid and humeral bone loss has been identified as an important factor in predicting recurrence after arthroscopic shoulder stabilisation. The “glenoid track” concept is proposed to predict recurrent instability by comparing the relative size of the glenoid to the humeral bone defect. The aim of this study was to investigate whether assessment of the glenoid track on a pre-operative MR arthrogram could be used to predict subsequent instability in a typical UK population. A retrospective study was undertaken of 175 primary arthroscopic stabilisation procedures of which 82% (n=143) were men. The median age was 26 years (IQR 22 to 32, range 16 to 77). The median follow-up was 76 months (range 21 to 125). A pre-operative MR arthrogram was used to determine if the shoulder was on-track or off-track. The endpoint of recurrent dislocation was examined. The prevalence of “off-track” bone loss in this group was 14.2% (n=25). There were 6 (24%) dislocations in the off-track group compared with 5 (3.33%) dislocations in the on-track group (RR 7.2, 95% CI 2.45 to 20.5, p=0.001). At 5 years, the cumulative redislocation rate was 26.1% in the off-track group compared with 8.7% in on-track group. The rate of any recurrent instability was 60% (n=15) v 18% (n=27) (RR 3.33, 95% CI 2.02 to 5.20, p<0.0001). Glenoid track (on v off) was not predicted by gender (p=0.411). In a typical UK population assessment of the glenoid track on an MR arthrogram can be used to risk stratify patients with shoulder instability

Intra-articular shoulder pathology has been recognised in more detail following widespread use of shoulder arthroscopy. The purpose of this epidemiological study is to present the incidence and exact type of SLAP lesions in our operated population and to correlate them with the presence of other shoulder lesions. Between 2004 and 2010 425 patients underwent shoulder arthroscopy in our department (311 for rotator cuff tears or subacromial impingement, 102 for shoulder instability, 12 for SLAP lesions). Eighty-two SLAP lesions (19.2% overall) were recognized during these procedures. In 44 cases the lesion was SLAP type I (53.6%), in 10 type II (12.2%), in 1 type III (1.2%), in 1 type IV (1.2%), in 24 type V (29.26%) and finally in 2 type VI (2.43%). In more detail SLAP I lesions were associated in 8 patients with subacromial impingement syndrome, in 33 with RC tear and in 3 patients with anterior instability. Type II, III and IV were preoperatively diagnosed, while type V and VI lesions were found in patients with chronic anterior shoulder instability. SLAP lesions are diagnosed more accurately during shoulder arthroscopy rather than with plain shoulder MRI scan. In our study population only 12 cases were accurately diagnosed with a pre-operative MRI scan, while the remaining 70 cases were missed. Additionally, there was significant correlation between rotator cuff problems and SLAP I lesions, while chronic shoulder instability was associated with SLAP V and VI (25.4% of patients with instability). Shoulder arthroscopy not only has changed SLAP lesion diagnosis and treatment but also reveals the correlation of various SLAP lesion types with specific shoulder pathologies

The bare area of the humeral head is limited in front by the cartilage and backwards by the insertion of the Infra Spinatus tendon. There are few references in the current literature. The aim of this work was to precise the anatomic description of the bare area and to compare the size of this area in patients with anterior shoulder instability and patients without anterior shoulder instability. Material and method. We have proceeded first to an anatomic study to precise the limit of the bare area. The second part of this study was a retrospective and prospective comparative arthro CT-scan study in two groups of patients. The first group (group 1) had 48 patients, going to have anterior instability surgery. The second group (group 2) had 38 patients, without shoulder instability. Mean age was respectively 28.2 years (range: 19–48) in group 1; and 39.3 years (16–69) in group 2. The size of the bare area was measured on the axial injected CT cut passing by the larger diameter of the humeral head, The size of the bare area was definite by the angle between the line connecting the centre of the head to the posterior limit of the cartilage and the line connecting the centre of the head to the anterior point of the Infra Spinatus tendon. The reproducibility of the measure has been evaluated by a Bland and Altman test and an intra class correlation test. The measures were realised by two independent surgeons in a blind manner. The results where compared by a Student test with a threshold at 5%. Results. In the anatomic part of this study, the average angle of the bare area was 32.7° equal to 13.7mm wide. Mean intraobserver variability was 4° (range: 0 to 20°) (NS) and mean interobserver variability was 4° also (range: 0 to 20°) (NS). Mean size of the bare area was 49.6° eaqual to 19.8mm wide [range 25° to 70°] in group 1 and 33.2° equal to 13.5mm wide [range 21° to 60°] in group 2 (p< 0,05). Discussion. Our measures were reproducible. This study confirms our hypothesis: the bare area is significantly larger in shoulders suffering of anterior instability, but we cannot yet tell if this result is a consequence or a risk factor of anterior shoulder instability

We treated 47 patients with a mean age of 57 years (22 to 88) who had a proximal humeral fracture in which there was a severe varus deformity, using a standard operative protocol of anatomical reduction, fixation with a locking plate and supplementation by structural allografts in unstable fractures. The functional and radiological outcomes were reviewed.

At two years after operation the median Constant score was 86 points and the median Disabilities of the Arm, Shoulder and Hand score 17 points. Seven of the patients underwent further surgery, two for failure of fixation, three for dysfunction of the rotator cuff, and two for shoulder stiffness. The two cases of failure of fixation were attributable to violation of the operative protocol. In the 46 patients who retained their humeral head, all the fractures healed within the first year, with no sign of collapse or narrowing of the joint space. Longer follow-up will be required to confirm whether these initially satisfactory results are maintained.

The generally-accepted treatment for large, displaced fractures of the glenoid associated with traumatic anterior dislocation of the shoulder is operative repair. In this study, 14 consecutive patients with large (> 5 mm), displaced (> 2 mm) anteroinferior glenoid rim fractures were treated non-operatively if post-reduction radiographs showed a centred glenohumeral joint.

After a mean follow-up of 5.6 years (2.8 to 8.4), the mean Constant score and subjective shoulder value were 98% (90% to 100%) and 97% (90% to 100%), respectively. There were no redislocations or subluxations, and the apprehension test was negative. All fragments healed with an average intra-articular step of 3.0 mm (0.5 to 11). No patient had symptoms of osteoarthritis, which was mild in two shoulders and moderate in one.

Traumatic anterior dislocation of the shoulder, associated with a large displaced glenoid rim fracture can be successfully treated non-operatively, providing the glenohumeral joint is concentrically reduced on the anteroposterior radiograph.