Purpose of the study: The purpose of this study was to report the clinical and radiographic outcomes a minimum five years after Latarjet-Patte treatment for recurrent traumatic anterior instability of the shoulder in rugby players. It was hypothesised that the Latarjet-Patte procedure fulfils the needs for shoulder stability in rugby players with anterior instability.

Material and methods: Thirty-four players (37 shoulders) were included. Mean age was 23.4 years (17–33). A bone lesion of the glenoid was noted in 73% of the shoulders, a humeral defect in 68%.

Results: Mean follow-up was 144 months (range 68–237). There was no recurrence (dislocation or subluxation). Apprehension persisted in five patients (14%). Sixty-five percent of the patients resumed playing rugby. Only one patient interrupted his sports activities because of the operated shoulder. The Walch-Duplay and Rowe scores were 86 and 93 points on average. The satisfaction rate was 94%. The block healed in 89% of shoulders (3 fractures, 1 nonunion). Twenty-six shoulders (70%) were free of degenerative disease, 11 shoulders (30%) presented stage 1 lesions.

Discussion: In rugby players, anterior instability exhibits characteristic bone lesions of the humerus and glenoid which can be identified as risk factors for recurrent instability. The Latarjet-Patte procedure provides a stable shoulder allowing resumption of rugby player for most patients with no long-term degradation of the shoulder joint. These results are in favour of our strategy to propose the coracoids block systematically for recurrent anterior instability in rugby players.

Purpose: Bilateral tears of the ACL are classically described as occurring after a first tear. Few reports have examined the underlying mechanism and the frequency and predisposing morphological factors

Material and methods: We reviewed retrospectively a series of 3722 ACL plasties performed from 1984 to 2001, including 148 patients who underwent bilateral repair. In this group, we detailed the demographic features, the time from tear to repair, the type of sports activity and focused on the radiological measurement of tibial tilt.

Results: The estimated frequency of bilateral tears was 4%. We noted that these bilateral tears were associated with: male predominance (60%), mean age 21 years (±5.5) at first tear, younger age for females, second tear at 24.5±6.5 years, predominant practice of pivot sports without contact (56%), and competition sports. The time between the two tears was 48 months on average. The rate of contralateral tears during the first postoperative year was 16%, it was 60% at three years. The mean tibial tilt was 9.91±2.87° versus 6.8±1.87° in the control population.

Discussion: Our findings were in agreement with the literature for frequency, young age at first tear, particularly for women, short time between the two tears, and type of sports activity. The high rate of contralateral tears during the first year is a significant finding. Hypotheses put forward include loss of confidence in the operated knee leading to more stress on the contralateral knee, but also poorly adapted use of the healthy knee in sports activity. Rehabilitation exercises focusing on bilateral proprioception, respecting sufficient time after the first repair before resuming sports activities, and good control of knee laxity with an ‘anatomic’ plasty appear to be important elements of prevention. The favouring role of a narrow intercondylar notch has been established in the literature. We found that tibial tilt should also be taken into consideration.

Conclusion: Careful search for predisposing factors is important because of the frequency of bilateral tears of the ACL. The rehabilitation program should be well adapted and the patient should be informed of the risk. These measures should help decrease the incidence of this relatively frequent complication.