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.

Introduction and Aims: To determine whether taurine influences skeletal muscle ischaemia-reperfusion injury in a rat hindlimb model.

Method: Twenty-three rats in five groups were subjected to right hindlimb ischaemia-reperfusion injury. The right femoral vein was exposed and cannulated, and a tourniquet applied to the right hindlimb. The left hindlimb acted as a control in each animal. In group 1 there was no treatment, group 2 had normal saline injected into the femoral vein distal to the tourniquet, group 3 had taurine 200mg/Kg injected distal to the tourniquet, group 4 had taurine 200mg/Kg injected proximal to the tourniquet, and group 5 had taurine 100mg/Kg distally and 100mg/Kg proximally. After ischaemia (four hours) and reperfusion (30 minutes), right and left gastrocnemius biopsies were taken and their contraction strength in response to a standardised electrical impulse was measured.

Results: Histology of all right-sided biopsies confirmed inflammatory changes consistent with ischaemia-reperfusion injury. In groups 1, 2, 4, and 5, the mean contraction strength of the right (ischaemia-reperfusion injury) biopsies was significantly less than that of the left (control) biopsies. In group 3 (taurine distal to the tourniquet) the difference in strength between right and left was an order of magnitude less than in the other groups, and was not statistically significant.

Conclusion: These data suggest that taurine during ischaemia confers some protection against ischaemia-reperfusion injury mediated functional impairment in rat skeletal muscle.

Introduction: The paradoxical further damage done to ischaemic tissue when blood flow and oxygenation are restored is termed ischaemia-reperfusion injury. The underlying mechanisms are complex but centre on oxidative damage to the cell membrane, which suggest a therapeutic role for antioxidants such as endogenous amino acid taurine.

Methods: In this study, 23 rats in 5 groups were subjected to right hind limb ischaemia-reperfusion injury. The right femoral vascular bundle was exposed and the femoral vein cannulated, and a tourniquet applied to the right hind limb. The left hind limb acted as a control in each animal. In group 1 there was no treatment administered, group 2 had normal saline injected into the femoral vein distal to the tourniquet, group 3 had turbine 200mg/Kg injected distal to the tourniquet, group 4 had taurine 200mg/Kg injected proximal to the tourniquet, and group 5 had taurine 100mg/Kg distally and 100mg/Kg proximally. After 4 hours of ischaemia and 30 minutes reperfusion, gastrocnemius biopsies were taken from right and left hind limbs and their contraction strength in response to a standardised electrical impulse was measured.

Results: There was a statistically significant difference in contraction strength between right and left hind limb samples in all groups. The difference in-group 4 was an order of magnitude less than that in groups 1, 2, and 3, with an intermediate value in-group 5. Histological examination confirmed inflammatory changes consistent with ischaemia-reperfusion injury and not simple necrosis.

Conclusion: These data suggest that taurine in the reperfusing blood, rather than in the ischaemic tissues, confers some protection against ischaemia-reperfusion injury mediated functional impairment in rat skeletal muscle.