Purpose: The purpose of this study was to assess long-term functional outcome after arthroscopic acromioplasty for full-thickness rotator cuff tears, to evaluate the efficacy of complementary procedures (biceps tenotomy, extended acromioclavicular resection), and to examine the course of anatomic lesions.

Material and methods: From 1988 to 1994, 141 full-thickness rotator cuff tears were treated by arthroscopic acromioplasty. Ninety-eight patients, mean age 60 years, were reviewed clinically, radiographically, and sonographically at more than eight years. The mean preoperative Constant score was 48.5 points. The tear involved the supraspinatus in 18 cases, the supraspinatus and infraspinatus in 40, the supraspinatus and the subscapularis in ten, and all three tendons in 20. Coronal extension showed a distal tear in four, an intermediate tear in 52, and a retracted stump in 32. Systemic acromioplasty was associated in 36 patients with tenotomy of the long head of the brachial biceps and in 44 with acromioclavicular extension.

Results: At mean follow-up of 10.7 years (8–13.5), the mean Constant score was 60 points. The clinical outcome was excellent or good in 39.7%, fair in 45.5%, and poor in 14.8. 62.5% of the patients were satisfied or very satisfied. The height of the subacromial space was 5.19 mm at last follow-up compared with 4.3 mm preoperatively. The antalgesic effect of biceps tenotomy was significant when the initial acromiohumeral space was less than 5 mm. This procedure did not produce any significant change in the subacromial height or development of osteoarthritis at last follow-up. Sonography showed stability of the size of the tear in 83.8% of the cases. The results were significantly less satisfactory when the initial tear involved the subscapularis or all three tendons.

Conclusion: The clinical results of arthroscopic acropmioplasty for full-thickness tears show long-term stability. Biceps tenotomy improves the antalgesic effect significantly, particularly if the subachromial space measures less than 5 mm preoperatively, without causing significant radiological degradation. Extension to the acromioclavicular level should be systematic in patients with acromioclavicular pain preoperatively and/or radiological anomalies.

Purpose: Posterior instability of the shoulder requires surgical treatment in involuntary forms and after failure of functional treatment. As for anterior instability, a bone block can be fashioned from an iliac graft or a pediculated graft harvested from the acromion. This retrospective analysis concerned the results obtained in eighteen consecutive cases.

Material and methods: This series included ten men and eight women, mean age 26 years (15–42) at time of surgery. Fourteen (77%) practised sports activities including four at competition level. Symptoms had persisted for four years on the average. For three patients (16%) posterior instability was expressed by recurrent luxation subluxation. For nine patients (50%) posterior subluxation was a common involuntary event. Six patients suffered from painful shoulders due to an unrecognised posterior instability accident. Diagnosis of posterior instability was establised by arthroscopy in seven patients (39%). For nine shoulders the intervention consisted in a screwed posterior iliac block associated with a tension procedure on the capsule (group 1). For the other nine shoulders the block was harvested from the acromion and pediculated on the deltoid (group 2).

Results: Mean follow-up for all patients was eight years. The Duplay score was 75 points at last follow-up. Twelve patients (85% of the athletes) were able to resume their sports activities, half at the same level. Nine patients were pain free. Six patients (33%) had persistent apprehension but did not present true recurrence at physical examination. The Duplay score was 69.4 points in group 1 (follow-up 12 years) and 82.2 points in group 2 (follow-up three years). Thirteen patients (77%) did not have any sign of joint degeneration at last follow-up. One patient had advanced stage IV degeneration related to an intra-articular screw. All patients felt their shoulder had been improved by surgery and one third were disappointed with the results.

Discussion: Use of a posterior block is an effective treatent for posterior instability giving results comparable with those obtained with anterior blocks in terms of shoulder stability, pain, recovery of motion, and subjective outcome. This procedure favours joint degeneration less than anterior stabilisation. Results obtained with pediculated acromial blocks are encouraging.

Purpose: Maisonneuve fracture is a rare variant of malleolar fractures. Standard surgical care is not well defined. We performed a retrospective analysis of operated patients to propose a system to determine adequate care as a function of the type of lesions observed.

Material and methods: This retrospective analysis involved 20 patients who underwent surgery for Mai-sonneuve fracture between 1989 and 2000. Mean age was 42 years at surgery. Male gender predominated (16 patients). Seven patients (group 1) were treated without a syndesmodesis screw (osteosynthesis of the medial malleolus in six cases and suture of the medial collateral ligament in one). Thirteen patients (group 2) were treated via a first lateral approach and a syndesmodesis screw followed by a complementary medial approach in seven cases (two cases of medial malleolus osteocynthesis and five cases of medial collateral ligament suture). The Duquennoy functional score was determined at last follow-up. Quality of the reduction and presence of degenerative disease were determined on standard x-rays and computed tomographies.

Results: Mean follow-up was four years nine months (range 1–10 years). No case of tibiotalar diastasis was observed at at least one year. Among the five patients reviewed clinically, outcome was excellent in four and fair in one. In group 2 (syndesmodesis), we found two cases of residual diastasis and two cases of tight syndesmosis at at least one year. Among the nine patients reviewed clinically, outcome was excellent in three and fair or poor in six.

Discussion: This retrospective analysis collaborates the few data in the literature on Maisonneuve fractures. Ligament injury has varied greatly (with or without tear of the medial lateral ligament, more or less full thickness rupture of the interosseous membrane). In our experience, it is always difficult to reduce the diastasis via the primary lateral approach. Conversely, the primary medial approach has, after testing, enabled eliminating the syndesmodesis screw, with its recognised deleterious effects, in seven cases.

Conclusion: Due to the diversity of the ligament injuries encountered in patients with Maisonneuve fractures, we have adopted the following surgical strategy. If there is diastasis, after confirmation of any injury to the medical compartment, medial approach to suture the medial collateral ligament or osteosynthesis of the medial malleolus: in the case of diastasis reduction, we advocate a syndesmodesis screw; if diastasis persists, a secondary lateral approach is useful to reduce the medial malleolar rotation and insert a syndesmodesis screw.