Arthroscopic Superior Capsular Reconstruction for Dislocation of the Shoulder with an Irreparable Rotator Cuff Tear: A Case Report.

CASE: A 49-year-old man presented with apprehension of a repeat dislocation after a left shoulder dislocation, which was accompanied by pain and restricted active range of motion of the shoulder. We performed an arthroscopic Bankart repair as well as an arthroscopic superior capsular reconstruction (ASCR) with fascia lata for the irreparable massive rotator cuff tear. Two years postoperatively, there was no shoulder pain or repeat dislocation; the range of motion had improved. CONCLUSION: We regard ASCR in combination with a Bankart repair as a useful treatment for recurrent shoulder dislocation that is accompanied by an irreparable massive rotator cuff tear.

Costal osteochondral autograft for reconstruction of advanced-stage osteochondritis dissecans of the capitellum.

BACKGROUND: Advanced-stage osteochondritis dissecans of the capitellum affecting the lateral wall may result in osteoarthritis, and suitable treatment is needed to avoid permanent deformation and impaired function. We aimed to assess postoperative outcomes of costal osteochondral autograft for treatment of this condition. METHODS: We included 22 young overhead athletes (mean age, 13.9 years) with advanced osteochondritis dissecans of the humeral capitellum who underwent costal osteochondral autograft. All patients had elbow pain and wide-range articular cartilage lesions. We evaluated clinical and radiographic outcomes at a mean follow-up of 27 months (range, 12-77 months). RESULTS: All patients achieved rapid functional improvement and returned to their former sports activity levels. The baseball players were able to play catch within 62 to 164 days (mean, 107 days) and returned to full pitching activity within 123 to 339 days (mean, 226 days). We assessed mean elbow function by the clinical rating system of Timmerman and Andrews and the Japanese Orthopaedic Association sports score; the scores improved from 121.5 and 53.7 points preoperatively to 169.2 points and 86.1 points, respectively, at the time of follow-up. Four patients required additional minor surgical procedures, including screw removal, loose body removal, and shaving off of spur formation. No patient showed obvious radiographic changes of osteoarthritis. All patients were satisfied with the final outcomes and had good functional recovery. CONCLUSION: Costal osteochondral autograft gave satisfactory results for advanced osteochondritis dissecans of the humeral capitellum with extensive lesions affecting the lateral wall.