Subacromial Platelet-Rich Plasma Injections Produce Significantly Worse Improvement in Functional Outcomes in Patients With Partial Supraspinatus Tears Than in Patients With Isolated Tendinopathy.

PURPOSE: To compare the effect of subacromial leukocyte-rich platelet-rich plasma (PRP) injections in patients with isolated rotator cuff tendinopathy (RCT) and those with partial-thickness rotator cuff tears (PTRCTs) based on functional outcomes, pain improvement, sleep disturbances, and return to sports. METHODS: Between November 2019 and March 2021, 150 patients underwent PRP injections at our institution for refractory rotator cuff tendinopathy and partial rotator cuff tears (105 RCTs and 45 PTRCTs). The American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) and The Pittsburgh Sleep Quality Index were evaluated at 2-, 6-, and 12-month follow-up. Return to sports was also evaluated. An ultrasound examination was performed to evaluate structural outcomes 12 months after the injection. RESULTS: The mean age was 36.6 years (±9.08). Overall, the ASES, VAS, SANE, and Pittsburgh scores showed statistical improvement after the injection (P < .01). Specifically, the improvement in the ASES score, which was the primary outcome measure was significantly greater in the group without tears than in the group with PTRCTs at all follow-up times. Moreover, 94% of the patients in the isolated RCT group and 49% in the PTRCTs group achieved a substantial clinical benefit at 12 months follow-up. Ten out of the 50 patients (20%) who received PRP injections due to a partial RC tear underwent surgery due to the lack of clinical improvement. CONCLUSIONS: Subacromial PRP injections produced a significant improvement in shoulder function, pain, and sleep disturbances in most patients with RCT refractory to conservative treatment that was maintained at the 12-month follow-up. Moreover, most patients returned to sports at the same level prior to injury. However, improvement in symptoms and functional outcomes was significantly worse in patients who had a PTRCT compared with patients who had an isolated tendinopathy. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs). METHODS: A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum 1-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA. RESULTS: A total of 45 studies comprising 1623 patients were included. The overall pooled age was 75.9 ± 3.4 years. At a mean follow-up of 34.6 (range, 12-108) months, there were no significant differences in ROM, VAS score, Constant-Murley score, rate of tuberosity healing, or reoperation rates between the cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4-76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9-90.0, P = .013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0%-6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5%-14.9%, P = .044). CONCLUSION: The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared with the cemented cohort (9.7% vs. 5.5%, respectively), the rate of reoperations was similar between the groups (1.6% vs. 1.9%, respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.

Cemented versus uncemented reverse shoulder arthroplasty for acute proximal humeral fractures.

BACKGROUND: The purposes of this study were (1) to compare postoperative range of motion (ROM) and functional outcomes in patients with proximal humeral fractures operated on with cemented or uncemented reverse shoulder arthroplasty (RSA), (2) to compare the rate of tuberosity healing between cemented and uncemented stems, (3) to determine whether there are significant differences in functional outcomes between patients with healed tuberosities and those with unhealed tuberosities, and (4) to compare complications and revision rates in patients with cemented RSA and uncemented RSA. METHODS: A cemented RSA was performed early in the study period, which represented a historical cohort (January 2015 to January 2017), followed by a transition to the uncemented RSA later in the study period (February 2017 to February 2019). We excluded 22 cases from postoperative evaluation because of fracture sequelae, age < 65 years, death, and institutionalization; 3 patients were lost to follow-up. The remaining 67 cases (32 cemented and 35 uncemented) underwent clinical and radiographic evaluation by 2 independent fellowship-trained shoulder surgeons. Patients were assessed regarding ROM and the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and Single Assessment Numeric Evaluation score. All intraoperative and postoperative complications were recorded. RESULTS: The mean follow-up period was 41 months (range, 24-72 months), and the mean age was 74 years (range, 65-84 years). Mean postoperative active elevation, internal rotation, external rotation in abduction, and external rotation in adduction were 130° (±15°), 27° (±5°), 28° (±10°), and 16° (±6°), respectively. The mean postoperative visual analog scale, American Shoulder and Elbow Surgeons, Constant, and Single Assessment Numeric Evaluation scores were 1.8 (±0.8), 74 (±6), 58 (±11), and 74% (±8), respectively. There were no significant differences in final ROM and functional scores between the cemented and uncemented groups. The rate of tuberosity healing did not vary significantly in relation to whether the stem was cemented. The subgroup of patients with tuberosity healing presented significantly better active elevation, external rotation, and Constant scores than the subgroup without tuberosity healing. There were 5 complications (7%) and no cases of aseptic humeral stem loosening. CONCLUSION: In the short term (mean, 41 months), there were no significant differences in postoperative ROM, functional outcomes, complications, and revisions between patients operated on with cemented RSA and those operated on with uncemented RSA for proximal humeral fractures. Patients with healed tuberosities presented significantly better ROM and functional scores than patients without tuberosity healing. The cementation of the stem did not significantly affect the rate of tuberosity healing.

Editorial Commentary: Arthroscopic Repair of Partial Thickness Rotator Cuff Tears: What Do We Know So Far and Where Should We Put the Focus of Our Future Research?

The available evidence shows that arthroscopic repair using either the transtendon in situ repair technique or the tear completion and subsequent repair technique are associated with favorable results in the short term. Likewise, the location of the lesions (articular or bursal) does not seem to significantly influence the clinical results, regardless of the technique used. Specifically with regard to the surgical technique of choice in the case of deciding to complete the tear and then repair it, it remains to be defined more clearly in future investigations whether it is better to repair with a single- or double-row technique, whether associated subacromial decompression has any advantage and what the results of this technique are in the subgroup of athletes, especially in competitive and overhead athletes in whom repair of rotator cuff tears has shown unfavorable outcomes mainly at the expense of a low return to the same level of sport.

Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy.

PURPOSE: The purpose of this study was to evaluate the effect of subacromial platelet-rich plasma (PRP) injections in patients with refractory rotator cuff tendinopathies based on pain improvement, functional outcomes, sleep disturbances, and return to sports to the same level as before the injury. METHODS: Between March 2019 and October 2019, 50 patients with rotator cuff tendinopathy refractory to conservative treatment were treated with one subacromial PRP injection in our institution. Magnetic resonance imaging was performed in all patients to confirm diagnosis. The visual analog scale (VAS) was used to evaluate pain. Range of motion, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant score were used to assess functional outcomes. Eighty percent of the patients (40 of 50 patients) and 86% of the patients (43 of 50 patients) achieved a clinically significant improvement that exceeded the substantial clinical benefit for the ASES and Constant scores, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorders. Return to sports was also evaluated. The mean follow-up was 12 months, and the mean (SD) age was 37.3 (9.3) years. RESULTS: All mobility parameters evaluated improved significantly after treatment. The VAS, ASES, and Constant scores showed statistical improvement after the injection (P < .001). Sleep disturbances were resolved in 86% of the patients. Of the 32 patients who practiced sports before the injury, 84% returned to sports and 78% returned to the same level. There were no complications associated with the procedure. CONCLUSIONS: In most patients with refractory rotator cuff tendinopathy, subacromial injections of leukocyte-rich PRP significantly decreased pain, improved functional outcomes, and resolved sleep disturbances. Moreover, most of the athletes returned to sports at the same level they had before the injury. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Is sarcopenia a risk factor for rotator cuff tears?

BACKGROUND: Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Currently, it is considered an independent risk factor for falls and fractures, disability, postoperative complications, and mortality. Rotator cuff tears are known to be influenced by systemic diseases such as diabetes mellitus, hypercholesterolemia, thyroid disease, and osteoporosis. The aim of our study was to determine if there is a correlation between sarcopenia prevalence and rotator cuff tears. METHODS: This is a prospective case-control study. Between May 2017 and May 2018, 106 patients were evaluated and divided into 2 groups. Group 1 (cases) included 53 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 72 ± 5 years), and group 2 (controls) included 53 patients without rotator cuff tears (mean age, 71 ± 6 years). Sarcopenia was diagnosed with the presence of 2 of 3 criteria: low skeletal muscle mass, inadequate muscle strength, and inadequate physical performance. Rotator cuff integrity was evaluated with magnetic resonance imaging in all patients. RESULTS: No significant differences were found in baseline data and demographic factors between the groups, except for the smoking habit (P = .02). The prevalence of sarcopenia was not significantly different between the groups, nor were gait speed, grip strength, and skeletal muscle mass index (P = .15, .99, and .9, respectively). CONCLUSION: The prevalence of sarcopenia in patients with rotator cuff tears was similar to an age- and sex-matched control population. Thus, with these results, we are not able to consider sarcopenia as an independent risk factor for rotator cuff tears.

Does the Use of Knotted Versus Knotless Transosseous Equivalent Rotator Cuff Repair Technique Influence the Incidence of Retears? A Systematic Review.

PURPOSE: To compare knotted and knotless transosseous equivalent (TOE) rotator cuff repair (RCR) techniques and evaluate their imaging-diagnosed retear rates. METHODS: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008 to 2019), EMBASE (2008 to 2019), and Medline (2008 to 2019) were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, with the following search terms: rotator cuff repair AND (knotless OR knotted) AND transosseous; rotator cuff repair AND (knotless OR knotted or transosseous); rotator cuff repair AND ("suture bridge" OR "suture bridging"). Data pertaining to demographic characteristics, surgical techniques, retears, and patient-reported outcomes were extracted from each study. Rates and locations of retear were reported using ranges, and risks of bias and heterogeneity for each study were assessed. RESULTS: A total of 7 studies (552 shoulders) were included. Patients had a weighted mean (± standard deviation) age of 60.5 ± 2.4 years with 27.8 ± 7.9-month follow-up. The incidence of retears ranged from 5.1% to 33.3% in patients treated with knotless TOE RCR, and the incidence for patients treated with knotted TOE RCR ranged from 7.5% to 25%. The incidence of type I retears ranged from 42.9% to 100% for patients treated with knotless TOE RCR and 20% to 100% for patients treated with knotted TOE RCR. The incidence of type II retears ranged from 0% to 57.1% in patients treated with knotless TOE RCR and 0% to 100% in patients treated with knotted TOE RCR. CONCLUSIONS: The incidence and location of retears after knotless and knotted TOE RCR appear to be similar.

Return to Sports After in Situ Arthroscopic Repair of Partial Rotator Cuff Tears.

PURPOSE: To evaluate return to sport, clinical outcomes, and complications in a series of athletes with painful partial-thickness rotator cuff tears treated with the arthroscopic in situ repair with a minimum 2-year follow-up. METHODS: Retrospective case series. Seventy-two patients who had undergone an arthroscopic in situ repair for partial-thickness rotator cuff tears were evaluated. We assessed return to sport and the level achieved after surgery. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS: The mean age was 42.2 years (range, 21-66 years), and the mean follow-up was 54 months (range, 24-113 months). Sixty-one patients (87%) were able to return to sports. Fifty-six patients (80%) returned to the same level they had previous to the injury. The mean interval between surgery and return to competition was 5.6 months. The final functional outcomes were related neither to the type of sports nor to the level of competition before the injury. All active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons score improved from 43.3 to 88.1, and the visual analog scale scores improved from 6.1 to 1.2 (P < .0001). No significant difference regarding return to sports or functional outcomes was found between articular and bursal-sided tears. Only 5 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS: In patients with partial-thickness rotator cuff tears, arthroscopic in situ repair resulted in excellent functional outcomes, with most of the patients returning to sport and at the same level they had before injury. The results were equally favorable in articular and bursal tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears.

PURPOSE: To analyze clinical outcomes, return to sports, and complications in a series of patients with painful partial-thickness rotator cuff tears treated with arthroscopic in situ repair with suture anchors who had a minimum of 8 years of follow-up. METHODS: Sixty-two patients who had undergone an arthroscopic in situ repair for partial-thickness rotator cuff tears were evaluated. All injuries involved the supraspinatus tendon. Clinical assessment consisted of glenohumeral range-of-motion measurement and the American Shoulder and Elbow Surgeons score. Pain was rated by using a visual analog scale. We assessed return to sports and the level of performance achieved after surgery. Postoperative complications were also assessed. RESULTS: Mean age was 52.4 years (range, 32 to 67 years), and mean duration of follow-up was 10.4 years (range, 8 to 12 years). All active range-of-motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons score improved from 45.6 to 85.1; and the visual analog scale scores improved from 6.4 to 1.6 (P < .0001). Thirty patients participated in sports before injury: 21 were recreational athletes and 9 were competitive athletes. Twenty-six (87%) were able to return to sports, and 24 (80%) returned to the same level they had achieved before injury. No significant difference regarding functional outcomes or return to sports was found between patients with articular-sided tears and those with bursal-sided tears. No revision surgeries were performed. Three patients had postoperative adhesive capsulitis that responded favorably to physical therapy. CONCLUSIONS: During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. Most patients return to their chosen sport at the same level they had achieved before injury. The results are equally favorable for articular-sided and bursal-sided tears. LEVEL OF EVIDENCE: IV, therapeutic case series.

Modified Latarjet Procedure Without Capsulolabral Repair for the Treatment of Failed Previous Operative Stabilizations in Athletes.

PURPOSE: To analyze time to return to sport, functional outcomes, and recurrences of the modified Latarjet procedure without capsulolabral repair in athletes with recurrent anterior shoulder instability after a failed previous operative stabilization. METHODS: We included athletes with recurrent anterior shoulder instability with a previous failed operative stabilization treated with the modified Latarjet procedure without capsulolabral repair with a minimum of 2-year follow-up. Return to sports, range of motion, the Rowe score, a visual analog scale for pain in sport activity, and the Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. RESULTS: Between June 2008 and June 2015, 68 athletes were treated with the modified Latarjet procedure without capsulolabral reconstruction for recurrent shoulder instability after a previous failed stabilization surgery. The mean follow-up was 44 months (range, 24-108 months), and the mean age at the time of operation was 26.8 years (range, 17-35 years). All the patients returned to sports, and 95% returned to the same sport they practiced before the surgery, all to the same level. No significant difference in shoulder range of motion was found between preoperative and postoperative results. The Rowe score, visual analog scale, and Athletic Shoulder Outcome Scoring System showed statistical improvement after operation (P < .001). There was no recurrence of shoulder dislocation or subluxation. The bone block healed in 92% of patients. There were 8 complications (12.3%) and 2 reoperations (3%). CONCLUSIONS: In athletes with previous failed operative stabilization procedures, the modified Latarjet without capsulolabral repair produced excellent functional outcomes with most athletes returning to sport at the same level they had before the surgery without recurrences. LEVEL OF EVIDENCE: Level IV, therapeutic, case series study.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty.

PURPOSE: To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. METHODS: Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS: Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS: In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Surgical treatment of displaced midshaft clavicular fractures with precontoured plates.

BACKGROUND: Plate fixation of displaced midshaft clavicular fractures has been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with nonoperative treatment. However hardware-related complications are a problem. The new features of the precontoured locking plates may reduce the need for hardware removal, thus maintaining the advantages of plate fixation. This study evaluated the clinical outcomes of patients with displaced midshaft clavicular fractures treated with precontoured locking plates. MATERIALS AND METHODS: From November 2008 to December 2012, we surgically treated 72 patients with displaced midshaft clavicular fractures. We retrospectively evaluated 68 patients who underwent 68 interventions. Postoperative functional outcomes were assessed with the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire, and radiographs. Pain was subjectively assessed with a visual analog scale. Complications were recorded. Patients were asked if they were able to return to their previous employment level. RESULTS: The mean follow-up period was 23.6 ± 10.7 months. The average values of the Constant, QuickDASH, and visual analog scale scores were 97.8, 1.8, and 0.4 points, respectively. At the last follow-up, 98.5% were able to return to their regular work. Of 15 complications (22.1%) that occurred, only 3 were considered as major: 1 subclavian vein extrinsic compression, 1 nonunion, and 1 hardware loosening. Hardware removal was required in 9 patients (13.2%). CONCLUSIONS: Satisfactory clinical results with a low rate of complications were achieved with precontoured locking plates for displaced midshaft clavicular fractures and a low rate of hardware removal compared with traditional plates.

Latin American formal consensus on the indications for the surgical treatment of massive and irreparable rotator cuff tears.

OBJECTIVES: To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS: The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS: The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS: The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE: V.

[Benefits of arthroscopic rotator cuff repair in octogenarians. Analysis of functional results and complications]. / Beneficios de la reparación artroscópica del manguito rotador en octogenarios. Análisis de resultados funcionales y complicaciones.

INTRODUCTION: There is a lack of information in the literature on the results of arthroscopic rotator cuff repair in patients older than 80 years. The purpose of this study was to evaluate a consecutive series of patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. METHODS: Retrospective analysis of patients older than 80 years who underwent arthroscopic rotator cuff repair between June 2004 and January 2016. The minimum follow-up was 2 years. For functional and pain assessment, the Constant, Dash, UCLA scale and Visual Analogue Scale (VAS) for pain were used. RESULTS: The average follow-up was 8.4 years. Significant improvements were obtained in the assessment of the range of motion and the evaluation of the Constant, Dash and UCLA scales, as well as in the VAS. No major complications were recorded and only 4 patients required a reoperation. CONCLUSION: The main findings obtained were functional and pain improvement in patients over 80 years of age operated on for a complete arthroscopic rotator cuff tear.

Introducción: Existe falta de información en la literatura sobre los resultados de la reparación artroscópica del manguito rotador en pacientes mayores de 80 años. El objetivo de este estudio fue evaluar una serie consecutiva de pacientes con rupturas del manguito rotador a los que se les realizó la reparación artroscópica del mismo. Métodos: Análisis retrospectivo de pacientes mayores de 80 años a quienes se les realizó reparación artroscópica de manguito rotador entre junio de 2004 y enero de 2016. El seguimiento mínimo fue de 2 años. Para la evaluación funcional y del dolor se utilizaron las escalas Constant, Dash, UCLA y Escala Visual Análoga (EVA). Resultados: El seguimiento promedio fue de 8.4 años. Se obtuvieron mejoras significativas en la valoración del rango de movilidad y la evaluación de las escalas de Constant, Dash y UCLA, y EVA. No se registraron complicaciones mayores y solo 4 pacientes requirieron una re-operación. Conclusión: Los principales hallazgos obtenidos fueron la mejoría funcional y del dolor en los pacientes mayores de 80 años operados por una ruptura completa del manguito rotador en forma artroscópica.

Glenoid index: a new risk factor for recurrence of glenohumeral instability after arthroscopic Bankart repair.

Background: The glenoid index (GI) (glenoid height to width ratio) has been shown to be a risk factor for instability in young healthy athletes. Nevertheless, whether the altered GI is a risk factor for recurrence after a Bankart repair remains unknown. Methods: Between 2014 and 2018, 148 patients ≥ 18 years old with anterior glenohumeral instability underwent a primary arthroscopic Bankart repair in our institution. We assessed return to sports, functional outcomes, and complications. We evaluate the association between the altered GI and the probabilities of recurrence in the postoperative period. Intraclass correlation coefficient was used to determine interobserver reliability. Results: The mean age at the time of surgery was 25.6 years old (19 to 29), and the mean follow-up was 53.3 months (29 to 89). The 95 shoulders who met the inclusion criteria were divided into 2 cohorts, 47 shoulders had a GI ≤ 1.58 (group A) and 48 had a GI > 1.58 (group B). At the final follow-up, 5 shoulders in group A (10.6%) and 17 shoulders in group B (35.4%) suffered a recurrence of instability. Those patients with a GI > 1.58 had a hazard ratio of 3.86 (95% confidence interval: 1.42-10.48) (P = .004) compared with those with a GI ≤ 1.58 of suffering a recurrence. When correlating GI measurements between raters, we observed an intraclass correlation coefficient of 0.76 (95% confidence interval: 0.63-0.84), these results fall under the qualitative definition of good interobserver agreement. Conclusion: In young active patients with an arthroscopic Bankart repair, an increased GI was associated with a significantly higher rate of postoperative recurrences. Specifically, those subjects with a GI > 1.58 had 3.86 times the risk of recurrence than those subjects with a GI ≤ 1.58.

Return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players.

Background: There is a shortage of relevant reports about the results obtained after shoulder stabilization in soccer players. Therefore, this retrospective study aims to report return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players. Methods: A total of 156 soccer players were treated for anterior shoulder instability at a single institution between 2008 and 2017. The Rowe score and Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Return to sport and recurrence rates were also evaluated. Results: The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after surgery (P < .001). Overall, 148 soccer players (94.8%) returned to sports, and 122 (78.2%) returned to the same level. The mean time to return to sport was 4.8 months. The recurrence rate was 5.2%. Discussion: Soccer players who underwent an arthroscopic isolated Bankart repair for anterior glenohumeral instability have shown remarkable outcomes, with most of the patients returning to sports, and at the same level they had before surgery with a low rate of recurrence.

The Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss.

Purpose: To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss. Methods: Between 2010 and 2017, 60 competitive athletes younger than 20 years old with a significant glenoid bone loss were operated with the Latarjet procedure. Return to sports, range of motion, and the Rowe and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated. Results: The mean follow-up was 58 months and the mean age was 16.3 years. Overall, 93% were able to return to sports and 84% returned at the same level. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation (P < .001). The total complication rate was 22% and the revision rate was 1.6%. The recurrence rate was 3.3%. The bone block healed in 93% of the cases. Conclusions: In competitive athletes younger than 20 years old with a significant glenoid bone loss, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences. However, this procedure is associated with a significant rate of complications and should preferably be performed by experienced surgeons.