Arthroscopic Distal Clavicle Bone Bock Combined With Hill-Sachs Remplissage for Primary Anterior Shoulder Instability Treatment.

Arthroscopic distal clavicle transfer is an effective option to treat anterior shoulder instability with glenoid bone loss. The use of this free bone graft in an all-inside procedure, with a cortical button fixation makes the construct simpler to perform and allows to be combined with a Hill-Sachs Remplissage to address humeral bone defect. The morbidity of the donor site is low and provide the biologic capacity of an autograft. We report a step-by-step procedure, and the rationale are discussed.

The arthroscopic Latarjet procedure with a posterior guided system and suture-button fixation enables more precise bone block positioning in the axial plane versus anterior screws fixation.

PURPOSE: Adequate position of the bone block during arthroscopic Latarjet procedure is critical for an optimal functional outcome. However, this procedure is complex with a long learning curve. Our aim was to compare the bone block position between a dedicated glenoid posterior instrumentation and suture button fixation versus an anterior screw fixation, on a postoperative computed tomography (CT) scan. METHOD: Seventy-nine consecutive patients operated on for an anterior shoulder instability were included in this retrospective study. The same surgeon performed arthroscopically the Latarjet procedure either with an anterior drilling and screw fixation (Group A), or with a specific posterior glenoid guide pin, a posterior drilling, and a suture cortical button fixation (Group B). Evaluations were made by two independent observers. The position was evaluated by CT scan in the axial and sagittal planes. Learning curves with operative time, complications and clinical outcomes were assessed at a minimum of 2 years of follow-up. RESULTS: Thirty-five patients were included in Group A and 44 in Group B. In Group A, 27 bone blocks were flush (87.1%) and 38 in Group B (92.7%) (p < 0.01). In Group A, 72% of the bone block height was below the equator and 76%, in Group B (ns). The mean operating time was 123 ± 32.5 min in Group A and 95 ± 34.1 min in Group B (p < 0.0001). At the final follow-up, the mean aggregate Rowe score was respectively 94.6 ± 10.4 and 93.1 ± 9.8 points in Groups A and B. The mean aggregate Walch-Duplay score was respectively 94.2 ± 11.6 and 93.4 ± 10.6 points in Groups A and B. There were 11 complications (31.4%) in Group A and five complications (11.3%) in Group B (ns). CONCLUSION: The arthroscopic Latarjet procedure with a posterior drilling guided system and suture-button fixation allows more precise positioning in the axial plane than with anterior drilling and screw fixation. This posterior-guided procedure could reduce intraoperative and short-term complications. LEVEL OF EVIDENCE: Level IV.

Revision rotator cuff repair: can a Sugaya III tendon considered to be healed or not.

BACKGROUND: Sugaya et al described a classification system to assess postoperative rotator cuff tendon healing. Although Sugaya I and II tendons can be considered as healed and Sugaya type IV and V can be considered as retorn, the exact status of Sugaya III tendons remains unclear. The objective of this study was to evaluate the impact of Sugaya III tendons on postoperative functional scores in a population of patients undergoing revision rotator cuff repair. METHODS: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in one of 12 different institutions between July 2001 and December 2020. A total of 203 shoulders were included (59% males, mean age: 51 ± 8 years old, mean follow-up 11.5 years [range: 2-28.8 yr]). Fifty-four patients (61% males, mean age 52 ± 6 years old, mean follow-up 14.1 years [range: 10.4-28.8 yr]) had a follow-up ≥10 years (mean 14.1 years [range: 10.4-28.8 yr]) and were included in a long-term follow-up subgroup analysis. Structural integrity of the repaired tendon was evaluated on magnetic resonance imaging at last follow-up. Functional scores, acromiohumeral index (AHI), and progression of fatty infiltration and of osteoarthritis were compared according to Sugaya type. RESULTS: Mean Constant score and mean strength were significantly higher in Sugaya I and II tendons than in Sugaya III (P = .021 and .003) and Sugaya IV and V tendons (P = .07 and .038), but did not differ between Sugaya III and Sugaya IV and V tendons. Mean Subjective Shoulder Value, pain, AHI were significantly higher and fatty infiltration and progression in the Hamada classification were significantly lower in Sugaya I and II tendons and in Sugaya III than in Sugaya IV and V tendons (P < .05), but did not differ between Sugaya I and II and Sugaya III tendons. Similar characteristics could also be observed in the long-term follow-up subgroup. CONCLUSION: Sugaya III tendons after revision rotator cuff repair do not allow restoration of strength thereby impacting the Constant score. However, there seems to be a protective effect of Sugaya III tendons with regard to pain, progression of proximal migration of the humeral head, osteoarthritis, and fatty infiltration, which seems to last at long-term follow-up.

Latarjet in women for anterior shoulder instability: a case series analysis.

PURPOSE: The Latarjet procedure is traditionally used to treat chronic anterior shoulder instability associated with glenoid bone loss. However, few series have analyzed outcomes in a female-only population. The objective of this study was to evaluate the clinical and radiological outcomes of a Latarjet bone block in this specific population. METHODS: This single-center retrospective study included 15 women (mean age 35 ± 11.3; 19-60) reviewed with a minimum follow-up of 2 years. The procedure was performed using the open bone block screw technique (n = 7) or by arthroscopy with cortical button (n = 8). Clinical evaluation was based on active range of motion measurements, Rowe and Walch-Duplay scores, and subjective shoulder value (SSV). Radiographic analysis explored bone block healing at the last follow-up. RESULTS: At a mean follow-up of 48 months (32-86), no recurrence was reported. The mean Rowe score was 91 points (70-100), Walch-Duplay 90 points (60-100), and SSV 87% (70-100). The active mobilities reached 169° (± 9°) in elevation, 57° (± 15°) in external rotation at side, and 89° (± 6°) in abduction. The return-to-sport rate was 91%. Five patients experienced persistent anterior pain, with screws requiring hardware removal in 2 (p = 0.02). Radiological assessment detected one case of nonunion (7%). CONCLUSION: Women treated with the Latarjet procedure experienced satisfactory midterm clinical outcomes. The arthroscopic technique using cortical button fixation seems to avoid residual anterior pain requiring hardware removal.

Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study.

HYPOTHESIS: Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up. METHODS: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up. A total of 54 patients (61% males, mean age 52 ± 6 years old) met the inclusion criteria. Outcome measures included pain (visual analog scale [VAS]), range of motion (ROM), Subjective Shoulder Value (SSV), and the Constant score. Superior migration, osteoarthritis, and acromiohumeral interval (AHI) were assessed on standard radiographs. Fatty infiltration and structural integrity of the repaired tendon were evaluated on magnetic resonance imaging or computed tomographic arthrogram. RESULTS: At a mean 14.1 years (10.4-20.5), range of motion did not progress significantly in elevation and internal rotation between pre- and postoperation (158° [range, 100°-180°] to 164° [range, 60°-180°], P = .33, and L3 [range, sacrum-T12] to T12 [range, buttocks-T7], P = .34, respectively) and decreased in active external rotation from 45° (range, 10°-80°) to 39° (range, 10°-80°) (P = .02). However, VAS, SSV, and Constant score were all significantly improved at last follow-up (P < .001). AHI decreased significantly (P = .002) from 10 mm (7-14 mm) to 8 mm (0-12 mm). Two percent of the supraspinatus/infraspinatus tendons were Sugaya 1, 24% were Sugaya 2, 35% were Sugaya 3, 12% were Sugaya 4, and 27% were Sugaya 5. Goutallier score progressed for all muscles, but this did not reach significance and mean Goutallier remained <2 for all 4 muscles at last follow-up. Hamada score progressed from 0% >grade 2 preoperatively to 6% >grade 2 at last follow-up. CONCLUSION: Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. The mild progression of fatty infiltration, AHI, and Hamada score suggests that despite high retear rates (39% of stage 4 and 5 in the Sugaya classification), revision repair could possibly have a protective role on the evolution toward cuff tear arthropathy.

The arthroscopic double-button Latarjet does not modify the static posterior translation of the humeral head.

INTRODUCTION: The Latarjet procedure treats anterior instability of the shoulder and is based on a triple anterior lock, where the conjoint tendon straps the lower third of the subscapularis muscle. Excessive posterior translation of the humeral head is a known risk factor for shoulder osteoarthritis. No in vivo study has investigated the effect of the bone block on the posterior static translation of the humeral epiphysis. The purpose of this study was to evaluate the effect of the bone block on the static posterior translation of the humeral head. The hypothesis was that this procedure increased this translation. MATERIALS AND METHODS: This retrospective study included patients treated arthroscopically for anterior shoulder instability by a double-button Latarjet. An independent examiner analyzed the CT scans preoperatively, at 15 days, and at least 6 months postoperatively according to a standardized protocol. The analysis focused on the position of the bone block in the axial and coronal planes relative to the glenoid. The posterior translation was automatically calculated using the Blueprint© planning software. RESULTS: Thirty-five patients were included with a mean age of 25 years (16-43), according to a 4M/1F sex ratio. The graft was perfectly flush to the subchondral bone in 63% (n=22) of cases and subequatorial in 91% (n=32). Preoperative posterior humeral translation was 52%. The mean immediate postoperative posterior humeral translation was 56%, and 57% at more than 6 months. The change in mean posterior humeral translation between preoperative/6 months was +0.94% [-20%; +12%] (p=0.29) and immediate postoperative/6 months +0.34% [-18%; +15%] (p=0.84). Gender, hypermobility and the axial position of the bone block did not influence the change in posterior humeral translation. The equatorial position of the bone block appeared to increase posterior humeral translation by +10%±5.2% [-0.427; 20.823] (p=0.07). CONCLUSION: This work refutes our initial hypothesis. The change in static posterior humeral translation after arthroscopic Latarjet bone block remains stable at more than 6 months of follow-up. This procedure does not alter the anatomical position of the humeral head in relation to the glenoid. On the other hand, a more cranial positioning of the bone block could have an influence. LEVEL OF EVIDENCE: IV.

Tenotomy or tenodesis versus conservation of the long head of the biceps tendon in the repair of isolated supraspinatus tears: A systematic review of the literature.

BACKGROUND: Few studies have directly compared the outcomes of rotator cuff repair (RCR) with or without concomitant LHBT tenotomy or tenodesis. The aim of this literature review was to assess: (i) whether an adjuvant procedure on the LHBT at the time of RCR gives better functional results than RCR alone; and (ii) whether reoperation rates are higher after RCR alone or RCR+tenotomy or tenodesis. METHODS: A literature search was carried out on PubMed, MEDLINE, Embase, Web of Science and the Cochrane database for papers published in English or French between 1st January, 2010, and 31st December, 2021. Included studies compared the results of RCR alone with RCR+concomitant tenotomy or tenodesis in patients with tears of the supraspinatus tendon or rotator cuff. ARTICLES: A total of 626 articles were identified in the literature search and 168 were retained for more detailed examination. Forty-seven articles were read in their entirety and nine articles comparing RCR with or without concomitant tenotomy or tenodesis of the LHBT were retained for the analysis. RESULTS: Nine articles comparing the results of RCR alone versus RCR+LHBT tenotomy or tenodesis were reviewed. The majority of patients were more than 50 years old and male. The rate of lesions to the LHBT in the studies included ranged from 26.8-60.2%. Eight of the nine studies compared the functional results of RCR alone versus RCR+tenotomy or tenodesis, with six reporting no significant difference, one reporting better outcomes after concomitant biceps surgery and one reporting worse outcomes after a biceps procedure. DISCUSSION: This review did not provide a strong answer to our questions, owing to the heterogenicity of clinical evaluation and low level of evidence of the studies. However, it appears that in the absence of biceps pathology or in the presence of small lesions, the LHBT could be preserved. The rate of revision did not seem to be higher and cuff healing lower in this situation. Therefore, further randomized studies are required to identify the role of concomitant procedure of the biceps in case of small isolated supraspinatus repair. LEVEL OF EVIDENCE: III; systematic review.

Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players.

Background: Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. Hypothesis: The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results: The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion: The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

Reverse shoulder arthroplasty renders better clinical scores at a minimum follow-up of two years for patients with no rotator cuff deficiency operated by the deltopectoral approach.

PURPOSE: The purpose of this multi-centre study was to report outcomes of a large cohort of reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years and to determine patient and surgical factors that influence postoperative outcomes. The hypothesis was that surgical indication, surgical approach, and implant design would affect clinical outcomes significantly. METHODS: The authors reviewed records of 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff (RC) tears, secondary OA due to RC tears, and irreparable massive rotator cuff tears (mRCT). The deltopectoral (DP) approach was used in 540 and the anterosuperior (AS) approach in 203. Pre- and postoperative Constant scores (CS) were recorded. Multivariable linear analyses were performed to determine if CS was associated with indications for surgery, surgical approach, or implant design. RESULTS: Of the 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised, leaving 501 for analysis. At a mean follow-up of 3.2 ± 0.9 years, net improvement in CS was 29.2 ± 17.0. Multivariable analyses revealed that postoperative CS decreased with age and was worse in shoulders that had preoperative rotator cuff deficiency and in shoulders operated by the AS approach. Multivariable analyses also revealed worse net improvement in shoulders operated for secondary OA due to RC tears or for irreparable mRCT, as well as shoulders operated by the AS approach. CONCLUSION: This large multi-centre study confirms that, at two or more years following RSA, Constant scores are not associated with implant design, but rather with rotator cuff deficiency and surgical approach. Multivariable analysis revealed that postoperative CS was worse for shoulders with preoperative rotator cuff deficiency and for shoulders operated by the AS approach. Multivariable analysis also revealed that net improvement in CS was worse in shoulders treated for secondary OA due to RC tears and for shoulders with irreparable mRCT, as well as for shoulders operated by the AS approach.

Incongruity of the scapulohumeral arch: an indirect sign of posterior subluxation of the humeral head in primary glenohumeral osteoarthritis.

BACKGROUND: In symptomatic glenohumeral osteoarthritis, arthroplasty is the gold standard to restore a mobile and painless shoulder. The kind of arthroplasty chosen is mainly based on the evaluation of the rotator cuff and the type of glenoid. The aim of this study was to analyze the scapulohumeral arch in primary glenohumeral osteoarthritis (PGHOA) with an uninjured cuff and to determine whether posterior humeral subluxation influences the Moloney line, which corresponds to an intact scapulohumeral arch. MATERIALS AND METHODS: Between 2017 and 2020, 58 anatomic total shoulder arthroplasties were implanted in the same center. We included all patients with complete preoperative imaging (radiographs and magnetic resonance imaging or arthro-computed tomography scans) assessing an intact rotator cuff. A total of 55 shoulders that had undergone surgery with a total anatomic shoulder prosthesis were analyzed after determination of the type of glenoid in the frontal plane according to the Favard classification on an anteroposterior radiograph and in the axial plane according to the Walch classification on computed tomography scans. The grade of osteoarthritis was evaluated according to the Samilson classification. We analyzed whether there was a rupture of the Moloney line on the frontal radiograph and assessed the acromiohumeral distance. RESULTS: After preoperative analysis of 55 shoulders, 24 shoulders had type A glenoids and 31 had type B glenoids. Scapulohumeral arch rupture was observed in 22 shoulders, and posterior subluxation of the humeral head was found in 31 shoulders, of which 25 had type B1 glenoids and 6 had type B2 glenoids according to the Walch classification. Most glenoids were type E0 (n = 47.85%). Incongruity of the Moloney line was more frequent in shoulders with type B glenoids (20 of 31 [65%]) than those with type A glenoids (2 of 24 [8%], P < .001). No patient with a type A1 glenoid (0 of 15) had a rupture of the Moloney line, and only 2 patients with a type A2 glenoid (2 of 9) had incongruity of the scapulohumeral arch. CONCLUSION: In PGHOA, rupture of the scapulohumeral arch seen on anteroposterior radiographs, also known as the Moloney line, may be an indirect sign of posterior humeral subluxation, corresponding to a type B glenoid per the Walch classification. Incongruity of the Moloney line may indicate a rotator cuff injury or posterior glenohumeral subluxation with an intact cuff in PGHOA.

Scapular fractures osteosynthesis via Judet's posterior approach: clinical and radiographic results.

PURPOSE: Scapular fractures are uncommon and mainly treated nonoperatively. Judet's posterior approach allows access to the fracture site through the infraspinatus fossa and may be a technical option when ORIF is decided. The aims of this study were to determine clinical and radiographic outcomes of patients who underwent scapular body and/or glenoid fractures fixation via Judet's posterior approach. METHODS: We conducted a retrospective single-centre study, and all patients admitted for scapular fracture who underwent osteosynthesis via Judet's approach between January 2014 and September 2021 were included. At a minimum follow-up of one year, clinical outcomes were analyzed through subjective shoulder value (SSV) and Constant-Murley score (CMS). Strength in external rotation was measured in adduction and in 90° abduction and compared to healthy side. Radiographic analysis evaluated postoperative fracture reduction on CT scan and glenohumeral osteoarthritis according to Samilson's classification at last follow-up. RESULTS: Twenty-one patients were included with a mean follow-up of 44.9 months. Mean SSV, CMS, and adjusted CMS were 73.8% ± 21.0, 65.8 points ± 19.5, and 72.8% ± 20.8, respectively. Strength in external rotation in adduction of the affected shoulder showed significant impairment when compared with the contralateral side (respectively 7.79 kg ± 4.29 and 12.0 kg ± 3.84, p = 0.02). All fractures healed uneventfully, but five patients (23.8%) required early revision surgery for intra-articular screws in three. Intra-articular gap measure decreased from 3.75 mm ± 1.93 in preoperative to 0.59 mm ± 0.97 after ORIF. The rate of arthritis was 15% at last follow-up. CONCLUSION: Patients who underwent scapular fracture osteosynthesis via Judet's posterior approach exhibited satisfactory but incomplete recovery of the affected shoulder as evidenced by functional scores and external rotation strength measurements at a mean follow-up of 44.9 months. Because of the risk of intra-articular screws, postoperative CT scan is mandatory.

Midterm outcomes allograft prosthetic composite reconstruction for massive bone loss at the elbow.

BACKGROUND: Revision of a loose total elbow arthroplasty (TEA) is challenging, particularly in the context of massive bone loss (MBL). The use of an allograft prosthetic composite (APC) at the elbow is rare, typically reserved as a salvage procedure for MBL. Thus, limited data describing the outcomes of APCs are available in current literature. HYPOTHESIS: The authors hypothesize that short to midterm clinical outcomes of APC for MBL about the elbow are satisfactory. PATIENTS AND METHODS: Between 2009 and 2018, 6 APCs implanted with a semi-constrained Coonrad Morrey prosthesis were performed in 5 females and 1 male. Median patient age was 70 years (range, 49-76 years). The indication for revision was aseptic loosening in all 6 cases (6 humeral and 2 ulnar). Median follow-up was 3.5 years (range, 2-6.7 years). Functional outcomes including Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), range of motion (ROM), and radiographic outcomes were assessed for all patients. RESULTS: Median MEPS and VAS scores were 75 (range, 40-90), and 0 (range, 0-8) at latest follow-up, respectively. Median postoperative flexion-extension and prono-supination arcs were 90̊ (range, 70-140̊) and 150 (range, 100-160̊), respectively. Allograft incorporation was noted in 5 (83%) patients; all prostheses were well-fixed. In total, 4 patients (63%) experienced 5 complications (83%) including periprosthetic fracture (n=2), ulnar neuropathy (n=1), aseptic loosening (n=1), and wound dehiscence (n=1). Two (33%) required reoperation with prosthetic retention. CONCLUSION: Elbow reconstruction using allograft prosthetic composite is a viable option for patients with MBL following TEA. The midterm functional outcomes are satisfactory with no revisions required, despite a relatively high rate of complications. Further long-term studies with larger cohorts are needed to better elucidate long-term outcomes and reasons for failure. LEVEL OF EVIDENCE: IV; therapeutic study (case series [no, or historical, control group]).

Which preoperative factors influence the patient's short-term subjective assessment after rotator cuff repair?

INTRODUCTION: To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing. HYPOTHESIS: Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing. METHODS: With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV>85%); and 47 patients in the second group (SSV<85%). RESULTS: In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p=0.002], fatty infiltration [-3.65 (-6.24 -1.06) p=0.006] and workers compensation [-19.15 (-24.04; -14.27) p<0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) CONCLUSIONS: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction. LEVEL OF EVIDENCE: IV, cohort study.

What treatment for humeral shaft non-union? Case-series assessment of a strategy.

INTRODUCTION: Humeral shaft non-union is frequent, with severe clinical impact. Management, however, is poorly codified and there is no clear decision-tree. HYPOTHESIS: Analyzing our experience over the last 15years could enable a reproducible strategy to be drawn up, with a decision-tree based on the 2 main causes: failure of internal fixation, and infection. MATERIAL AND METHOD: Sixty-one patients were included in a retrospective cohort, with a mean 94 months' follow-p. The treatment strategy was based on screening first for infection then for mechanical stability deficit in case of prior internal fixation. Any fixation revision was associated to cancellous autograft. In case of suspected or proven infection, 2-stage treatment was implemented. In case of primary non-operative treatment, the strategy was based on the non-union risk on the Non-Union Scoring System (NUSS), with internal fixation and possible graft. RESULTS: There were 6 failures, for a consolidation rate of 90%; excluding patients not managed according to the study protocol, the consolidation rate was 95%. There was 1 case of spontaneously resolving postoperative radial palsy, and 3 patients required surgical revision. DISCUSSION: The present strategy achieved consolidation in most cases, providing the surgeon with a decision-tree for these patients. Infectious etiologies are often overlooked and should be a focus of screening. LEVEL OF EVIDENCE: IV, retrospective or historical series.

Long-term results of arthroscopic Bankart repair with Hill-Sachs remplissage.

Background: Arthroscopic Bankart repair with Hill-Sachs remplissage (BHSR) is suggested for the treatment of anterior shoulder instability in the presence of an engaging humeral lesion. The objective of this study is to report the long-term clinical and radiological results of this procedure. Methods: This is a single-center retrospective study including 51 patients who underwent surgery by BHSR for anterior shoulder instability with engaging Hill-Sachs lesion and who were reviewed after a minimum follow-up of 5 years. The mean age was 26 years (16-49; ±8.4) and 70% of the patients practiced sports. The average for Instability Severity Index score was 3.3 points (3-7; ±1.7). At the last follow-up, active range of motion, Subjective Shoulder Value, Walch-Duplay and Rowe scores, and the incidence of osteoarthritis according to the Samilson classification were assessed. Results: At a mean follow-up of 87 months (60.0-124; ±17), 83% of the patients had resumed their sports activities. The mean Rowe, Walch-Duplay, and Subjective Shoulder Value scores were respectively 88 points (51-100; ±12), 82 points (50-100; ±16.4), and 89% (50-100; ±8). There was a recurrence of dislocation or subluxation for 8 patients (15.6%). In univariate analysis, patients who were unstable at follow-up had a deeper Hill-Sachs lesion (25% vs. 18% of the humeral head radius, P = .04) and were younger (19 vs. 27 years, P = .04). Radiographically, 17% of the patients showed signs of osteoarthritis (14% grade 1). Conclusion: Considering that at a follow-up of more than 5 years, the failure rate was more than 15% of the BHSR, this procedure should be recommended with caution in case of deep Hill-Sachs lesions in young patients. The incidence of osteoarthritis after this procedure was acceptable, with few severe forms.

Arthroscopic Latarjet With Cortical Buttons Versus Open Latarjet With Screws: A Short-Term Comparative Study.

BACKGROUND: The arthroscopic bone block procedure according to Latarjet remains a controversial subject, and few comparative studies have demonstrated the benefit of arthroscopy over open surgery. PURPOSE/HYPOTHESIS: The objective of this study was to compare both procedures by analyzing the short-term clinical results. The hypothesis was that the arthroscopic procedure is superior to the standard open procedure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: This was a retrospective comparative study. Patients treated for chronic anterior instability by arthroscopic Latarjet with double cortical buttons (group A) or open Latarjet with screws (group O) with a minimum follow-up of 12 months were included. Intraoperative (duration, complications) and postoperative (complications, pain, mobility, functional scores, resumption of sport, Patient and Observer Scar Assessment Scale scar aesthetics, satisfaction) data were compared. RESULTS: In total, 50 patients were included (n = 24 in group A, n = 26 in group O). Operating time was longer in group A (103 vs 61 min; P = .001). The average number of days on analgesics was higher in group A (8.9 vs 5.3 days; P = .04). The complication rate was similar for the 2 groups (12.5% vs 27%; P = .46). At 3 months, the loss of external rotation was greater in group A (-33° vs -18°; P = .01), and resumption of sports was less frequent (11% vs 48%; P = .01). At 12 months, the average scores were excellent, with no significants differences between the 2 groups: Walch-Duplay average, 90 points; Rowe, 94 points; Subjective Shoulder Value (SSV), 92.5%; sport SSV, 85%; and Patient and Observer Scar Assessment Scale score, 17.2 points. CONCLUSION: Over the short term, this comparative study did not prove the superiority of the cortical-button arthroscopic Latarjet procedure over the open Latarjet procedure. A delay in the resumption of sports, longer time to recover range of motion, and no benefit regarding postoperative pain or the aesthetic aspect of the scar were observed in this study with the arthroscopic procedure.

Mechanical behavior of hybrid glenoid components compared to all-PE components: a finite element analysis.

PURPOSE: The purpose of this finite element study was to compare bone and cement stresses and implant micromotions among all-polyethylene (PE) and hybrid glenoid components. The hypothesis was that, compared to all-PE components, hybrid components yield lower bone and cement stresses with smaller micromotions. METHODS: Implant micromotions and cement and bone stresses were compared among 4 all PE (U-PG, U-KG, A-KG, I-KG) and 2 hybrid (E-hCG, I-hPG) virtually implanted glenoid components. Glenohumeral joint reaction forces were applied at five loading regions (central, anterior, posterior, superior and inferior). Implant failure was assumed if glenoid micromotion exceeded 75 µm or cement stresses exceeded 4 MPa. The critical cement volume (CCV) was based on the percentage of cement volume that exceeded 4 MPa. Results were pooled and summarized in boxplots, and differences evaluated using pairwise Wilcoxon Rank Sum tests. RESULTS: Differences in cement stress were found only between the I-hPG hybrid component (2.9 ± 1.0 MPa) and all-PE keeled-components (U-KG: 3.8 ± 0.9 MPa, p = 0.017; A-KG: 3.6 ± 0.5 MPa, p = 0.014; I-KG: 3.6 ± 0.6 MPa, p = 0.040). There were no differences in cortical and trabecular bone stresses among glenoid components. The E-hCG hybrid component exceeded micromotions of 75 µm in 2 patients. There were no differences in %CCV among glenoid components. CONCLUSIONS: Finite element analyses reveal that compared to all-PE glenoid components, hybrid components yield similar average stresses within bone and cement. Finally, risk of fatigue failure of the cement mantle is equal for hybrid and all-PE components, as no difference in %CCV was observed. LEVEL OF EVIDENCE: IV, in-silico.

Arthroscopic double-button Latarjet osteolysis and remodeling at 1-year follow-up.

HYPOTHESIS: The aim of this study was to evaluate the osteolysis rate, graft remodeling, and risk factors for osteolysis at the 1-year threshold after an arthroscopic Latarjet procedure with double-button fixation. METHOD: In this multicenter, retrospective study, postoperative computed tomography scans obtained after an arthroscopic Latarjet procedure with double-button fixation to treat anterior shoulder instability were analyzed at 15 days and at 3, 6, and 12 months. Graft volume, dimensions, and morphologic remodeling were analyzed. RESULTS: Twenty-seven patients were included (mean age, 26 years). At 1 year, osteolysis occurred in 19 of 27 patients (70%). The volume initially decreased until 6 months' follow-up (-35%; range, -75% to +26%) and then increased until our last follow-up. At 1 year, the graft volume decreased by 17% (range, -61% to +56%) compared with the immediate postoperative volume. In multivariate analysis, the rate of osteolysis was inversely associated with an unhealed graft at 3 months (P = .02; ß coefficient = -44.50 [95% confidence interval, -81 to -8]). The maximal height of the graft significantly grew 0.2 cm (range, -55 to +124 mm) (P = .015). In the sagittal plane, osteolysis occurred in the superior part in 100% of patients (27 of 27) whereas bone formation occurred in the inferior part. In the axial plane, osteolysis occurred in the anterior part whereas bone formation occurred in the posterior part. In the articular part, the observed remodeling was aimed to obtain a new anatomic and congruent glenoid. CONCLUSIONS: At 1 year after an arthroscopic Latarjet procedure with double-button fixation, osteolysis occurred in 70% of patients. The rate of osteolysis was 17% of the initial volume. Osteolysis occurred mainly during the first 6 months, in the anterior and superior parts. Remodeling led to a circular anatomic glenoid. This osteolysis did not cause any recurrence of instability or require revision surgery.

Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft.

PURPOSE: In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation. METHODS: A multicentric retrospective study of consecutive SCR's performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI). RESULTS: A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9 months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure. CONCLUSIONS: In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate. LEVEL OF EVIDENCE: IV. Retrospective case series, treatment study.

Does intraoperative ultrasound help the surgeon in arthroscopic excision of rotator cuff tendon calcifications ?

PURPOSE: Arthroscopic excision of rotator cuff tendon calcifications is a common procedure in cases where medical treatment has failed. The objective of this study was to evaluate how intraoperative ultrasound contributes to improving the interventional procedure. Our hypothesis was that through the use of ultrasonography the frequency of postoperative residual calcium deposits could be reduced without increasing operating time. METHODS: In a non-randomized single-operator comparative study, 56 patients who underwent arthroscopic excision of calcification were retrospectively included: group 1 (n = 20) without ultrasound guidance and group 2 (n = 36) with guidance. Operating time was measured and localization failures noted. Radiological follow-up was carried out with x-ray images at conventional angles and ultrasound at 1.5, 3 and 6 months postoperatively. Clinical follow-up was based on the Constant score (CS) at 6 months. RESULTS: The mean operating time was 18 min in group 1 (9-33 ± 8.1) and 22 min in group 2 (10-48 ± 7.7) (p = 0.03). The rate of failure to identify calcifications was 8% and 2% in groups 1 and 2, respectively (p = 0.22). At 6 months, four calcifications were still visible on radiography in group 1 vs 1 in group 2 (20% vs 2.7%, p = 0.03). The mean CS increased from 35 to 81 points in group 1 (p < 0.001) and from 34 to 82 points in group 2 (p < 0.001). CONCLUSION: Despite an increase in operating time, intraoperative ultrasound improves the process of excising rotator cuff intratendinous calcifications, prevents localization failures and enables a more complete extraction.