Arthroscopic anterior shoulder stabilization with percutaneous assistance and posteroinferior capsular plication.

To study the technique and clinical outcomes of arthroscopic shoulder stabilization with anterior labral repair and percutaneous posteroinferior capsular plication, we retrospectively reviewed 20 cases. Mean (SD) final postoperative follow-up was 3.4 (0.6) years (range, 2.7-5.1 years). A mean (SD) of 4.9 (0.9) suture anchors (range, 4-7) was used during surgery, with 1.6 (0.7) (range, 1-3) devoted to the posteroinferior plication. There were statistically significant improvements in forward elevation (P = .016) and internal rotation (P = .018) from before surgery to final postoperative follow-up; external rotation did not change (P = .336). Significant improvements (P < .001) were also seen in visual analog scale pain ratings, American Shoulder and Elbow Surgeons survey scores, and Simple Shoulder Test scores. Mean (SD) Rowe instability score at final follow-up was 81.1 (28.9). Eighty-five percent of the patients returned to sport at or above preinjury level, and 70% returned to a degree of athletic physical contact at or above preinjury level. Two cases (10%) were categorized as treatment failures (redislocation). Percutaneously assisted arthroscopic anterior stabilization with posteroinferior capsular plication produces acceptable results, with functional outcomes and redislocation rates comparable to those reported in the literature.

Precontoured plating of clavicle fractures: decreased hardware-related complications?

BACKGROUND: Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal. QUESTIONS/PURPOSES: We compared the outcomes after precontoured and noncontoured superior plating of acute displaced midshaft clavicle fractures. Primary outcomes were rate of plate prominence, rate of hardware removal, and rate of complications. Secondary outcomes were ROM and pain and function scores. PATIENTS AND METHODS: We retrospectively reviewed 52 patients with 52 acute, displaced midshaft clavicle fractures treated with either noncontoured or precontoured superior clavicle plate fixation. Fourteen patients with noncontoured plates and 28 with precontoured plates were available for followup at a minimum of 1 year postoperatively. Postoperative assessment included ROM, radiographs, and subjective scores including visual analog scale for pain, American Shoulder and Elbow Surgeons questionnaire, and Simple Shoulder Test. RESULTS: Patients complained of prominent hardware in nine of 14 in the noncontoured group and nine of 28 in the precontoured group. Hardware removal rates were three of 14 in the noncontoured group and three of 28 in the precontoured group. Postoperative ROM and postoperative subjective scores were similar in the two groups. CONCLUSIONS: Precontoured plating versus noncontoured plating of displaced midshaft clavicle fractures results in a lower rate of plate prominence in patients who do not undergo hardware removal. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Isolated rupture of the teres major tendon.

Acute isolated rupture of the teres major is an uncommon injury. This article presents the first report of midterm subjective and objective functional results following nonoperative management of an isolated teres major rupture. A 30-year-old right hand dominant man presented after a waterskiing traction injury to his left upper extremity. On physical examination, the patient had swelling and retraction of the teres major at the lower scapular border, which was accentuated with resisted adduction of the extremity. His teres major attachment at the humerus was not palpable. Magnetic resonance imaging revealed an isolated teres major tendon rupture. The patient was treated non-operatively with a rehabilitation protocol emphasizing rotator cuff, periscapular, and latissimus muscle strengthening. By 3 months postinjury, the patient had returned to all of his usual sporting activities, despite a persistent muscle retraction deformity over the teres major. At 3-year follow-up, the patient had no subjective complaints in the injured extremity and excellent functional outcome scores. A mean 37 kg loss of internal rotation strength (as measured by dynamometer) in the affected extremity with the arm abducted to 90° existed, although this difference was not subjectively appreciable. Although previously published reports have presented various options for the management of teres major injuries, the present case demonstrates that nonoperative treatment can produce excellent midterm subjective results in spite of objective internal rotation weakness.

Treatment of glenohumeral arthrosis.

The successful diagnosis and treatment of glenohumeral arthrosis in the young and active patient can be challenging to even the most experienced of clinicians. A thorough preoperative evaluation, including a detailed understanding of patient expectations, facilitates the selection of a treatment strategy. Arthroscopy is the gold standard for detecting chondral injuries, and it is increasingly used as an effective first line of management. In patients who fail arthroscopic debridement and reparative techniques, further treatment should proceed with an algorithmic decision-making approach encompassing patient-based and disease-based factors. Restorative and reconstructive techniques may provide improvements in pain and functional outcome while delaying the need for total shoulder arthroplasty, although the longevity of these treatments has yet to be established in the literature. Hemiarthroplasty and total shoulder arthroplasty have historically proven to be the most durable and reliable options in properly selected patients. However, concerns about progressive glenoid erosion and glenoid component loosening have led many to pursue alternative nonarthroplasty techniques for the management of arthrosis in active young individuals.

Open capsular shift: there still is a role!

As our understanding of the pathoanatomy of glenohumeral instability has improved, surgical techniques for the treatment of anterior instability have progressed. Many stabilization procedures are now successfully performed arthroscopically; open capsular shift, however, continues to play an important role in the management of instability in certain patients, providing an accurate and selective means of capsular plication. When performed with proper surgical technique, shoulder range of motion can be preserved with low recurrence rates and high subjective satisfaction, making the open capsular shift a durable and effective option in the modern management of shoulder instability.