Level IV, retrospective case series.

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Background: The treatment of anterior glenohumeral instability with a Bankart repair combined with a capsular plication is a frequently used arthroscopic technique. Latarjet created an open bone block procedure in 1954 for the treatment of anteroinferior glenohumeral instability. This procedure has been further developed by Lafosse in 2003 for arthroscopic surgery. The aim of this study is to evaluate the clinical outcome and complications of the latter procedure, most notably infection rate and nerve damage. Materials and Methods: 132 shoulders (106 males/19 females, 68 right/64 left) were included in this retrospective study. Patients were included if treatment was performed for anterior instability and if the patient's instability severity index score was at least 4, or if a revision procedure was performed after a prior unsuccessful arthroscopic or open capsule and labral repair. Treatment included the arthroscopic transfer of the coracoid process for the anterior stabilization of the shoulder joint. The disabilities of the arm, shoulder, and hand score were evaluated postoperatively in 76 patients and compared with the results found in the literature. Mean followup was 20.1 [±14.09] months. Results: The rate of recurrent glenohumeral instability which needed revision surgery after the arthroscopic Latarjet procedure was 6.1% ( n = 8). There were no severe neurovascular complications seen in our cohort. In 32 cases, re-operation was performed due to subjective discomfort because of screw impingement or postoperative shoulder stiffness. Conclusion: The all-arthroscopic Latarjet procedure developed by Lafosse is a valid and reliable method for the treatment of shoulder instability. Our favorable results indicating that this procedure can prevent chronic shoulder luxation are repeatable, and the rate of postoperative recurrence is low.

Massive rotator cuff tendon tears have a poor clinical prognosis. This holds especially true in older patients and after revision surgery. In order to reduce tears and increase long term shoulder parameters, patches made of a variety of materials have been applied to reinforce sutures in current orthopaedic practice. In a clinical study on rotator cuff surgery from 2005 to 2011 (date of surgical intervention), we tested the efficacy of three different commercial patches, with 89 patients (63 m/26 w) enrolled with a mean age of over 60. Graft Jacket, a regenerative stable human tissue scaffold, Artelon, a slow-resorbable polyurethane-urea patch and Restore, an orthobiological degradable graft, were arthroscopically implanted in order to augment the fragile tendon-bone interface after massive tears of 2 to 3 tendons (supraspinatus and/or infraspinatus and/or subscapularis). An overall repair integrity score of 75 % was achieved in primary rotator cuff surgery and of 65 % in revision surgery with either non- or slowly resorbable patches outperforming the degradable material. This effect is more marked after primary surgery. CS values indicate overall patient recovery at 6 months of 81.43 vs. 47.29 for Graft Jacket, 81.34 vs. 46.18 for Artelon and 78.45 vs. 41.93 for Restore. Subjective shoulder value (SSV) at 3 years increased to 9.11 vs. 4.32 for Graft Jacket, 9.31 vs. 3.53 for Artelon and 9.45 vs. 2.9 for Restore. No severe adverse affects were encountered. Tendons with reduced mechanical characteristics can greatly profit from patch augmentation. This holds especially true for older patients and in revision surgery. The success rate of our patch studies was up to 87 % for Graft Jacket in primary rotator cuff surgery and a minimum of 58.3 % for Restore in pure revision surgery (comparable studies/metastudies on massive rotator cuff tear repair success rates range from 43 to 59 %). This paves the way for a continued search for better and more intelligent materials. Yield load, stiffness and ultimate load will probably improve further in the very near future.

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Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery; only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.