Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

Patient reported outcome measures (PROMs) are key tools when performing clinical research and PROM data are increasingly used to inform clinical decision-making, patient-centered care, health policy and more recently, reimbursement decisions. PROMs must possess particular properties before they are used. Thus purpose of this paper is to give an overview of PROMs, their definition, how their evidence can be assessed, how they should be reported in clinical research, how to choose PROMs, the types of PROMs available in orthopaedics, where these measures can be found, PROMs in orthopaedic clinical practice and what are some key next steps in this field. If PROMs are used in accordance with the guidance in this article, I believe we will gain considerable insight into PROMs in orthopaedics and will advance this field in a way that can contribute to science, improve patient care and save considerable resources. Why Patient Reported Outcome Measures? The development, testing and implementation of tools to aid in the measurement of phenomena in medicine are central to clinical practice and clinical research. Measurements in clinical practice form the basis of diagnosis, prognosis, evaluation and follow-up. Measurements in clinical research allow for the collection of data that afford us the information needed to test specific hypotheses [1]. The field of measurement in medicine includes both psychometrics and clinimetrics [2-4]. But, it has been argued thatthere is little distinction between these two areas [3]. Throughout this paper the term psychometrics will be used and more generally the term measurement to refer to these fields.

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Abstract:Over the past few decades, there has been increased awareness of pectoralis major muscle injuries necessitating further evaluation of management options and, in particular, surgical repair. Injury typically occurs when an eccentric load is applied to the muscle, such as with bench pressing, and failure usually occurs through the tendon. Although nonoperative management is sometimes appropriate, given the injury's propensity for young, active male patients, surgical intervention is often warranted. Because the injury typically occurs at the muscle-tendon interface, surgery focuses on repair of the avulsed tendon into its anatomic attachment site. We describe the use of a unicortical suture button to repair the ruptured tendon. This technique achieves the goals of strong fixation and anatomic repair of the tendon back into its native footprint.

Caution should be used when evaluating a failed ACL graft with MRI, especially in the absence of an acute mechanism of injury, as it may be unreliable and inconsistent.