Ettore Taverna

The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears.

To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major lesions (that required operative treatment, changed postoperative rehabilitation, or altered the expected end result) noted at arthroscopic examination were osteoarthritis in nine patients, partial biceps tendon tears in three, labrum tears in three, Bankart lesions in two, superior labrum anterior posterior lesions in five, and glenohumeral synovitis in three patients. Glenohumeral arthroscopy can provide valuable information in patients with a complete rotator cuff tear.

Arthroscopic Rotator Interval Repair in Glenohumeral Instability: Description of an Operative Technique

Rotator interval tear is one of the lesions identified in patients with glenohumeral instability. We present our technique for arthroscopic repair that eliminates entry into the subacromial space and allows the surgeon to suture the rotator interval under direct intra-articular vision.

Arthroscopic treatment of rotator cuff tear and greater tuberosity fracture nonunion

The association of full-thickness rotator cuff tear combined with a nonunion of the greater tuberosity is uncommon. We present one case, describing management of both lesions using arthroscopic technique.

Arthroscopic Bone Graft Procedure for Anterior Inferior Glenohumeral Instability

There are many described surgical techniques for the treatment of recurrent anterior shoulder instability. Numerous authors have performed anterior bone block procedures with good results for the treatment of anterior shoulder instability with glenoid bone loss. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and the best possible outcome for external rotation. We describe an arthroscopic anteroinferior shoulder stabilization technique with an iliac crest tricortical bone graft and capsulolabral reconstruction. It is an all-arthroscopic technique with the advantage of not using fixation devices, such as screws, but instead using special buttons to fix the bone graft. The steps of the operation are as follows: precise placement of a specific posterior glenoid guide that allows the accurate positioning of the bone graft on the anterior glenoid neck; fixation of the graft flush with the anterior glenoid rim using specific buttons under arthroscopic control; and finally, subsequent capsular, labral, and ligament reconstruction on the glenoid rim using suture anchors and leaving the graft as an extra-articular structure.

One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation

This case presents the challenges of the surgical management for a patient with a history of recurrent posterior shoulder instability and subsequently traumatic anterior dislocation. The patient was already on the waiting list for an arthroscopic posterior stabilization with anchors, when a car accident caused an additional anterior shoulder dislocation. This traumatic anterior dislocation created a bone loss with a glenoid fracture and aggravated the preexisting posterior instability. In order to address both problems, we decided to perform an arthroscopically assisted Latarjet procedure for anterior instability and to stabilize with a bone graft for posterior instability. To our best knowledge, this type of surgical procedure has so far never been reported in the literature. The purpose of this report is to present the surgical technique and to outline the decision making process.

Arthroscopic Reduction with Endobutton Fixation for Glenoid Fracture

Glenoid rim fractures, accompanied by acute glenohumeral dislocation or subluxation usually results in persistent instability. Traditionally open reduction and internal fixation has been recommended in displaced intra-articular glenoid fractures. However, open reduction is difficult, and it may not be possible to address the associated intra-articular soft-tissue injuries. A few reports of arthroscopic-assisted fixation of these fractures have been recently published. The most anatomic method for addressing an acute glenoid rim lesion is a reduction (either open or arthroscopic) and internal fixation. We are reporting a case of arthroscopic reduction and fixation of a glenoid fracture utilizing Endobuttons with clinical and radiological results at 18 months follow-up.

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement

Background The effectiveness of the Latarjet largely depends on accurate graft placement, as well as on proper position and direction of the screws. We present our technique for an arthroscopically-assisted Latarjet comparing radiological results with the open technique. Methods We retrospectively reviewed the postoperative computed tomography scans of 38 patients who underwent a Latarjet procedure. For 16 patients, the procedure was performed with the open technique and, for 22 patients, it was performed using an arthroscopically-assisted technique. An independent radiologist evaluated graft and hardware position, as well as graft integration or resorption. Postoperative complications were also documented. Results The graft was correctly placed in only 18.8% of cases in the open group and 72.7% of cases in the arthroscopically-assisted group. There were no postoperative complications in the arthroscopically-assisted group, whereas one patient had a recurrence and two required hardware removal in the open group. Conclusions The Latarjet procedure is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck and correct position of the screws. The present study substantiates a clear benefit for the use of a guide with an arthroscopically-assisted technique in terms of graft and hardware placement. At short-term follow-up, there appears to be a benefit for graft integration and avoidance of resorption.

Failed Open Anterior Instability Repair: Case Example

The Latarjet procedure is the most used surgical procedure to address anterior shoulder instability with bone loss. This procedure is more commonly performed in an open fashion, albeit arthroscopically assisted or arthroscopic Latarjet is currently used. A failed open Latarjet procedure can be successfully treated with an arthroscopic bone block procedure. After hardware removal and the preparation of the glenoid rim, a bone allograft or autograft from the iliac crest is placed on the anterior margin of the glenoid with the help of an arthroscopic guide, and its fixation is obtained with a double-button system, tensioned with a dedicated device. At the end of the procedure, a standard soft tissue repair is performed with arthroscopic suture anchors.

Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect

Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this Technical Note is to present an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation for treating glenohumeral instability with glenoid bone loss and anterior capsulolabral deficiency. Two glenoid tunnels are set up from the posterior to the anterior side using a dedicated bone block guide, and 4 buttons are used to fix the graft to the glenoid. The subscapularis tenodesis is performed using a suture tape anchor. This combined arthroscopic technique (bone block associated with arthroscopic subscapularis augmentation) could be a valid and safe alternative to the arthroscopic or open Latarjet procedures.

Biceps Tendinopathy (ICL 2)

The long head of the biceps is the common entry landmark when starting a shoulder arthroscopy. Sometimes it may be tricky to differentiate between normal biceps, an innocent congenital variant and a pathological tendon.