Francesco Caranzano

Arthroscopic Bankart Repair Versus Open Bristow-Latarjet for Shoulder Instability: A Matched-Pair Multicenter Study Focused on Return to Sport.

Background: The arthroscopic Bankart repair and open Bristow-Latarjet procedure are the 2 most commonly used techniques to treat recurrent shoulder instability. Purpose: To compare in a case control–matched manner the 2 techniques, with particular emphasis on return to sport after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A study was conducted in 2 hospitals matching 60 patients with posttraumatic recurrent anterior shoulder instability with a minimum follow-up of 2 years (30 patients treated with arthroscopic Bankart procedure and 30 treated with open Bristow-Latarjet procedure). Patients with severe glenoid bone loss and revision surgeries were excluded. In one hospital, patients were treated with arthroscopic Bankart repair using anchors; in the other, patients underwent the Bristow-Latarjet procedure. Patients were matched according to age at surgery, type and level of sport practiced before shoulder instability (Degree of Shoulder Involvement in Sports [DOSIS] scale), and number of dislocations. The primary outcomes were return to sport (Subjective Patient Outcome for Return to Sports [SPORTS] score), rate of recurrent instability, Oxford Shoulder Instability Score (OSIS), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI), and range of motion (ROM). Results: After a mean follow-up of 5.3 years (range, 2-9 years), patients who underwent arthroscopic Bankart repair obtained better results in terms of return to sport (SPORTS score: 8 vs 6; P = .02) and ROM in the throwing position (86° vs 79°; P = .01), and they reported better subjective perception of the shoulder (SSV: 86% vs 75%; P = .02). No differences were detectable using the OSIS or WOSI. The rate of recurrent instability was not statistically different between the 2 groups (Bankart repair 10% vs Bristow-Latarjet 0%; P = .25), although the study may have been underpowered to detect a clinically important difference in this parameter. The multiple regression analysis showed that the independent variables associated with return to sport were preoperative DOSIS scale, type of surgery, and recurrent dislocations after surgery. Patients who played sports with high upper extremity involvement (eg, swimming, rugby, martial arts) at a competitive level (DOSIS scale 9 or 10) had a lower level of return to sport with both repair techniques. Conclusion: Arthroscopic stabilization using anchors provided better return to sport and subjective perception of the shoulder compared with the open Bristow-Latarjet procedure in the population studied. Recurrence may be higher in the arthroscopic Bankart group; further study is needed on this point.

Glenohumeral instability and rotator cuff tear.

The prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, a likely consequence of the age-associated deterioration of the structure and mechanical properties of the tendons of the rotator cuff. These are the effective stabilizers of the glenohumeral joint, compressing the humeral head in the 3-dimensional concavity of the glenohumeral joint. It is impossible to establish whether a lesion of the capsular-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the “terrible triad” of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion.

Importance of neurological evaluation before reverse shoulder arthroplasty in patients with previous poliomyelitis

We present a case report of a patient, affected by post-polio syndrome and cuff tear arthropathy of his right shoulder, who underwent reverse shoulder arthroplasty. A previous radial deficiency was unmasked in the post-operative follow-up, with passive elbow bending when the forearm was put in an antigravitational position. A precise preoperative neurological evaluation is mandatory in shoulder replacement in order to estimate the functional outcome after surgery.

Subacromial widening osteotomy of the scapular spine: surgical technique and literature review.

Scapular fractures are usually treated non-operatively with short-term sling immobilisation and early active motion. However, some patterns of fracture require surgical reduction and internal fixation with plates and screws. These fracture patterns are rare, and there are few reports regarding long-term outcome of non-operative treatment or the management of the severe malunion which may follow. The definition of malunion is related to fracture type (spine, glenoid neck). We have found no relevant epidemiological data in the literature. In this paperwe have focused on fractures of the lateral scapular spine (type III) that tend to heal with a downwards malalignment of the acromial fragment. This malunion reduces the subacromial space and alters the normal kinematics of the acromioclavicular and scapulothoracic joints, presenting clinically as a pseudo scapular winging related to the deformity (the lateral fragment is often anteriorly rotated). This anatomical situation can give rise to considerable pain, disability and weakness, with dysfunction of the rotator cuff, trapezius, deltoid and rhomboid muscles and consequent loss of normal range of movement of the shoulder. Clavicular involvement (clavicular malunion or acromioclavicular dislocation) may be also be present and can lead to discomfort and instability. We report on a technique for subacromial opening osteotomy of the scapular spine, which raises the acromion and restores anatomical geometry after varus malunion of the acromion.