BACKGROUND:This study aims to evaluate the outcomes of arthroscopically assisted latissimus dorsi (LD) transfer for massive rotator cuff tears involving irreparable subscapularis tendon tears. METHODS:This case series study was conducted at a specialized Shoulder Unit in Paris from June 2014 to January 2023 to evaluate outcomes of LD transfer for irreparable subscapularis tendon tears. The primary outcome was the Constant score; secondary outcomes included visual analog scale, subjective shoulder value, and satisfaction levels. A subgroup analysis was performed to compare postoperative outcomes between patients with reparable versus irreparable supraspinatus tendons. Additionally, all complications were recorded. RESULTS:Twenty-one patients, predominantly male (90.5%) with a mean age of 58.6 years (SD 8.2), were included. Most had the right shoulder affected (85.7%), with a mean follow-up of 15.3 months (SD 11.9). The mean Constant score significantly increased from 37.4 ± 9.7 preoperatively to 70.5 ± 11 postoperatively (gain of 31.5 ± 20, P < .001). The mean visual analog scale score decreased from 4.4 ± 1.9 to 1.5 ± 1.5 (reduction of -2.7 ± 2.6, P < .001). The mean subjective shoulder value improved from 49.5 ± 14.3 to 76 ± 11.4 (gain of 25.2 ± 25, P < .001). Satisfaction levels were high, with 16 patients very satisfied, 4 satisfied, and 1 disappointed. Subgroup analysis showed a trend toward better outcomes in the reparable supraspinatus group, although these differences were not statistically significant. Three complications (14.3%) occurred: one surgical failure requiring revision to reverse shoulder arthroplasty, one persistent painful shoulder without functional improvement, and one infection that was resolved with treatment. The Gerber test remained positive in 9 patients (42.9%), and the belly press test remained positive in 3 patients (14.3%). CONCLUSION:LD transfer for irreparable subscapularis tendon tears leads to significant improvements in shoulder function, pain reduction, and patient satisfaction. While it offers a viable option, residual subscapularis insufficiency persists in a subset of patients.

The objective of this study is to report the outcomes after revision of anatomical total shoulder arthroplasty (ATSA) to reverse shoulder arthroplasty (RSA) and to compare between groups depending on the primary ATSA glenoid implant type, cemented polyethylene (PE) versus a convertible metal-backed (MB). Group A included ten cases of MB glenoid and Group B included ten cases of cemented PE that were revised to RSA. Reasons for revision included prosthesis instability, n = 6; rupture or non-functional posterosuperior rotator cuff (PS RC), n = 2; mechanical dissociation of the PE insert, n = 1; subscapularis (SSC) rupture, n = 1 for group A, and glenoid loosening, n = 6; PS RC rupture, n = 2; dislocation, n = 1 (bad quality SSC); painful stiffness, n = 1 for group B. Active motion, Constant-Murley score, subjective shoulder value, Simple Shoulder Test and pain (VAS) were evaluated at minimum follow-up of two years. Student’s t test and Mann-Whitney tests were used for statistical analysis. Level of significance was set at α = 0.05. Incidence of revision was 20

BACKGROUND:Lower trapezius transfer (LTT) has been demonstrated to restore external rotation (ER) in patients with brachial plexus palsies. In certain cases of cuff tear arthropathy, patients exhibit preserved forward elevation but lack active ER. This study evaluates the clinical outcomes of LTT, augmented with a semitendinosus tendon autograft and anchored to the infraspinatus insertion using an arthroscopically assisted technique and, to determine whether pain relief and functional improvement are maintained at minimum 7.5-year follow-up compared to the 11-month follow-up. METHODS:Between March 2014 and February 2024, 23 patients (15 men, 8 women; mean age 55 years, range 32-75) underwent surgical reconstruction of irreparable posterosuperior rotator cuff tears involving the supraspinatus, infraspinatus, and nonfunctional teres minor. A 6 cm horizontal incision was made just inferior to the scapular spine to harvest the lower trapezius tendon, which was augmented with the semitendinosus tendon. The extended tendon was fixed laterally to the greater tuberosity at the infraspinatus insertion via arthroscopy. The proximal stump was fixed medially into the lower trapezius muscle belly with the arm in maximum ER. Clinical outcomes were assessed using the Constant-Murley score, visual analog scale (VAS), active range of motion, and subjective shoulder value (SSV). RESULTS:Twenty-three patients were included, with a first mean follow-up of 11 months (range: 5-19 months). Twelve patients had a second mean follow-up of nine years and four months (range: 92-128 months). At the first follow-up, the average increase in ER in adduction was 40°, and 70° at 90° of abduction (P < .001). The Constant-Murley score improved from 46 to 82 points (P < .001), the SSV increased from 40% to 67% (P < .001), and VAS pain decreased from 5 to 1 (P < .001). Both the lag sign and Hornblower sign were negative post-transfer. The subgroup with a follow-up of at least 7.5 years showed slight improvements in functional outcomes, including active range of motion, Constant score, VAS, and SSV, but no statistically significant differences compared to the 11-month follow-up. Complications included 2 hematomas, only 1 requiring revision due to infection. CONCLUSION:LTT is an effective treatment for irreparable posterosuperior rotator cuff tears with ER deficiency. This procedure results in significant improvement in pain and active ER in adduction and at 90° of abduction. Functional results remain stable over a long-term follow-up of minimum 7.5 years.

Hypothesis: The aim of this study was to evaluate the healing and functional outcomes of an arthroscopic repair for massive posterosuperior rotator cuff tears using 8 strands knotless double-row parachute technique. We hypothesized that this technique would lead to a high rate of healing and would restore functional range of motion (ROM). Purpose: To evaluate the healing and functional outcomes of arthroscopic repair for massive posterosuperior rotator cuff tears using an 8-strand knotless double-row parachute technique. Methods: This retrospective single-center study included patients who underwent arthroscopic repair for massive posterosuperior rotator cuff tears between June 2018 and October 2022. Inclusion criteria were full-thickness tears involving at least 2 tendons, at least 1 tendon with retraction Patte grade 2, at least 1 tendon with fatty infiltration Goutallier grade 2 (or Fuchs equivalent), and absence of glenohumeral arthropathy beyond Hamada grade 2. A minimum of 12 months of clinical follow-up and post-operative magnetic resonance imaging at ≥6 months were required. All repairs were performed arthroscopically using an 8-strand knotless double-row “parachute” construct, designed to provide broad tendon compression and tension-free fixation. The primary outcome was the structural integrity of the repair on magnetic resonance imaging, classified according to Sugaya. Secondary outcomes included improvements in Constant score, Subjective Shoulder Value, visual analog scale for pain, range of motion, and complication rate. Subgroup analyses compared healed versus retear cases. Results: A total of 52 shoulders (51 patients; mean age 60.7 ± 7.6 years) were analyzed at a mean follow-up of 45.1 ± 16.1 months. The healing rate was 86.5% (45/52 shoulders), with 7 retears (13.5%). The Constant score improved from 51.6 ± 18.5 to 91.8 ± 18.5 (P < .001), visual analog scale from 4.8 ± 1.8 to 1.0 ± 1.1 (P < .001), and Subjective Shoulder Value from 54.8 ± 17.7 to 83.6 ± 14.0 (P < .001). Forward elevation increased from 133° ± 40° to 166° ± 11° (P < .001). Among healed repairs, 93% achieved the substantial clinical benefit for Constant score. All 8 patients (100%) with pre-operative pseudoparalysis regained active elevation >150° postoperatively. No infections, stiffness, or anchor-related complications occurred. Conclusions: The arthroscopic 8-strand knotless double-row parachute technique is effective with a high healing rate reaching 86.5% and excellent clinical outcomes in patients with massive posterosuperior rotator cuff tears.

Background Posterior shoulder instability is an uncommon but challenging condition, representing less than 5% of all shoulder instability cases. Arthroscopic capsuloplasty has progressively replaced open repair; however, the optimal soft-tissue construct to restore posterior capsulolabral anatomy remains debated. The purpose of this study was to report the clinical outcomes of arthroscopic posterior capsulolabral reconstruction using Lasso-Loop sutures combined with a capsulolabral “Bump effect” for chronic posterior shoulder instability. We hypothesized that recreating a reinforced posterior capsulolabral thickening would enhance posterior constraint and stabilize the shoulder. Methods This single-center retrospective study included 19 patients (mean age 26 ± 8 years; 68% male) treated between 2010 and 2020 for chronic symptomatic posterior shoulder instability without bone loss or glenoid retroversion >10°. The standardized arthroscopic technique used Lasso-Loop sutures with 2.9-mm biocomposite anchors (Biopusclock®) to achieve an anatomic capsulolabral reduction and create a stabilizing capsulolabral thickening (“bump effect”). Functional evaluation included the Constant-Murley, Walch-Duplay, and Rowe scores, shoulder range of motion, the posterior jerk test, and the return-to-sport level (competitive vs recreational). Results All functional outcomes improved significantly. The Constant–Murley score increased significantly from 55 ± 10 preoperatively to 87 ± 8 postoperatively (mean gain +32; 95% CI 27–36; p < 0.001). Similarly, the Walch–Duplay score improved from 41 ± 9 to 93 ± 7 (gain +52; 95% CI 46–58; p < 0.001), and the Rowe score increased from 39 ± 8 to 92 ± 6 (gain +53; 95% CI 48–57; p < 0.001). Clinical stability was restored in most cases, with the posterior jerk test becoming negative in 18 of 19 shoulders (95%). Shoulder range of motion was largely preserved, with postoperative external rotation reaching 85% of the contralateral side. A total of 14 patients (74%) returned to sports, including 8 patients (42%) who resumed their previous competitive level. One recurrence of posterior subluxation occurred in a hyperlax patient (Beighton ≥4). No intraoperative complications were observed. Conclusion Arthroscopic posterior capsuloplasty using a Lasso-Loop Bump reconstruction appears to restore the posterior capsulolabral anatomy effectively and provide satisfactory functional recovery in chronic posterior shoulder instability without bone loss or excessive retroversion. Level of evidence IV, Retrospective case series.

Chronic acromioclavicular joint instability (ACJI) remains challenging, and the optimal surgical technique is debated. Weaver–Dunn reconstruction is widely used, but modifications have been made to improve horizontal and vertical stability. This study addressed the clinical outcomes of a modified Weaver–Dunn procedure reinforced with a double EndoButton construct. This retrospective single-center study included 23 patients undergoing modified Weaver–Dunn reconstruction for chronic ACJI between 2012 and 2024, with a minimum follow-up of 12 months. Indications included symptomatic Rockwood grade 3 or higher after failed conservative management. Surgery was performed arthroscopically in most cases; five cases used an open approach. Clinical assessment included Constant–Murley score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) for pain, ROM, piano-key sign, and clavicular drawer test. Radiographic evaluation included coracoclavicular distance, alignment, and loss of reduction. Complications and revisions were documented. At a mean follow-up of 79 months, pain improved significantly (VAS 2.9 to 0.4, p = 0.001). Constant score increased from 60 to 87 (p = 0.001), and SSV improved significantly. Forward flexion improved from 159° to 175° (p = 0.015), and abduction from 163° to 175° (p = 0.03). Clinical stability improved, with disappearance of the piano-key sign and drawer sign in 82

Background:Scope-assisted lower trapezius tendon transfer (SALTT) has emerged as a viable treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs) due to its biomechanical advantages and favorable clinical outcomes. However, there is limited research on deltoid muscle volume (DMV) and muscle strength recovery after SALTT. Purpose:To evaluate the changes in DMV and its effect on clinical outcomes-including muscle strength after SALTT. Study Design:Case-control study; Level of evidence, 3. Methods:This retrospective study analyzed 54 patients with PSIRCT who underwent SALTT from January 2021 to January 2022, with a minimum follow-up of 2 years. The deltoid muscle area of each 2-dimensional axial magnetic resonance image was identified and segmented using ITK-SNAP automatic segmentation software. The 3-dimensional (3D) deltoid muscle model was generated by combining each segmented 2D axial image, and the volume was automatically calculated. The clinical assessment included shoulder pain, patient-reported outcome measures (PROMs), active range of motion (aROM), and muscle strength of aROM. Results:The postoperative clinical outcomes were significantly improved after SALTT. The postoperative body mass index-adjusted DMV (aDMV) showed a statistically significant increase compared with the preoperative aDMV. Based on the mean postoperative Constant score, 32 patients had scores above the mean (optimal function group), while 22 patients had scores below the mean (suboptimal function group). The pre-aDMV and post-aDMV in the optimal function group were significantly larger than those in the suboptimal function group. However, there was no significant difference in ΔaDMV (the difference between pre-aDMV and post-aDMV) between the 2 groups. A graft rupture occurred in 6 patients. The graft-intact group showed statistically significantly better outcomes than the graft-rupture group. Although there was no difference in pre-aDMV between the 2 groups, post-aDMV and ΔaDMV were significantly larger in the graft intact group. The ΔaDMV is significantly correlated with postoperative PROMs, aROM, and muscle strength. Conclusion:This study confirmed that the postoperative aDMV was significantly increased after SALTT, and the increase of aDMV was significantly associated with good clinical outcomes-including PROMs, aROM, and aROM strength. These findings contribute to understanding the mechanism of aROM strength recovery by demonstrating an increase in DMV after SALTT.

Background: Lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are 2 parameters that have been described for a better planification of arthroplasty, but the range of these angles is very wide. The purpose of this study was to investigate the best combination in terms of lateralization and distalization to optimize the outcome of reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) with a functional deltoid. Methods: This retrospective cohort study, conducted between 2014 and 2018 at a specialized shoulder unit in Paris, focused on patients exclusively treated with RTSA for CTA, ensuring a minimum follow-up of 1 year. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcome measures included range of motion and patient-reported outcomes at the final follow-up, such as the Constant score, Subjective Shoulder Value, Simple Shoulder Test, and visual analog scale. Optimal RTSA outcomes were delineated by scores surpassing the patient's acceptable symptom state for ASES, set in literature at 76. Patients were categorized into 2 groups based on ASES scores at the last follow-up: those below and those above 76. The capabilities of LSA and DSA to predict the outcome of interest were assessed, and the corresponding optimal thresholds for having a better outcome were calculated using the receiver operating characteristic curve. Results: Sixty-two patients with a mean age of 74.51 +/- 6.79 years were included in the study. Correlation analysis revealed a significant medium correlation between ASES and both LSA (r = -0.43, P = .001) and DSA (r = 0.39, P = .002). The DSA of patients with ASES >76 was 48.55 degrees +/- 12.44 degrees with an interquartile range (IQR) of 39.5 degrees-57.5 degrees, as compared with the lower value for patients with ASES <76, which was 37.82 degrees +/- 9.8 degrees (IQR: 32 degrees-46.5 degrees, P = .009). Similarly, the LSA of patients with ASES >76 was 86.43 degrees +/- 11.4 degrees (IQR: 79.5 degrees-93.5 degrees), as compared with the higher value for patients with ASES <76, which was 100.09 degrees +/- 7.63 degrees (IQR: 93 degrees-105.5 degrees, P < .001). The receiver operating characteristic curve confirmed LSA and DSA as good predictors for the ASES outcome, with areas under the curve of 0.851 and 0.741, respectively. The optimal LSA should be no more than 90.5 degrees (sensitivity = 100%, specificity = 67.7%). The optimal DSA should be no less than 37.5 degrees (sensitivity = 78.4%, specificity = 63.6%). Conclusion: The LSA and DSA could represent a helpful tool to optimize the clinical outcomes of an adaptable RTSA in CTA with a functional deltoid and a complete passive range of motion.

Background: This study aims to analyze the mid -to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high -quality publications and to determine its efficacy and safety. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta -Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random -effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. Results: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 +/- 4 years. Of these, 277 patients had mid-term follow-up (49 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I-2 = 89%; P <.001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P <.001; I-2 = 89%; P <.001); forward flexion, with a MD = 43 degrees (95% CI 21 degrees, 65 degrees; I-2 = 95% P <.001); abduction, with a MD = 38 degrees (95% CI 20 degrees, 56 degrees; I-2 = 85%; P <.01), and external rotation, with a MD = 8 degrees (95% CI 1 degrees, 16 degrees; I-2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I-2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I-2 = 0%). Conclusions: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient -reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid -to long-term follow-up. In well -selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.

To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38–85) were included. At a mean follow-up of 20.9 months (range 12–56 months), 93.3

Introduction The purpose of this study was to evaluate the feasibility of transferring the pectoralis minor (PM) in its entirety and assess its relationship with the musculocutaneous nerves (MCN) and axillary nerves (AXN). Methods Sixteen fresh transthoracic cadaver specimens were used. After PM transfer, the following measures were obtained: (a) the distance between the coracoid process (CP) and the subscapularis insertion on the lesser tubercle during external, neutral, and internal rotation. (b) The distances between the CP and PM, PM and musculocutaneous nerve, and PM and the axillary nerve. All measurements were performed using a precision caliper by two independent and blind-to-each-other findings observers. Results The median distance between the CP and PM muscles was 24 ± 7.7 mm, while the width of the coracoid was 24 ± 5.2 mm. PM-MCN distance was 23.25 ± 21.9 mm, CP-MCN distance was 72.1 ± 32.4 mm, and PM-AXN distance was 4.9 ± 0.7 mm. The distance between the coracoid process and lesser tuberosity varied by rotation: 29.2 ± 5.5 mm in internal rotation, 41.1 ± 8.9 mm in neutral rotation, and 51.1 ± 10.7 mm in external rotation. The distance significantly increased between internal and neutral or external rotation (p <0.05), but no significant difference was observed between neutral and external rotation (p > 0.05). Conclusion The distance between the coracoid process and lesser tuberosity increased considerably only between internal and neutral or external rotation positions. Additionally, the importance of identifying the musculocutaneous and axillary nerves and their branches when transferring the pectoralis minor should be highlighted.

Background To evaluates the impact of patient height (less than 160 cm and greater than 170 cm) on outcomes of lateralized reverse total shoulder arthroplasty (rTSA). Method This retrospective case–control study of 31 lateralized rTSA patients, with follow-ups ranging from 12 to 28 months, was divided into 2 groups: 14 short-stature (≤160 cm) and 17 taller (≥170 cm) patients. Preoperative planning utilized e-ORTHO templating software (FH Orthopaedics, Mulhouse, France), ensuring uniform lateralization shoulder angle and distalization shoulder angles across groups. Primary outcomes included range of motion (ROM), while secondary outcomes comprised Constant Score (absolute/ponderate), subjective shoulder value (SSV), and visual analog scale (VAS). Discrepancies in scores between groups were evaluated for clinical relevance against minimal clinically important difference benchmarks. Incidences of scapular notching were also recorded. Results All the clinical parameters analyzed were improved postoperatively in both groups (P < .05). No significant difference was observed in postoperative ROM, ponderate Constant, and VAS between groups (P > .05) except for forward elevation which was higher in the taller group (142.9 ± 27.6 compared to 163.5 ± 11.1 P = .018). For SSV, the taller group had higher postoperative SSV (P = .037). However, the difference was less than the minimal clinically important difference for SSV (−5.97 [95% confidence interval: −10.17 to 1.76], P = .01) and thus was considered not clinically significant. No scapular notching was detected in either group. Conclusion When planned positioning angles are respected (lateralization shoulder angle, distalization shoulder angle), the benefits of highly lateralized rTSA are consistent regardless of patient stature. Both groups had comparable results across ROM, ponderate Constant, and VAS except for forward elevation which was higher in the taller group.

Hypothesis/Background:Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimization of IR and anterior stability after RTSA, in the setting of an irreparable subscapularis may be achieved with a pectoralis major (PM) tendon transfer. This study aims to describe a novel surgical technique involving PM transfer in RTSA for irreparable subscapularis and report the initial clinical and radiological outcomes.Methods:This study included 13 patients with an average of 65.5 years (range, 52-82 years). All patients underwent a lateralized RTSA with concurrent PM transfer, associated to an irreparable subscapularis, performed by a single surgeon (PV). Preoperative and postoperative range of motion, including internal rotation 1, internal rotation 2, external rotation 1 (ER1) and forward elevation, were measured. The absolute Constant score, the age and sex-adjusted Constant Murley score, Visual Analog Scale and subjective shoulder value were evaluated by the same surgeon. Standard X-rays, preoperative magnetic resonance imaging, and computed tomography scan were performed for all patients.Results:With an average follow-up of 37 months, the mean Constant score improved from 17.7 preoperatively to 61 postoperative (P < .05). Postoperative clinical outcomes significantly improved across the study group. Mean internal rotation 2 increased from 44.6° to 61.5° (P < .05), while internal rotation 1 improved from 2.6 to 5 (P < .05). The Gerber test yielded positive results for all patients, while the belly press test was negative for eleven patients. Postoperative imaging assessment of the transferred PM tendon transfer showed intact repair, a good cicatrization on the lesser tuberosity with excellent trophicity of the muscle without any fatty infiltration in all patients.Conclusion:PM transfer combined with a lateralized RSTA in cases of irreparable subscapularis leads to improved shoulder range of motion, particularly in IR, increased strength and pain relief.

PurposeA retrospectively analyze of instability after RSA in terms of aetiology, treatment and final functional outcome.MethodsA bicentric retrospective study of 31 patients (mean age 67.6 years; 42-83) treated for RSA instability using RSA Arrow System (FH Orthopedics, Mulhouse, France), mean follow-up 41months (range 12-158). Aetiologies for dislocation were evaluated using a previously described classification system for RSA instability. Actions performed during the Revision Surgeries were analyzed and grouped into five categories. Clinical outcome measures included range of motion, SSV, VAS, Constant-Murley scores, satisfaction level and recurrence of instability.ResultsThe most frequent aetiology for RSA instability was loss of compression (18), followed by impingement (8) and loss containment (5). Total RSA revision (bipolar procedure) involving both distalization and lateralization occurred in 13 instances. Isolated distalization through the humerus was performed in ten patients and Isolated lateralization through the glenoid in three patients. Three cases of components exchange due to mechanical failure were noted. Bone graft was used in nine instances. Three patients (10%) suffered recurrent instability following Revision Surgery and required an additional stabilizing procedure. At final follow-up all 31 RSA were reported as stable with a mean VAS of 1.1, SSV 54.5%, constant score 48.3, constant ponderate 74.9%.ConclusionThe management of unstable RSA represent a challenge that can be successfully overcome with a revision surgery with compromised functional results. Loss of compression was the most common cause for primary and recurrent RSA instability that were treated principally with bipolar revisions involving component lateralization and distalization.

Background: Sugaya et al described a classification system to assess postoperative rotator cuff tendon healing. Although Sugaya I and II tendons can be considered as healed and Sugaya type IV and V can be considered as retorn, the exact status of Sugaya III tendons remains unclear. The objective of this study was to evaluate the impact of Sugaya III tendons on postoperative functional scores in a population of patients undergoing revision rotator cuff repair. Methods: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in one of 12 different institutions between July 2001 and December 2020. A total of 203 shoulders were included (59% males, mean age: 51 +/- 8 years old, mean follow-up 11.5 years [range: 2-28.8 yr]). Fifty-four patients (61% males, mean age 52 +/- 6 years old, mean follow-up 14.1 years [range: 10.4-28.8 yr]) had a follow-up >= 10 years (mean 14.1 years [range: 10.4-28.8 yr]) and were included in a long-term follow-up subgroup analysis. Structural integrity of the repaired tendon was evaluated on magnetic resonance imaging at last follow-up. Functional scores, acromiohumeral index (AHI), and progression of fatty infiltration and of osteoarthritis were compared according to Sugaya type. Results: Mean Constant score and mean strength were significantly higher in Sugaya I and II tendons than in Sugaya III (P = .021 and .003) and Sugaya IV and V tendons (P = .07 and .038), but did not differ between Sugaya III and Sugaya IV and V tendons. Mean Subjective Shoulder Value, pain, AHI were significantly higher and fatty infiltration and progression in the Hamada classification were significantly lower in Sugaya I and II tendons and in Sugaya III than in Sugaya IV and V tendons (P < .05), but did not differ between Sugaya I and II and Sugaya III tendons. Similar characteristics could also be observed in the long-term follow-up subgroup. Conclusion: Sugaya III tendons after revision rotator cuff repair do not allow restoration of strength thereby impacting the Constant score. However, there seems to be a protective effect of Sugaya III tendons with regard to pain, progression of proximal migration of the humeral head, osteoarthritis, and fatty infiltration, which seems to last at long-term follow-up. (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Introduction: The footprint medialization allows a tension free repair in severely retracted rotator cuff tears (RCT), thereby de-creasing the rate of retear. The purpose of the study was to evaluate the clinical and radiological results in a cohort of chronic RCT treated with medialized repair. Secondary purpose was to analyze the impact of medialization length on shoulder function and tendon healing.Hypothesis: It was hypothesized that the medialization length would have an impact on clinical and radiological outcome.Material and methods: A consecutive series of thirty patients that underwent arthroscopic repair of a massive posterosuperior RCT at a single institution were retrospectively studied at mean follow-up 18.4 months (SD 15.3; range 9-58). The medialization of the medial footprint was measured intraopera-tively. Preoperative and postoperative examination included active range of motion, abduction strength, pain assessment, and functional scores. The postoperative rotator cuff integrity was evaluated according to the Sugaya's classification. Types IV-V were categorized as absence of healing.Results: At final follow-up the clinical outcomes were significantly improved in all patients (p <= 0.001) with the exception of external rotation that displayed no significant improvement (p = 0.05). In group 1 (n = 8) medialization length was <= 10 mm (mean 8, SD 1.9) and in group 2 (n = 14) > 10 mm (mean 12.6, SD 1.7). There were no significant differences regarding preoperative and postoperative clinical outcomes (p > 0.05) between two groups. Group 2 demonstrated moderate correlation between length of medi-alization and Sugaya stage of tendon healing (r = 0.53, p = 0.049). Absence of healing was noted in 4/22 patients, 1/8 in group 1 and 3/14 in group 2.Discussion: Medialized repair is an effective technique for treating chronic, massive and retracted pos-terosuperior RCT. A medialization of the footprint less than or equal to 10 mm is recommended, as it was associated with good clinical and radiological results. The rate of tendon healing decreases when medialization exceeds 10 mm.Level of evidence: III.(c) 2022 Elsevier Masson SAS. All rights reserved.

Is to describe a novel surgical technique of Pectoralis Major transfer in RSA for deficient subscapularis and to report our preliminary results.

La médialisation de la réinsertion d’une rupture des tendons de la coiffe des rotateurs rétractée à la glène permet une réparation sans tension, diminuant ainsi le taux de re-rupture. Le but de l’étude était d’évaluer les résultats cliniques et radiologiques d’une cohorte de ruptures de la coiffe des rotateurs traitées par une technique de médialisation de la réparation. Le but secondaire était d’analyser l’impact de la longueur de cette médialisation sur la fonction de l’épaule et la cicatrisation du tendon. L’hypothèse était que la longueur de la médialisation de la réinsertion aurait un impact sur les résultats cliniques et radiologiques. Il s’agit d’une étude rétrospective de 30 patients, présentant une rupture da la coiffe des rotateurs chronique, postéro-supérieure massive ayant bénéficié d’une réparation arthroscopique selon une technique de médialisation. La médialisation de la réinsertion du tendon a été mesurée en peropératoire. Les examens préopératoires et postopératoires comprenaient l’amplitude active des mouvements, la force d’abduction, l’évaluation de la douleur et les scores fonctionnels. L’intégrité postopératoire de la coiffe des rotateurs a été évaluée selon la classification de Sugaya. Les types IV-V ont été classés comme un défaut complet de cicatrisation tendineuse. Avec un recul moyen de 18,4 mois (SD 15,3 ; gamme 9–58) les résultats cliniques ont été significativement améliorés chez tous les patients (p ≤ 0,001), à l’exception de la rotation externe qui n’a montré aucune amélioration significative (p = 0,05). Dans le groupe 1 (n = 8), la longueur de médialisation était inférieure ou égale à 10 mm (moyenne 8, écart-type 1,9) et dans le groupe 2 (n = 14) supérieur ou égale à 10 mm (moyenne 12,6, écart-type 1,7). Il n’y avait pas de différence significative concernant les résultats cliniques préopératoires et postopératoires (p > 0,05) entre les deux groupes. Le groupe 2 a démontré une corrélation modérée entre la longueur de la médialisation et le stade de Sugaya de la cicatrisation du tendon (r = 0,53, p = 0,049). Une absence de cicatrisation a été notée chez 4 patients sur 22 soit 1/8 dans le groupe 1 et 3/14 dans le groupe 2. La réinsertion des tendons de la coiffe des rotateurs selon la technique de médialisation est efficace pour traiter les ruptures postéro-supérieures chroniques, massives et rétractées à la glène. Une médialisation égale ou inférieure à 10 mm est recommandée, car elle a été associée à de bons résultats cliniques et radiologiques. Le taux de cicatrisation du tendon diminue lorsque la médialisation dépasse 10 mm. III.

Arthroscopic posterior bone block procedure using cortical screws has been reported since 2012 for management of recurrent posterior instability associated with bone defects. To avoid screw complications, we describe a full arthroscopic technique based on cortical button fixation. With 4 portals (posterior, poster lateral, anterior, and anterolateral), we use a specific glenoid guiding system (to perform 2 tunnels) and 2 cortical buttons fixation. With a specific glenoid guide, the iliac crest bone graft (ICBG) is secured to the posterior glenoid rim by fixation with 2 cortical buttons. The ICBG is positioned protruding outside the joint through the space, and the posterior capsule is repaired while maintaining an extra-articular bone graft. The protruding bone graft increases the concavity of the glenoid with a progressive bony remodeling to improve the posterior stability of the shoulder in our clinical experience.