Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft.

Purpose: To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up.

Methods: We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded.

BiPOD Arthroscopic Acromioclavicular Repair Restores Bidirectional Stability.

Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth.

Evaluation of functional outcomes and complications following modified Latarjet reconstruction in athletes with anterior shoulder instability.

Background: The optimal management of anterior shoulder instability in athletes continues to be a challenge. The present study aimed to evaluate the functional outcomes of athletes with anterior shoulder instability following modified Latarjet reconstruction through assessing the timing of return to sport and complications.

Methods: Retrospective assessment was performed of athletes (n = 56) who presented with recurrent anterior shoulder instability and were treated with modified congruent arc Latarjet reconstruction over a 1-year period.

Metal markers for radiographic visualization of rotator cuff margins: A new technique for radiographic assessment of cuff repair integrity.

Surgically repaired rotator cuff repairs may re-tear in the post-operative follow-up phase, and periodic imaging is useful for early detection. The authors describe a simple surgical technique that provides a visible clue to the tendon edge on an anteroposterior radiograph of the shoulder. The technique involves arthroscopic or mini-open radio-opaque tagging of the tendon edge using a metal marker, and followed by a double-row rotator cuff repair using suture anchors.

Biomechanical comparison of indirect and direct arthroscopic excision of the distal clavicle.

The purpose of this study was to compare the stability and force of ultimate failure of the acromioclavicular joint (ACJ) after direct arthroscopic distal clavicle excision (DCE) through superior portals and indirect arthroscopic DCE through inferior portals in paired cadaveric shoulders. Ten paired saline-embalmed cadaveric shoulders were operated alternatively using the indirect and direct technique. Biomechanical testing was performed in the horizontal plane, testing displacement at 15N and 30N and finally failure strength was measured testing the constructs until failure occurred.

Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making.

Objective: To evaluate the reliability of glenoid bone loss estimations based on either axial computed tomography (CT) series or single sagittal ("en face" to glenoid) CT reconstructions, and to assess their accuracy by comparing with actual CT-based bone loss measurements, in patients with anterior glenohumeral instability.

Materials And Methods: In two separate series of patients diagnosed with recurrent anterior glenohumeral instability, glenoid bone loss was estimated on axial CT series and on the most lateral sagittal (en face) glenoid view by two blinded radiologists. Additionally, in the second series of patients, glenoid defects were measured on sagittal CT reconstructions by an independent observer.

Video analysis of the mechanisms of shoulder dislocation in four elite rugby players.

Background: Shoulder injuries are common in rugby, with the most severe match injury being shoulder dislocation and instability. A limitation of epidemiological studies is that the injury information is based on player interviews after the injury or reports from the medical staff. The objective of this study is to describe the specific injury mechanisms for shoulder dislocation using video recordings in a consecutive series of 4 elite male rugby players who sustained an episode of shoulder dislocation during an official match.

Glenoid bone defects--open latarjet with congruent arc modification.

Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When the defect is significant, bony reconstruction is typically necessary. The congruent arc modification of the Latarjet procedure uses the concavity of the undersurface of the coracoid to optimally reconstruct the glenoid.

Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis.

The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis. The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic reconstruction for anterior instability (1 patient) and inflammatory arthritis (3 patients).

The "subscapularis-sparing" approach: a new mini-open technique to repair a humeral avulsion of the glenohumeral ligament lesion.

Anterior approaches to the shoulder involve partial or complete detachment of the subscapularis muscle. We have developed a new technique that permits adequate access to the humeral attachment of the inferior glenohumeral ligament (IGHL) without any detachment of the subscapularis, and have used this to successfully repair humeral avulsions of glenohumeral ligament lesions. Preliminary diagnostic arthroscopy using air insufflation of the glenohumeral joint is used to identify and grade the lesion.

An anatomic study of inferior glenohumeral recess portals: comparative anatomy at risk.

Purpose: The purpose of this study was to describe the musculotendinous relations and neurologic structures at risk during establishment of posterior portals for access to the inferior glenohumeral recess (IGHR).

Methods: Three 18-gauge spinal needles were used to establish 2 posteroinferior portals and 1 axillary pouch portal in 14 embalmed cadaveric shoulders, without joint distention and arthroscopic visualization. At dissection, musculotendinous structures traversed by the needles were recorded, and distances from the (1) axillary nerve (at the deltoid undersurface, quadrangular space, and capsule), (2) nerve to teres minor (at the inferior border of the teres minor muscle and at the capsule), and (3) suprascapular nerve were measured.

Direct arthroscopy of the bicipital groove: a new approach to evaluation and treatment of bicipital groove and biceps tendon pathology.

Assessment of the intra-articular and intertubercular regions of the long tendon of the biceps forms an important aspect of routine glenohumeral arthroscopic examination. We describe a new technique of direct visualization of the bicipital groove and tendon by positioning the arthroscope in linear alignment with the bicipital groove. A 4.

The sensory branch distribution of the suprascapular nerve: an anatomic study.

The suprascapular nerve is responsible for most of the sensory innervation to the shoulder joint and is potentially at risk during surgery. In this study, 31 shoulders in 22 cadavers were dissected to investigate the sensory innervation of the shoulder joint by the suprascapular nerve, with special reference to its sensory branches. In 27 shoulders (87.

The axillary pouch portal: a new posterior portal for visualization and instrumentation in the inferior glenohumeral recess.

Arthroscopic access to the inferior glenohumeral recess is necessary in several surgical procedures on the shoulder. Posteroinferior portals described for access to this region may pose a theoretic risk to the posterior neurovascular structures (outside-in technique) and to the articular cartilage (inside-out technique). The first author (D.

Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon.

Irreparable ruptures of the subscapularis tendon represent a difficult surgical problem. An accepted treatment has been to utilize the pectoralis major as a transfer, using the superior half of the tendon, which involves parts of both the sternal and clavicular heads of the muscle. We undertook an anatomic study to investigate the possibility of using a segmentally split pectoralis transfer of the sternal portion alone, which may provide a transfer with a vector more closely matching that of the functioning subscapularis muscle.

Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss.

Purpose: The purpose of this study was to analyze the results of the modified Latarjet procedure for shoulder instability associated with an inverted-pear glenoid (bone loss of at least 25% of the width of the inferior glenoid) or an engaging Hill-Sachs lesion.

Methods: From March 1996 to December 2002, 102 patients underwent an open Latarjet procedure for shoulder instability with an inverted-pear glenoid, with or without an associated engaging Hill-Sachs lesion, by the 2 senior authors (S.S.

The Clavicular Hook Plate: Consequences in Three Cases.

The small fragment AO clavicular hook plate is indicated for certain fractures of the lateral end of clavicle and for symptomatic acromio-clavicular joint dislocations where there is rupture of the stabilizing ligaments. The complex anatomy and biomechanics of the acromio-clavicular joint can lead to complications that result in damage to the joint itself or acromial erosion. In addition, the rotator cuff complex is at risk of injury when inserting the plate.

Coracoid process anatomy: implications in radiographic imaging and surgery.

The coracoid process forms an important part of scapular-glenoid construct and is involved in many surgical procedures on the glenohumeral joint. The unique three-dimensional orientation of each coracoid pillar makes radiographic imaging difficult. Congenital variations and minimal traumatic/iatrogenic changes in this orientation can predispose to subcoracoid impingement.