Modified Putti-Platt procedure for recurrent anterior shoulder instability.

Purpose: The classic Putti-Platt technique was modified by suturing the lateral subscapularis tendon to the capsule instead of the anterior glenoid edge. We report the clinical results of a modified Putti-Platt procedure in patients with traumatic anterior shoulder instability.

Methods: The study reports results in 434 patients (450 shoulders) with traumatic anterior shoulder instability. The patients comprised 322 men and 122 women with a mean age of 22 years. Clinical results were evaluated by the Rowe score, Japan Shoulder Society Shoulder Instability Score (JSS-SIS); recurrence of instability, instability severity index score (ISIS), restriction of external rotation, return to sports activities, and osteoarthritis on plain radiographs and MRI were examined.

Results: The mean Rowe score improved from 26 to 90 points, and the mean JSS-SIS improved from 51 to 88 points. Altogether, 419 patients (97%) had no recurrence at a minimum of two years of follow-up, even though the study included 87 patients with an ISIS of ≥ 7 points. External rotation was limited at 6 months, and 33 of 228 patients (14%) could not return to the same level of sports activities. Among 44 patients at the follow-up extending to ten to 27 years, external rotation was still limited but no plain radiography showed osteoarthritis more than stage 2.

Conclusion: This modified Putti-Platt procedure was not appropriate for throwing athletes but could be a surgical option for patients with high risk of recurrence.