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Background: Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears., Methods: A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification., Results: The final sample consisted of 45 patients with an average age of 55 ± 9 years. After a mean follow-up time of 107 ± 54 months, the mean UCLA and DASH scores were 8.7 ± 1.3 and 42.2 ± 6.4, respectively. ROM and CMS showed statistically significant improvements (all P < .001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4 ± 9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (P = .039, β = 5.538) and a longer follow-up period (P = .044, β = 0.001). The postoperative CMS (P < .001) and UCLA scores (P = .001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals., Conclusion: Arthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate, and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiologic outcomes of femoral head allografts for glenoid bone defects in primary RSA., Methods: We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 cases (50%), concentric osteoarthritis in 9 cases (45%), and fracture sequelae in 1 case (5%). Each patient was evaluated preoperatively and at follow-up by radiologic and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient-specific instrumentation were used to shape the graft and to assess the position of K-wire for the central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption., Results: After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all P = .001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and -13.5° (-23° to -12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°-1.5°) (P = .001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in 4 patients: 2 dislocations, 1 baseplate failure following a high-energy trauma, and 1 septic baseplate failure. Partial graft resorption without glenoid component failure was observed in 3 cases that did not require revision surgery., Conclusion: The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function, with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The aim of the present study was to compare the clinical outcomes of 4 surgical techniques in patients with recurrent anterior shoulder dislocation, glenoid bone loss (GBL) <15% and Instability Severity Index (ISI) score >3., Methods: A retrospective multicenter study was conducted on 226 patients who underwent 1 of 4 different techniques (Bankart plus arthroscopic subscapularis augmentation (ASA), Bankart plus remplissage, Latarjet, Arthro-Latarjet). The inclusion criteria were: recurrent dislocation, GBL <15%, and ISI score >3. The exclusion criteria were: GBL >15%, voluntary instability, multidirectional instability, preexisting osteoarthritis, throwing athletes' first dislocation, and ISI score<3. Follow-up ranged from 24 months to 6 years. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Clinical outcomes were assessed using the Rowe score and the Western Ontario Shoulder Instability Index (WOSI) for each technique. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. The Pico area method was used to assess the percentage of GBL. The operations were performed by 10 experienced surgeons; the functional outcomes were evaluated by 2 independent observers., Results: A total of 226 patients who met the inclusion criteria were included in the present series. A total of 89.2% of patients in the ASA group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale, improved from 838 to 235 points. A total of 79.9% of patients in remplissage (R) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1146 to 465 points. A total of 98.5% of patients in the Latarjet (L) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1456 to 319 points. A total of 81.6% of patients in the Arthro-Latarjet (AL) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1250 to 221 points. The recurrence rates were as follows: ASA group (7%), remplissage group (6.1%), L group (1.5%), Arthro-Latarjet group (0%). Patients in the open L group had 15.5% (10/66) more complications., Conclusion: The use of ASA and remplissage to augment the Bankart repair have been demonstrated to be effective for restoring joint stability, yielding good clinical outcomes similar to the L procedure in patients affected by recurrent anterior dislocation with GBL <15% and an ISI score score >3. Soft tissues augmentations of the Bankart repair have been demonstrated to be effective for addressing anterior soft tissue deficiency dysfunction and critical Hill-Sachs lesions., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Massive, irreparable rotator cuff tears, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability and pain. The primary outcome of this systematic review was to evaluate differences in functional outcomes between the arthroscopic superior capsular reconstruction (SCR) and latissimus dorsi tendon transfer (LDTT) for the treatment of massive, irreparable posterosuperior rotator cuff tears without arthritis. The secondary outcome was to compare complication and reoperation rates between the 2 surgical procedures., Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched using keywords, and 20 studies were included in this review. Data extracted for quantitative analysis included the American Shoulder and Elbow Surgeons score, the Constant-Murley score, the subjective shoulder value, the range of motion, the visual analog scale for pain, numbers and types of complications, and reoperation rate. The preoperative fatty degeneration of the muscles and the preoperative and follow-up acromiohumeral distance and glenohumeral osteoarthritis according to the Hamada grading system were also reported., Results: A total of 1112 patients were identified, among whom 407 and 399 underwent SCR and LDTT, respectively. The SCR group showed a higher mean age at the time of operation (64.5 ± 7.8 vs. 62.1 ± 8.9 years; P < .001). The SCR group showed a lower rate of previous surgical procedures on the shoulder (35 out of 407 vs. 111 out of 399; P < .001) and a shorter mean follow-up (30.4 ± 7.5 vs. 36.3 ± 10.3 months; P < .001). Patients who underwent SCR reported significantly better functionality and residual pain as measured by the Constant-Murley score (75.5 ± 11.2 vs. 65.6 ± 22.8, P < .001), the American Shoulder and Elbow Surgeons score (84.3 ± 13 vs. 67.7 ± 23, P < .001), the subjective shoulder value (79.4 ± 13 vs. 64.4 ± 23, P < .001), and the visual analog scale (1.4 ± 2 vs. 2.8 ± 3, P < .001) than patients who underwent LDTT. A greater acromiohumeral distance (5.8 ± 2.5 vs. 7.6 ± 2.7, P < .001) was found in the SCR group. The SCR group showed a significantly lower infection rate (0.2% vs. 2.8%., P = .003) and a higher graft failure rate (12.3% vs. 6.8%, P = .012). No differences in terms of reoperation for graft failure (1% vs. 2.3% for SCR and LDTT, respectively; P = .172) or for conversion to reverse total shoulder arthroplasty (1.7% vs. 2% for SCR and LDTT, respectively; P = .800) were found., Conclusion: Patients undergoing SCR report better functional outcomes and greater acromiohumeral distance than those undergoing LDTT. The LDTT group shows a significantly higher infection rate, while the SCR group shows a significantly higher graft failure rate, but there are no differences in terms of reoperation between the 2 surgical procedures., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The open Latarjet procedure is a standard surgical treatment option for anterior shoulder instability in patients with a high risk of failure following soft tissue stabilization. The arthroscopic technique has potential advantages of minimal invasiveness, reduced postoperative stiffness, and faster rehabilitation but is regarded as technically challenging with concern over surgical risk during the learning curve. The aim of this study was to undertake a multisurgeon, large-volume learning curve analysis of the arthroscopic Latarjet procedure using continuous learning curve analysis., Methods: Individual patient data from 12 surgeons across 5 countries were retrospectively reviewed. A total of 573 patients undergoing the arthroscopic Latarjet procedure were included. Outcome measures of learning were collected, including operative time, computed tomography (CT) bone-block positioning, complications, and patient-reported outcome measures (PROMs). A segmented linear regression modeling technique was used for learning curve analysis., Results: High-volume surgeons converged to an operative time steady state after 30-50 cases. Surgeons completing fewer procedures demonstrated a constant reduction in operative time without reaching a plateau. Low-volume surgeons completing fewer than 14 operations did not demonstrate a reduction in operative time. Accuracy of bone-block positioning on postoperative CT demonstrated constant improvement without reaching a plateau after 53 cases. There was no change in PROMs or complications with increased operative volume., Conclusion: Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning. Only surgeons expecting to undertake the arthroscopic Latarjet in high volume should consider adopting this procedure., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors., Methods: The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up., Results: As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes., Conclusions: Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Modern semiconstrained reverse shoulder arthroplasty (RSA) has shown a great improvement in function and range of motion (ROM) in different etiologies, including revision surgery, sequelae of fractures, or tumors. Few studies have evaluated RSA for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease, and data on patients' quality of life after this surgery are lacking., Methods: In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed preoperatively and postoperatively in 62 of these patients., Results: At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. The length of follow-up was found to be associated with the severity of scapular notching., Conclusions: This study introduces new predictors for surgical outcomes, and it shows that patients who had undergone RSA a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls. Physicians should consider these results when discussing the outcomes of this surgery with patients., Level of Evidence: Level IV, Case series, treatment study., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)