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Objective: Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain., Indications: Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head., Contraindications: Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head., Surgical Technique: After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair., Postoperative Management: The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months., Results: While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

This present article summarizes established and current developments and aspects of rotator cuff surgery. Achieved milestones as well as current approaches are presented and assessed with respect to their clinical and radiographic impact. Despite biomechanical and technical improvements in modern rotator cuff repair techniques, re-defect and re-tearing rates could not be fully eliminated. Meanwhile, the importance of biological processes around successful tendon-bone reintegration has been increasingly recognized. Hence, this article presents the current scientific standing regarding biological growth factors, platelet-rich plasma and rotator cuff augmentation techniques (with allogenic/autologous grafts). In summary, there are clear biomechanical advantages as well as many promising approaches to biological augmentation; however, the latter have not yet been transferred into regular clinical application.

Rotator cuff avulsion fractures represent rare lesions in younger individuals and are caused by different trauma mechanisms. The present article outlines current concepts regarding diagnosis, indications, and surgical approaches to the treatment of greater and lesser tuberosity fractures, as discussed in the international literature. Modified arthroscopic double-row rotator cuff repair techniques allow for the anatomical reduction and retention of fragments and the treatment of concomitant intra-articular lesions at the same time. Moreover, the article provides practical hints on different surgical repair techniques, their respective limitations and results from the literature.

Background: Despite modern surgical and intensive-care concepts, diffuse peritonitis remains a major source of high morbidity and mortality. The aim of this study was to critically evaluate the value of relaparotomy on demand (ROD) for patients with diffuse peritonitis., Patients and Results: In a retrospective analysis, the clinical course of 231 patients with diffuse peritonitis was analysed. The mean Mannheim Peritonitis Index (MPI) was 25.3. Overall lethality in this cohort was 14.3 %. In 214 patients, source control was successful during the index operation, and these patients were treated according to an on-demand strategy. For 178 of these patients, there was no demand for a relaparotomy, whereas 36 of these patients required further surgical interventions. Lethality for these subgroups was 9 % (no relaparotomy) and 27 % (relaparotomy), respectively., Conclusions: This retrospective analysis confirms that an on-demand strategy is reasonable and feasible after successful source control and lavage. However, it still remains of clinical importance to identify parameters that may assist in selecting those patients who require a relaparotomy., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim of this study was to evaluate the clinical and radiological results of 37 consecutive patients (Ø age 37.9; 4♀, 33♂) following arthroscopically assisted and image intensifier-controlled AC joint reconstruction using the double TightRope™ technique for acute AC joint separations grade V according to Rockwood., Material and Methods: After 12 months 30 patients with a mean age of 38.8 years (range 18.6-65.8 years) could be included. The postoperative assessment included the Subjective Shoulder Value (SSV), Constant Score (CS), and Taft Score (TF) as well as radiological evaluation using bilateral stress views and bilateral Alexander views for determining vertical and horizontal AC joint instability., Results: The clinical scores reached 91.4±9.8% for SSV, 87.8±5.2 for CS, and 10.1±2.1 points for TF. The initial coracoclavicular distance (CCD) was 22.1±5.6 mm and could be reduced to 8.6±2.8 mm postoperatively (p<0.05). The CCD increased at final follow-up to 12.8±2.4 mm. The difference of the CCD compared to the contralateral side was initially 13.7±4.8 mm; postoperatively it was 0.3±3.0 mm with an increase at final follow-up to 3.6±3.5 mm. A posterior instability on the Alexander view occurred in 53.3% of patients. A correlation between inferior clinical results and horizontal instability could be detected. Only one patient was slightly tender to palpation at the AC joint., Conclusion: Following arthroscopic AC joint stabilization using the double TightRope™ technique, despite partial recurrent instability, favorable clinical results can be expected.

Immobilization of the shoulder following dislocation and reduction is traditionally carried out using internal rotation braces. However, high recurrence rates of up to 96% may result depending on several concomitant intrinsic and extrinsic prognostic factors, such as age and level of physical activity. Recently, different cadaveric and radiologic studies have suggested an improved tissue apposition of the affected labroligamentous structures in a better anatomic position during external rotation of the humeral head. Recent clinical outcome studies have supported the hypothetical benefit of this immobilization technique. Significantly lower recurrent dislocation rates and a better anatomic positioning of the affected structures were observed after immobilization in external rotation compared to immobilization in internal rotation.However, the number of available studies in this respect is still limited. Further prospective evidence is therefore desirable to evaluate the contribution of exact positioning of the immobilization, influence of hemarthros and specific capsulolabral lesions to the long-term clinical and radiological outcome of this new concept of immobilization.