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Background: Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of infection, hematoma, and lymphoedema. Technological advancements now enable LDTT to be fully arthroscopic, but its benefits and safety have not yet been confirmed. Purpose: To compare the clinical outcomes and complication rates of arthroscopic-assisted versus full-arthroscopic LDTT for irreparable posterosuperior massive rotator cuff tears in shoulders with no surgical antecedents. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 90 patients who had undergone LDTT over 4 consecutive years by the same surgeon and did not have prior surgery. During the first 2 study years, all procedures were arthroscopically assisted (n = 52), while during the last 2 years, all procedures were fully arthroscopic (n = 38). Procedure duration and all complications were recorded, as well as clinical scores and range of motion at minimum 24-month follow-up. To enable direct comparison between the techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up. Results: From the initial cohort of 52 patients who underwent arthroscopic-assisted LDTT, 8 had complications (15.4%), of which 3 (5.7%) required conversion to reverse shoulder arthroplasty and 2 (3.8%) required drainage or lavage. From the initial cohort of 38 patients who had full-arthroscopic LDTT, 5 had complications (13.2%), of which 2 (5.2%) required conversion to reverse shoulder arthroplasty but no patients (0%) required other procedures. Propensity score matching resulted in 2 groups, each comprising 31 patients, with similar outcomes in terms of clinical scores and range of motion. The procedure time was about 18 minutes shorter for full-arthroscopic LDTT, which had different complications (2 axillary nerve pareses) as compared with arthroscopic-assisted LDTT (1 hematoma and 2 infections). Conclusion: Equivalent outcomes at minimum 24-month follow-up were found for arthroscopic-assisted and full-arthroscopic LDTT in terms of complications rates (15.4% and 13.2%, respectively), conversion to reverse shoulder arthroplasty (5.7% and 5.2%), clinical scores, and range of motion.

Background: The preoperative number of dislocations has been previously proved to be a major factor influencing the results after Bankart repair with more preoperative dislocations correlated with higher recurrence rates and more reoperations. This could possibly be because of the lower quality of the tissue repaired during the procedure after multiple dislocations. On the other hand, the Latarjet procedure does not “repair” but rather reconstructs and augments the anterior glenoid. Purpose/Hypothesis: The main objective was to report the clinical outcomes of patients undergoing a Latarjet procedure after 1 dislocation versus multiple (≥2) dislocations. The hypothesis was that the preoperative number of dislocations would not influence clinical results. Study Design: Cohort study; Level of evidence, 3. Methods: Patients older than 18 years who had undergone a primary Latarjet procedure for shoulder instability with at least 2 years of follow-up were included. Three different techniques were used: a mini-open technique using 2 screws, an arthroscopic technique using 2 screws, and an arthroscopic technique using 2 cortical buttons. Patients were evaluated and answered a questionnaire to assess the number of episodes of dislocation before surgery, the time between the first dislocation and surgery, recurrence of the dislocation, revision surgery, the Walch-Duplay score, the Simple Shoulder Test score, and the visual analog scale (VAS) score for pain. Results: A total of 308 patients were included for analysis with a mean follow-up of 3.4 ± 0.8 years. Of that, 83 patients were included in the first-time dislocation group and 225 in the recurrent dislocation group. At last follow-up, the rates of recurrence and reoperation were not significantly different between groups: 4.8% in the first-time dislocation group versus 3.65% in the recurrent dislocation group and 6.1% versus 4.0%, respectively. The overall Walch-Duplay scores at last follow-up were also comparable between the 2 groups, 67.3 ± 24.85 and 71.8 ± 25.1, even though the first-time dislocation group showed a lower pain subscore (15.0 ± 8.6 vs 18.0 ± 7.5; P = .003). The VAS for pain was also significantly higher in the first-time dislocation group compared with the recurrent dislocation group (1.8 ± 2.3 vs 1.2 ± 1.7; P = .03). Conclusion: The number of episodes of dislocation before surgery does not affect postoperative instability rates and reoperation rates after the Latarjet procedure. However, patients with first-time dislocations had more postoperative pain compared with patients with recurrent dislocations before surgery.

Background: One of the most frequent demands from patients after shoulder replacement surgery is to return to sport. Purpose: To determine the rate of return to sport after shoulder arthroplasty (total shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty) in recreational athletes. Study Design: Meta-analysis and systematic review. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating return to sport after shoulder replacement surgery and on patients practicing a sport regularly, whatever the level, with all ages and sports included. The main criterion was the rate of patients who returned to a sport activity. Results: Nine studies were selected among the 35 identified, including a total of 613 patients (39% male and 61% female) with a mean age of 71.7 years (range, 22.6-92.6 years). All the included patients practiced sports before surgery. The most common reported sports were golf (n = 140), swimming (n = 128), and tennis (n = 54). The mean rate of return to sport was 80.7% (range, 57.1%-97.3%). All patients who returned to sport were practicing in the 3 months before surgery. No radiological data were reported in the literature. The subgroup analysis for resuming golf after shoulder arthroplasty revealed a rate of return to sport of 79.2% (95% CI, 62.9%-89.5%). In the swimming subgroup, the rate was 75.6% (95% CI, 61.3%-85.8%) and in the tennis subgroup was 63.5% (95% CI, 34.1%-85.5%). The subgroup analysis for reverse shoulder arthroplasty reported a lower rate of return to sport than for all types of shoulder arthroplasty combined: 76.5% (95% CI, 60%-87%) versus 80.7% (95% CI, 70.9%-87.8%), respectively. Conclusion: Most patients returned to sport after surgery, and all who returned to sport were practicing their sport in the 3 months before surgery. No radiological data were reported in the literature.

Objectives: The objective was to evaluate the clinical results of a new surgical technique to improve the Bankart repair by adding a prosthetic block called the Recenter. Methods: Thirty-two patients were retrospectively included in this multicenter study. Five patients were lost to follow-up. The surgical indications were similar to those for a standard Bankart repair. A metal implant called a Recenter was inserted in the anterior inferior glenoid and fixed with two TightRopes. A Bankart repair was then performed over the implant. All the patients had a follow-up CT scan and a clinical examination. The mean follow-up period was 37 months (29-47). The mean ISIS score was 2.42 (0-6). Results: Twenty-six patients aged 33.9 ± 10.2 (16-50) years were included. Patients presented with an average of 2.4 ± 3.2 (0-12) true dislocations prior to surgery and 6.1 ± 8.5 (0-30) subluxations. The time that had elapsed between the occurrence of the first symptoms and surgery was 6.8 ± 6.9 years. The last follow-up showed a residual VAS score of 1.3. The mean Walch-Duplay score was 78.9 ± 21.4 - SD (range 5-100), the mean ROWE score, 88.5 ± 15.9 - SD (30-100) and the mean SST score, 90.6 ± 14.5 - SD (41.6-100). 77.8% of the patients (n=21) had no apprehension, 11.1% (n=3) were apprehensive, 7.4% (n=2) were afraid of the possibility of luxation and 3.7% (n=1) had a recurrence. In terms of satisfaction, 59.3% were very satisfied, 33.3% satisfied and 7.4% dissatisfied with their operation. Concerning the CT study, we found no shifting of material or ballooning of the TightRope tunnels. Conclusion: The Recenter showed a recurrence rate of 4% (1 patient) with an average follow-up of 3 years. Despite a small number of patients, the Recenter appears to be a worthwhile addition to the arthroscopic Bankart technique.

Background: Recurrent anterior instability associated with hyperlaxity remains a difficult challenge. In 1954, Trillat proposed osteoclasis of the coracoid process in order to make it more distal and more medial to place the conjoint tendon just in front of the humeral head. The conjoint tendon lowers and reinforce the stabilizing action of the subscapularis muscle in abduction. This open surgery technique has provided satisfactory results in patients with chronic anterior glenohumoral instability associated with massive irreparable rotator cuff tears. We hypothesized that this procedure could be arthroscopy-assisted with the use of an endobutton to treat anterior glenohumoral instability with hyperlaxity without engaging bone defects. Methods: This is a prospective study on 14 patients (9 females, 5 males; average age 25 years) who underwent surgery between 05/2014 and 12/2016. These were patients with anterior instability with hyperlaxity (external rotation > 85° / positive sulcus sign and no associated bone lesions). Arthroscopic surgery consisted of an antero-inferior capsuloplasty with Bankart repair combined with coracoid osteoclasis and fixation with an endobutton with a self-locking mechanism. The results were evaluated using SSV, Walch-Duplay, Rowe and Constant scores. Standard X-rays and a CT scan with 3D reconstructions were also performed at follow-up. Results: With an average follow-up of 26 months (24 to 32 months), no recurrent instability was reported, but persistent apprehension was found in 2 cases. The average Walch-Duplay score was 85 points, Rowe 89 points, the SSV 91% and adjusted Constant score 95.8%. The average VAS score was 0.8 points. The mean preoperative active anterior elevation of 178° decreased to 165° postoperatively and similarly, external rotation with the elbow at side decreased from 90° to 57°. At the last follow-up, all osteotomies healed. No complications were reported. Conclusion: Arthroscopy-assisted Trillat technique with the use of an endobutton appears to be a reliable technique for the treatment of hyperlaxity associated with chronic anterior glenohumoral instability without bone defect. Stabilization and adjustment of coracoid osteoclasis are provided by the endobutton; lowering and medial placement of the coracoid causes lowering of the subscapularis muscle by the conjoint tendon in abduction and thereby reinforces anterior capsuloplasty. Longer follow-up is required to confirm the reliability of this technique.