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Purpose To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. Materials and methods Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19–56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior–posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. Results Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8–19.0) to 14.5 ± 3.3 mm (8.7–20.6 mm) (p p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). Conclusions Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. Level of evidence IV.

Background Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. Methods Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006–2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. Results The mean follow up for this study was 55.6 months (24 – 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. Conclusion Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. Study design Level III. Trial registration Retrospectively registered.

Consider a positive Borel measure on a locally compact group. We define a notion of uniform density for such a measure, which is based on a group invariant introduced by Leptin in 1966. We then restrict to unimodular amenable groups and to translation bounded measures. In that case our density notion coincides with the well-known Beurling density from Fourier analysis, also known as Banach density from dynamical systems theory. We use Leptin densities for a geometric proof of the model set density formula, which expresses the density of a uniform regular model set in terms of the volume of its window, and for a proof of uniform mean almost periodicity of such model sets., 28 pages, introduction rewritten, references added, new Lemma 3.8

Purpose To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. Methods All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. Results A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. Conclusion Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. Level of evidence Retrospective case series, Level IV.

Die isolierte Arthrose des Patellofemoralgelenkes stellt eine seltene und komplexe Erkrankung dar. Nach Ausschopfen der konservativen Therapie stehen dem Orthopaden diverse weichteilige und knocherne rekonstruktive Verfahren sowie knorpelregenerative Verfahren zur Verfugung. Bei fehlgeschlagener oder unbefriedigender Therapie wird die Patellofemoralprothese als Therapiealternative weiterhin kontrovers diskutiert. Bei genauerer Betrachtung der Studien zeigen sich vielversprechende Ergebnisse bei korrekter Indikationsstellung und Patientenselektion. Die unterschiedlichen Prothesendesigns liefern gute postoperative Ergebnisse bei Beachtung von generellen und spezifischen Risiken. Die aktuelle Generation der patellofemoralen Inlay-Prothesen zeigt eine hohe Patientenzufriedenheit mit signifikanten Verbesserungen der Kniefunktion und Schmerzlinderung in mittelfristen Ergebnissen, bei allerdings nicht unerheblicher Revisionsrate.

Purpose The aim of this study was, to investigate the rate of return to sports (RTS) and physical activity after implantation of PFIA and to identify factors predictive of improved postoperative sporting ability. Methods Sixty-two patients with a mean age of 46 ± 11 years, who underwent implantation of PFIA at the senior authors’ institution, were enrolled. They were prospectively evaluated preoperatively and at a minimum of 2 years postoperatively with a mean follow-up of 60 ± 25 months. Clinical outcomes, return to sports and activity, type of sport or activity, subjective satisfaction, and frequency were evaluated by questionnaire. Results The transformed overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 67 ± 16 to 77 ± 19 (p = 0.003), Tegner activity scale results improved from 3 ± 2 points to 4 ± 1 points (p p p = 0.001). Ninety-four percent of the patients who did not fail could return to the same or higher level of sports, with 74% of the patients reporting an improved ability to perform sports. No preoperative factors could be detected to significantly influence RTS after surgery. Conclusions PFIA is a valid treatment option for the active patient with end-stage isolated patellofemoral OA. Reliable improvements in knee function, pain, and participation in low-impact sports were found. Level of evidence IV.

Purpose The purpose of this study was to identify modifiable factors associated with research activity among residents working in orthopedic surgery and traumatology. Methods Residents at 796 university-affiliated hospitals in Austria, Germany, and Switzerland were invited to participate. The online survey consisted of questions that ascertained 13 modifiable and 17 non-modifiable factors associated with the residents’ current research activities. Responses of 129 residents were analyzed. Univariate linear regression was used to determine the association of individual factors with the current research activity (hours per week). The impact of significant non-modifiable factors (with unadjusted p values Results The univariate analysis demonstrated six non-modifiable factors that were significantly associated with the current research activity: a University hospital setting (p p = 0.024), Swiss residents (p = 0.0012), the completion of a dedicated research year (p = 0.007), female gender (p = 0.016), and the department’s size (p = 0.048). Multivariate regression demonstrated that the number of protected research days per year (p p p Conclusions As hypothesized, more frequent and predictable protected research days were associated with higher research activity among residents in orthopedic surgery and traumatology. Level of evidence III.

Background To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology. Methods 3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa. Results Measurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively). Conclusion In this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.

Epidemiologic data of proximal hamstring avulsions have mainly been reported in relatively small patient cohorts. Detailed information on patient demographics, injury mechanism, and injury patterns is lacking in the literature. Since these injuries are rare and frequently misdiagnosed, a better understanding may help to increase awareness and to improve diagnosis of proximal hamstring avulsions. A chart review was performed to identify all patients who had undergone surgical repair for complete proximal hamstring avulsions between 01/2006 and 02/2019 at the authors’ institution. The following demographic and injury-specific data were obtained: Sex, age, body mass index (BMI), cause of injury (sports, activities of daily living, and others), presence of neurologic symptoms referable to the sciatic nerve, time to surgery, injury pattern (affected tendons), tendon retraction, and type of injury according to Wood et al.`s classification (Type 1: osseous avulsions, Type 2: tear at the musculotendinous junction, Type 3: incomplete avulsion from bone, Type 4: complete avulsion with only minimal retraction, and Type 5: complete avulsion with retraction > 2 cm). Data were analyzed for the entire study population and group comparison was performed with regard to sex, cause of injury, and the type of injury. A total of 263 patients were included (53% male). The mean age was 49 ± 13 years with most patients (56%) aged between 45–59 years. Most injuries occurred while participating in sports (52%) and injury type 5 was most commonly diagnosed (66%). Five percent of patients had sensory deficits referable to the sciatic nerve. Gender comparison showed that female patients were significantly older, predominantly represented in the age group 45–59 years, and most commonly injured during activities of daily living, whereas male patients were significantly more often represented in younger age groups, and the most common cause of injury was sports. Compared to Type 4 and 5 injuries, patients with a Type 1 injury were significantly younger and had a significantly longer time to surgery. Proximal hamstring avulsion occurs predominately in the middle-aged patient and only rarely in patients under the age of 30 years. No gender dominance exists. Female patients are typically older and get injured during activities of daily living, whereas male patients are younger and get injured more often during sports. These epidemiologic data may help physicians to make an accurate and early diagnosis. IV.

Shoulder stiffness is characterized by restriction of the active and passive movement of the glenohumeral joint. The stiffness is ultimately caused by fibrosis and the resulting contracture of the glenohumeral joint capsule and its ligaments; however, the term stiff shoulder is only a descriptive umbrella term that must be further defined as the course of the disease and the recommended treatment are decisively influenced by the cause of the shoulder stiffness. Primary shoulder stiffness, also known as idiopathic shoulder stiffness or "frozen shoulder", must be distinguished from various forms of secondary shoulder stiffness and often occurs in three stages, which can all last for several months to years: the initial "freezing phase", followed by a "frozen phase" and finally a "thawing phase". Although primary shoulder stiffness is a frequent pathological alteration with an prevalence of 2-5% in the general population, the exact etiology remains largely unknown; however, there is consensus throughout the literature that certain systemic pathologies, such as diabetes mellitus are associated with a higher incidence of primary shoulder stiffness.

An amendment to this paper has been published and can be accessed via the original article.

Basierend auf der ausgepragten Heterogenitat der Patientengruppen im Stadium III des nichtkleinzelligen Lungenkarzinoms („non-small-cell lung cancer“, NSCLC) – trotz der etwas differenzierteren neuen 8. Stadieneinteilung der Union Internationale Contre le Cancer (UICC)/International Association for the Study of Lung Cancer (IASLC) – wird eine zunehmend individualisierte Therapie dieser Patienten notwendig. Die initiale interdisziplinare Einschatzung der Operabilitat ist ein wesentlicher Faktor fur die Therapieselektion. Die kombinierte simultane Chemostrahlentherapie bleibt fur die Mehrzahl der Patienten im Stadium III die Standardbehandlung. Dieser Behandlung sollte sich aber – basierend auf den eindeutig und klinisch relevant positiven Ergebnissen der PACIFIC-Studie – eine konsolidierende Behandlung mit Durvalumab uber 12 Monate bei positiver PD-L1-Expression im Tumor anschliesen. Fur die interdisziplinar als potenziell operabel eingeschatzten Patienten werden weiter multimodale Behandlungsprotokolle unter Einschluss der Operation den Standard darstellen. Aufgrund der positiven Datenlage fur die Immuntherapie beim NSCLC in der Gruppe der inoperablen Patienten ergeben sich nun zwangslaufig auch in den lokal begrenzten Stadien hochrelevante Chancen fur eine Integration der Checkpointinhibition in den Therapiealgorithmus, welche zukunftig detailliert im Rahmen von prospektiven klinischen Studien analysiert werden sollten.

The relationship between posterior shoulder instability and increased glenoid retroversion has been documented. Posterior open wedge glenoid osteotomy is a possible treatment option for patients with increased glenoid retroversion, but outcomes in the literature are limited. Therefore, the purpose of this study was to report the clinical and radiological outcomes following posterior glenoid osteotomy. Patients that underwent posterior glenoid osteotomy for posterior shoulder instability with a GR angle of more than or equal to 10°, and were at least 12 months out from surgery, were included in the study. General data, medical history, and radiographic data such as the pre- and postoperative glenoid retroversion angle were extracted from the patients’ hospital documentation notes. To evaluate the postoperative outcome, the Rowe standard rating scale for shoulder instability and the Oxford shoulder instability score were collected retrospectively. A total of 12 shoulders (11 patients) could be included. The mean pre-operative glenoid retroversion was 23.3° (range 12°–35°) and this reduced significantly (p = 0.003) to a mean of 13° (range 1°–28°) postoperatively. At a mean follow-up of 19.8 months (range 14–36), the median Rowe score was 90 points (range 45–100 points) and the median Oxford instability score was 44 points (range 21–48 points). There were no postoperative re-dislocations or revision surgeries; however, one patient reported signs of recurrent shoulder instability and four asymptomatic glenoid neck fractures occurred. Open wedge posterior glenoid osteotomy provides reliable clinical results with a low rate of clinical failure in a stringently selected patient cohort at short-term follow-up. However, due to the risk of potentially severe complications, we advocate this procedure for experienced shoulder surgeons only, who are familiar with its anatomical and technical considerations. IV (case series).

The purpose of this study was to investigate clinical outcomes following Achilles tendon allograft-augmented latissimus dorsi tendon transfer (LDTT) for the treatment of irreparable posterosuperior rotator cuff tears with a minimum of 2 years post-operative follow-up. We hypothesized that patients would show significant improvement in outcomes scores with a low failure rate. Patients who were treated with Achilles tendon allograft-augmented LDTT for irreparable posterosuperior rotator cuff tears with a minimum follow-up of 2 years were included. Patient-reported outcomes scores, including ASES, QuickDASH, SANE, SF-12 PCS, and satisfaction, were collected pre- and post-operatively. Pre- and post-operative scores were compared with a Wilcoxon test. Revision to reverse total shoulder arthroplasty (RTSA) was considered as failure. Between March 2006 and November 2014, a total of 16 patients with a mean age of 49 years (range 34–57 years) were included. Minimum 2-year outcomes data were available for 14 of the 16 patients (87.5%) with a mean follow-up of 5.5 years (range 2.1–10.5 years). Two patients (12.5%) advanced to RTSA at a mean of 1.1 years following LDTT. Postoperative median subjective outcomes scores improved, but did not reach statistical significance (SF-12 PCS: 35.4–46.4, P = 0.182; ASES: 47.5–69.9, P = 0.209; QuickDASH: 57.9–31.8, P = 0.176; SANE: 40.0–39.5, P = 0.273). Median post-operative patient satisfaction was 5 on a 10-point scale (range 1–10). Patients with irreparable rotator cuff tears treated with Achilles tendon allograft-augmented latissimus dorsi tendon transfer did not experience significant post-operative improvement in patient-reported outcomes. Thus, the use of an additional allograft-augmentation remains questionable. Retrospective case series, level IV.

Economic pressure highlights the critical need for appropriate diagnosis and treatment of various shoulder pathologies since under-diagnosis and under-treatment can result in increased costs to society in the form of disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient. Therefore, it is crucial to distinguish the indications between operative and nonoperative management, especially in common shoulder pathologies such as rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular joint, and proximal humeral fractures. As a result, a detailed analysis of individual risk factors for potential failures should be performed and treatment should be based on individualized care with consideration given to each patient's particular injury pattern, functional demands, and long-term goals.Der zunehmende Kostendruck in der Medizin verstärkt die Notwendigkeit einer rasch zielführenden Diagnose und Therapie verschiedener pathologischer Veränderungen im Bereich der Schulter. Unterversorgte Patienten erhöhen die Kosten für die Gemeinschaft durch längere Ausfallzeiten und damit erniedrigte Produktion, während überzogene Therapien die bereits ausufernden Kosten in der medizinischen Versorgung weiter erhöhen und den Patienten sogar potenziell schädigen können. Deshalb ist es unabdingbar, die Indikationen für operative und konservative Therapien zu kennen und anzuwenden, besonders im Hinblick auf häufige pathologische Veränderungen wie Rotatorenmanschettenläsionen, vordere Schulterinstabilität, Bizepssehnentendinitis, Akromioklavikular Gelenkluxationen und proximale Humerusfrakturen. Grundsätzlich ist es dabei wichtig, individuelle Risikofaktoren für ein Therapieversagen zu erkennen, den Erwartungshorizont des Patienten bezüglich funktionaler Ansprüche und Langzeitziele abzuklären und auch das Verletzungsmuster zu analysieren, um so letztendlich die Therapie individuell an den jeweiligen Patienten anpassen zu können.

Bei keiner anderen Tumorentitat wurde die Immuntherapie bisher so konsequent etabliert und in die alltagliche Patientenversorgung integriert wie beim nichtkleinzelligen Lungenkarzinom. Immuntherapeutische Ansatze zeigen sich in sorgfaltig definierten Patientengruppen der konventionellen Chemotherapie uberlegen — bei einer geringeren Rate von Nebenwirkungen. Entscheidend fur den Therapieerfolg ist die kritische Patientenselektion anhand molekularbiologischer Marker und klinischer Kriterien.

Therapie von intraartikularen Lasionen und Beseitigung von strukturellen Risikofaktoren bei klinisch manifestem anterosuperioren Schulterimpingement (ASI). Dies umfasst in der Maximalvariante die Naht der Subskapularis- (SSC) und Supraspinatussehne (SSP), die subpektorale Tenodese der langen Bizepssehne (LBS) und die arthroskopische Korakoidplastik. Konservativ austherapierte anteriore Schulterschmerzen, die klinisch einem ASI und radiologisch einem strukturellen intraartikularen Schaden zugeordnet werden konnen. Dies betrifft die SSC, die SSP und die LBS. Als Risikofaktor fur das Auftreten eines ASI wird ein hypertropher oder fehlverheilter Proc. coracoideus angesehen und sollte bei entsprechender Klinik ebenfalls operativ therapiert werden. Fehlende strukturelle intraartikulare Lasionen sowie eine fortgeschrittene Omarthrose. Dauerhafte Storungen der aktiven und passiven Beweglichkeit glenohumeral sowie skapulothorakal durch neurologische Schaden oder Kontrakturen/Kapselsteife. Arthroskopische Tenotomie der LBS. Anschliesend arthroskopische Naht der SSP und SSC. Bei Bedarf erfolgt eine Korakoidplastik. Abschliesend wird eine subpektorale Tenodese in Mini-open-Technik durchgefuhrt. Vermeiden von aktiver Bizepsbeubung fur 6 Wochen postoperativ. Tragen eines Schulterabduktionskissens sowie Einschrankung der Abduktion, Flexion und Ausenrotation fur 6 Wochen. Beginn mit sportartspezifischem Training nach 3 Monaten. Uberkopfsportarten werden erst nach dem 6. postoperativen Monat empfohlen. In klinischen Nachuntersuchungen verschiedener Autoren zeigen sich sehr reliable Ergebnisse bezuglich verbesserter klinischer Funktion, Schmerzlinderung und sehr guten Werten in postoperativen Schulter-Scores. Die allgemeine Komplikationsrate des Eingriffs ist niedrig.

Stabilisierung des Schultergelenks. Symptomatische, rezidivierende vordere Schulterinstabilitat mit chronischem Glenoiddefekt von ca. 20–35 % der Glenoidflache, einhakender Hill-Sachs-Lasion und/oder nach Versagen von minimal-invasiven Weichteileingriffen. Bei Hochrisikopatienten (Kontaktsportlern) oder irreparablen Weichteilschadigungen in Ausnahmefallen als Primareingriff. Kontraindikation bei prinzipieller Moglichkeit der Durchfuhrung einer arthroskopischen Bankart-Operation. Chronische Defekte des Glenoids >35 %, da meist keine ausreichende Korakoidflache zur Deckung des Knochendefekts. Irreparabler Schaden des M. subscapularis (SSC). Willkurliche Luxationen des Schultergelenks. Relative Kontraindikation bei Patienten im Wachstumsalter. Zugang zum ventralen Schultergelenk uber einen ca. 6 cm deltoideopektoralen Mini-open-Zugang. Darstellen des Processus coracoideus und der „Conjoined Tendons“. Absetzen des Processus coracoideus mittels Winkelsage an der Korakoidbasis. Subskapularissplit. Anfrischen des Glenoiddefekts und ggf. Vorlage von Fadenankern. Anlage zweier paralleler Bohrlocher in den Korakoidblock. Fixation des Knochenblocks im Bereich des vorderen Glenoiddefekts mit 2 kanulierten Schrauben und Verschluss der Gelenkkapsel. Extrakapsulare Redondrainage und schichtweiser Wundverschluss. Armschlinge mit Einschrankung der Abduktion, Flexion und Ausenrotation fur 6 Wochen. Sportartspezifisches Training nach 3 Monaten, Uberkopfsportarten erst nach dem 6. postoperativen Monat. Im eigenen Vorgehen wurden seit 2009 64 Latarjet-Operationen (61 Patienten) in Mini-open-Technik durchgefuhrt. Rund 9,4 % der Patienten litten seit der Indexoperation unter persistenter Instabilitat, jedoch musste nur ein Patient aufgrund persistenter Instabilitat operativ revidiert werden.

Therapie einer posterioren Instabilitat durch biomechanisch stabile Reduktion der Glenoidretroversion mittels posteriorer Open-wedge-Glenoidosteotomie mit autologem Knochenspan. Symptomatische, atraumatische dorsale Schulterinstabilitat mit vermehrter Retroversion (>20°) nach Versagen von konservativer Therapie und/oder minimal-invasiven Weichteileingriffen. Allgemeine Kontraindikationen gegenuber operativem Eingriff. Relative Kontraindikationen: hochgradige Omarthrose, grose Glenoiddefekte, Osteoporose, Nikotinabusus oder zu erwartende Patientenincompliance. Zugang zur dorsalen Schultergelenkkapsel uber ca. 7 cm langen Hautschnitt medial des posterolateralen Akromionecks bis zur dorsalen Axillarfalte mit Praparation durch den M. deltoideus und den M. infraspinatus. Kapseloffnung uber T‑formige Inzision. Durchfuhren der vorher berechneten Osteotomie. Passende Knochenspanentnahme aus Beckenkamm oder Spina scapulae und Einbringung in „Press-fit“-Technik. Bei Erhalt des ventralen Glenoids keine zusatzliche Fixierung notig. Gleichzeitig Raffung der dorsalen Kapsel fur eine straffe Fuhrung des Schultergelenks. Einlage einer extrakapsularen Redondrainage. Schichtweiser Wundverschluss. Tragen eines 0°-Schulterlagerungskissens fur 6 Wochen postoperativ; horizontale Abduktion fur 8 Wochen vermeiden. Nach Redondrainagenzug limitierte aktiv-assistierte Beubung aus dem Schulterlagerungskissen heraus. Ausubung von Uber-Kopf-Sportarten nach ca. 6 Monaten. Von 2009–2015 wurden 6 posteriore Glenoid-Open-wedge-Osteotomien durchgefuhrt: Glenoidretroversion praoperativ 26,0 ± 8,6°, postoperativ 11,2 ± 9,4°. Persistentes subjektives Instabilitatsgefuhl postoperativ bei 2/6 Schultern, restliche 4 Schultern beschwerdefrei. Keine operativen Revisionen notwendig.