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Background: Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. Purpose: To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. Results: A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side ( P < .001) and for the nondominant side ( P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side ( P < .001) and for the dominant side ( P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. Conclusion: Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. Registration: NCT05150379 (ClinicalTrials.gov identifier).

Resume Hypothese/Contexte La reparation de la coiffe des rotateurs par arthroscopie donne generalement de bons resultats cliniques, neanmoins les facteurs predictifs influencant le resultat final sont mal connus. Objectif Le but de notre etude etait d’evaluer les resultats cliniques apres cicatrisation du tendon sus-epineux chez des patients ayant subi une chirurgie reparatrice par arthroscopie de la coiffe des rotateurs, et d’identifier les facteurs pre- et perioperatoires predictifs d’un bon resultat clinique. Methodes Une etude multicentrique prospective a suivi 188 patients apres arthroscopie reparatrice d’une dechirure isolee et cicatrisation du tendon du sus-epineux. Les criteres d’inclusion etaient les suivants : âge inferieur a 70 ans, dechirure isolee du sus-epineux, infiltration graisseuse de stade 0 a I, cicatrisation du tendon du sus-epineux un an apres l’intervention chirurgicale, et meme methode de reparation de la coiffe des rotateurs par arthroscopie a double rangee pour tous les patients. L’evaluation clinique reposait sur le score de Constant (ou CMS, pour Constant Murley Score) et la Valeur Subjective de l’epaule (ou SSV pour Subjective Shoulder Value) evalues en preoperatoire et un an apres l’intervention. Une echographique de controle evaluait la qualite de la reparation du tendon selon la classification de Sugaya. Les Types I-II-III etaient consideres comme cicatrises. Resultats L’âge moyen de notre cohorte etait de 57,57 ans (min-max : 41-70 ans) et le ratio femmes/hommes etait de 1,14 (100/87). La moyenne des CMS preoperatoires etait de 53,75 ± 13,50 (moyenne ± ecart type [ET] ; min-max : 16-83). A la fin du suivi, le CMS moyen etait de 79,95 ± 12,05 (moyenne ± ET ; min-max : 28-100). 12,22 % (23/188) des patients avaient un CMS inferieur a 70 indiquant une difference cliniquement significative par rapport au CMS moyen, la difference minimale cliniquement importante (DMCI) etant de 10 points pour ce score. Une analyse statistique montrait que seule la predominance des femmes etait significative chez les patients ayant les plus bas scores (p = 0,001). Aucune difference n’etait trouvee pour l’âge, le CMS preoperatoire, la degenerescence graisseuse, ou les autres facteurs analyses. Conclusion Notre etude a montre que tous les patients avaient une cicatrisation du sus-epineux, mais tous n’avaient pas un bon resultat clinique final. Le seul facteur impactant le resultat clinique final etait le sexe feminin. Aucun autre facteur structurel n’a semble influencer le resultat clinique final. Les futures etudes devraient se concentrer davantage sur l’analyse des traits de personnalite et autres facteurs psychosociaux qui jouent un role important dans la determination du resultat final apres une arthroscopie reparatrice de la coiffe des rotateurs. Niveau de preuve III, etude de cohorte retrospective.

Osteochondritis dissecans of the knee is characterized by sterile necrosis of the subchondral bone and typically affects skeletally immature patients. When left untreated, osteochondritis dissecans can lead to early-onset osteoarthritis, resulting in pain and disability. This study shows the pearls and pitfalls of an arthroscopic technique of fixation performed successfully using a bioabsorbable nail for unstable osteochondritis dissecans lesions located in the medial femoral condyle of the knee., Technique Video Video 1 This video presents a reproducible one-stage technique for the arthroscopic fixation of unstable osteochondritis dissecans of the knee with bioabsorbable nails.

Background: The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery. Hypothesis: The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery. Study Design: Diagnostic study. Level of Evidence: Level 4. Methods: Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility. Results: The 8 components of the S-STARTS score provided additional information (0.01 ≤ | r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001). Conclusions: The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure. Clinical Relevance: Using an S-STARTS score–based assessment to monitor an athlete’s progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.

Background: Recent meta-analyses have advised against distal clavicle resection (DCR) as an adjuvant procedure during rotator cuff repair (RCR), whether performed routinely or in shoulders diagnosed with symptomatic acromioclavicular joint (ACJ) arthropathy. However, the efficacy of DCR as a secondary procedure in patients with persistent pain attributed to symptomatic ACJ arthropathy remains unknown. Purpose: To evaluate outcomes of secondary DCR in patients with failed nonoperative treatment of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2018, the senior surgeon performed isolated RCR in 1935 patients, of which 23 (1.2%) presented with ACJ pain and discomfort at ≥12 months after the index RCR, despite complete healing of repaired tendons. Those 23 patients underwent secondary DCR, as ACJ arthropathy was confirmed clinically and radiographically. Clinical assessment before DCR included the Subjective Shoulder Value (SSV) and pain at rest. Clinical assessment at >12 months after DCR included the SSV, pain at rest, Constant-Murley score, range of motion, and satisfaction. Pre- and post-DCR SSV and pain scores were compared. Results: Of the initial cohort, 5 patients did not consent to the use of their data, leaving 18 patients aged 53.3 ± 7.6 years (mean ± SD; range, 39-68 years) for outcome assessment. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV significantly improved from 58.7 ± 17.2 to 76.1 ± 20.2 ( P < .001), and the pain at rest significantly decreased from 4.7 ± 1.5 to 2.8 ± 1.9 ( P < .001). At final follow-up, the Constant-Murley score was 70.2 ± 21.0. Of 18 patients, 15 had none or mild residual pain (0-2; 83%), while 3 had substantial residual pain (5 or 6; 17%). Only 1 of the 3 patients with substantial residual pain had a poor SSV score (20 points) and was against opting for DCR in retrospect. No patient had infections or gross ACJ instability after DCR. Conclusion: Secondary DCR for cases of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing reduced pain in 83% of patients, and 94% were satisfied and would undergo secondary DCR again.

Resume Introduction Les lesions du tendon subscapularis (SSC) sont differentes de celles du tendon supraspinatus bien que ces 2 tendons de la coiffe des rotateurs presentent une structure histologique similaire avec 2 couches tendineuses distinctes liees a l’organisation des fibres collagenes. Hypothese La classification lesionnelle basee sur la structure tendineuse du supraspinatus (lesion partielle/transfixiante) peut etre appliquee pour le tendon subscapularis selon des criteres objectifs. Materiel et methodes L’etude porte sur 100 videos de reparations arthroscopiques de la coiffe des rotateurs impliquant une lesion du SSC. La lesion du SSC etait decrite selon 3 criteres objectifs : la visibilite du tendon superieur horizontal, la desinsertion du trochin et la visibilite du bord lateral du SSC. La combinaison de ces criteres permet de decrire des lesions partielles articulaires, superficielles ou interstitielles, s’opposant aux lesions transfixiantes concernant toute l’epaisseur du tendon. Le degre de retraction tendineuse etait note. Resultats Parmi les 73 lesions partielles, 46 concernaient le feuillet articulaire profond, souvent retracte, mais avec conservation du tendon superieur horizontal laissant croire a tort a l’integrite du subscapularis ; 23 etaient interstitielles sans desinsertion tendineuse du trochin et 4 concernaient uniquement le feuillet superficiel. Les lesions transfixiantes etaient toujours retractees et s’accompagnaient de la disparition du tendon superieur horizontal, de la visibilite du bord du tendon lateral et de la presence du « comma sign ». L’analyse inter et intra-observateurs demontrait une reproductibilite satisfaisante. Discussion - conclusion Comme pour les lesions de la coiffe superieure, il est possible d’appliquer une classification basee sur la structure tendineuse des lesions du SSC selon des criteres objectifs. Niveau de preuve IV.

Resume Introduction En cas d’echec de traitement conservatif d’une rupture isolee du supra-epineux, une reparation chirurgicale du tendon peut etre proposee dans le but d’ameliorer la fonction de l’epaule et de diminuer la douleur. Nous avons emis l’hypothese que le taux de cicatrisation d’une reparation d’une rupture isolee du supra epineux (SSN) serait eleve et ameliorerait les resultats cliniques. Materiels et methodes Au cours d’une etude prospective multicentrique, 199 patients (âge moyen 57 ans) ont ete suivis pendant un an. Nous avons inclus des patients avec une rupture transfixiante du SSN, une retraction inferieure a un stade 2, reparee avec la meme technique arthroscopique par double rang. L’evaluation clinique a ete effectuee selon le score de Constant–Murley (CMS) a 6 semaines, puis 36 et 12 mois. Une echographie de controle a permis de verifier la qualite de la reparation du tendon, selon les criteres de la classification de Sugaya, les types I-II-III etant consideres comme cicatrises. Resultats A un an, le score de Constant moyen a augmente de 26 points (p Conclusion La reparation arthroscopique d’une rupture isolee du SSN a mis en evidence un taux de cicatrisation de 94 %. Les resultats cliniques etaient superieurs dans le groupe tendon cicatrise. Niveau d’evidence I, cohorte d’etude prospective.

Introduction Acromioclavicular (AC) arthropathy can contribute to shoulder pain; it can be treated surgically by distal clavicle resection (DCR). The aim of this study was to determine whether increased T2 signal intensity in the clavicle on MRI is an argument in favour of AC resection arthroplasty by DCR during rotator cuff repair. Methods The MRI images from 107 shoulders in 107 patients were analysed. We looked for statistical relationships and correlations between shoulders with T2 hyperintensity (HI+) and those without (HI−) before surgery and then in shoulders with T2 hyperintensity (HI+) that underwent AC resection arthroplasty (AC+) and those who did not (AC−). Results On MRI, T2 hyperintensity in the AC joint was correlated with sex (more often found in men) and radiological signs of AC arthropathy. There was no statistical correlation before surgery, particularly with AC pain, or after surgery, with outcomes in shoulders undergoing DCR. Conclusion When repairing rotator cuff tears, the presence of T2 hyperintensity on MRI in the distal clavicle is not a predictor of better clinical outcomes after AC resection arthroplasty is done. The AC pain may be related to the rotator cuff tear instead. Level of evidence II, prospective randomised study.

Resume Introduction Une arthropathie acromio-claviculaire peut etre a l’origine de douleurs de l’epaule et etre traitee chirurgicalement par une resection du quart externe de la clavicule. Le but de cette etude etait de savoir si un hypersignal de la clavicule a l’IRM, en T2, apporte des arguments pour faire une arthroplastie AC par resection de l’extremite distale de la clavicule lors d’une reparation de la coiffe. Methode Nous avons analyse 107 IRM et nous avons cherche des liens statistiques et correlations entre les cas avec hypersignal (HS + ) et les cas sans hypersignal (HS−), avant chirurgie ; et pour le groupe hypersignal (HS + ), entre les patients ayant eu une arthroplastie AC (AC + ) et les patients n’ayant pas eu d’arthroplastie AC (AC−). Resultats Sur l’IRM, un hypersignal AC est correle avec le sexe (plus d’homme) et une arthropathie AC radiologique. Aucune autre correlation statistique n’a ete retrouve que ce soit avant chirurgie, notamment avec des douleurs AC, ou apres chirurgie avec de meilleurs resultats en cas de resection. Conclusions Lors d’une reparation de la coiffe des rotateurs, la presence d’un hypersignal IRM du quart externe de la clavicule ne permet pas d’esperer un meilleur resultat clinique si une resection arthroplastie est faite. La douleur AC pourrait etre une douleur de rupture de coiffe. Niveau de preuve II, etude prospective randomisee niveau.

Resume Introduction La rupture de la coiffe des rotateurs est tres frequemment associee a une arthropathie acromio-claviculaire (AC). Il est souvent difficile de faire la part des choses entre les douleurs dues a la rupture de coiffe ou a l’AC, malgre l’examen clinique et les examens complementaires. On observe donc une augmentation du nombre de resections AC associees a une reparation arthroscopique de la coiffe des rotateurs. L’objectif de cette etude etait de comparer le resultat fonctionnel a 1 an d’une reparation arthroscopique de la coiffe des rotateurs entre des patients ayant beneficie ou non d’une resection de l’extremite distale de la clavicule. L’hypothese principale etait que la resection AC systematique ameliorait la qualite du resultat clinique. Materiel et methode Il s’agit d’une etude prospective, multicentrique, randomisee, en simple aveugle. Au total, 200 patients ont ete inclus, tous operes d’une rupture isolee du supra-epineux selon une technique identique. Les patients ont ete suivis jusqu’a 1 an postoperatoire selon un protocole de revision radioclinique standardise. La randomisation a permis la constitution de 2 groupes : 97 patients ont beneficie d’une resection AC (R+) et 103 patients n’ont pas beneficie d’une resection AC (R−). Resultats A 1 an postoperatoire, l’ensemble des parametres cliniques etudies etaient inferieurs dans le groupe R+, mais seuls la rotation externe coude au corps (53° vs 59°, p = 0,04) et le score SSV (86,5 vs 90,1, p = 0,04) etaient statistiquement diminues. On retrouvait une douleur globale de l’epaule statistiquement plus intense dans le groupe R+ jusqu’a 3 mois postoperatoire (p = 0,04). A 1 an, les douleurs residuelles etaient plus importantes dans le groupe R+, principalement localisees face superieure de l’epaule (p = 0,03), surtout en cas de resection AC superieure a 11 mm (p = 0,01). Le taux d’echec de cicatrisation echographique de la coiffe etait superieur dans le groupe R+ mais de facon non significative (p = 0,5). Conclusion L’hypothese principale n’est donc pas confirmee. La resection AC systematique associee a une reparation arthroscopique de la coiffe des rotateurs ne peut pas etre recommandee. Niveau de preuve I, etude prospective, randomisee, simple aveugle.

In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results.A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed.At one year, mean Constant score had increased by 26 points (p0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing.Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved.I, prospective cohort study.

Resume Contexte L’instabilite posterieure de l’epaule (IPE) est une pathologie rare qui represente 2 a 10 % de toutes les instabilites de l’epaule. L’objectif de cette etude etait de comparer la douleur et les scores fonctionnels apres chirurgie pour IPE traumatique et non traumatique. Hypothese L’hypothese des auteurs etait que les patients dont l’IPE etait d’origine traumatique avaient un risque plus eleve de douleur residuelle et de subluxation recidivante. Materiel et methodes L’analyse a porte sur les dossiers de 150 patients operes pour IPE entre 2000 et 2015 dans 10 centres differents. Les criteres d’inclusion etaient une IPE symptomatique (subluxation et/ou douleur) avec signes radiologiques d’erosion ou de fracture posterieure de la glene, lesions du labrum posterieur, ou lesions de Mc Laughlin. Cent dix-sept patients ont ete inclus, dont 84 % presentaient des symptomes de subluxation et/ou luxation, et 16 % avaient une epaule douloureuse sans symptomes cliniques de subluxation et/ou luxation. Les patients ont ete evalues avec un recul de 48 ± 33 mois (etendue, 12–159 mois) par des tests de Constant, de Walch-Duplay et de Rowe ; la douleur etait evaluee par l’echelle visuelle analogique (EVA). Resultats Par rapport aux patients dont l’IPE etait d’origine non traumatique, la proportion d’hommes etait plus elevee dans le groupe des IPE traumatiques (84,4 % contre 61,9 %, p = 0,031), et les douleurs moins frequentes (15,8 % contre 23,8 % des patients, n.s.). La proportion d’epaules dominantes etait plus elevee dans le groupe a IPE non traumatique, mais de facon non significative (81,0 % contre 59,4 %, n.s.). Il n’y avait pas de difference significative entre les IPE traumatiques et non traumatiques en matiere des caracteristiques lesionnelles preoperatoires ni concernant les procedures realisees. Bien que les differences ne fussent pas significatives, il faut noter que les recidives d’instabilite etaient plus frequentes (15,6 % contre 4,8 % des patients, p = 0,298) et les scores de douleur EVA plus bas (1,5 ± 2,3 contre 2,6 ± 3,0, n.s.) chez les patients a IPE traumatique. Discussion Les scores fonctionnels postoperatoires des patients dont l’IPE etait d’origine traumatique n’etaient pas significativement differents de ceux des patients dont l’IPE etait non traumatique, bien que les recidives d’instabilite aient ete plus frequentes chez les patients a IPE traumatique, et les douleurs persistantes plus fortes chez les patients a IPE non traumatique. Niveau de preuve IV, Etude de cohorte retrospective.

Background: Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. Purpose/Hypothesis: The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. Results: Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. Conclusion: The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.

To evaluate short-term clinical outcomes of shoulders treated for anterior instability by open Latarjet procedures (OLP) followed by immediate self-rehabilitation. The hypothesis was that patients would recover preoperative function at 3 months with no adverse events related to self-rehabilitation. The authors retrieved clinical and radiographic records of 307 consecutive shoulders treated by the same surgeon for anterior instability by OLP with immediate self-rehabilitation. Four shoulders did not meet eligibility criteria and 38 were lost to follow-up, leaving a study cohort of 265 shoulders. Patients performed self-rehabilitation exercises at home from the first postoperative day. Follow-ups at 1 and 3 months evaluated recurrence of instability, postoperative complications, pain, active forward elevation (AFE), passive forward elevation (PFE), external rotation (ER) and internal rotation (IR). The difference between mobility before surgery and at 3 months was 0° for AFE, 0° for PFE, 10° for ER, and 0 spine segments for IR. Thirteen shoulders (5%) which had not followed the self-rehabilitation protocol during the first month had significantly more pain and less improvements in mobility (p

Background Several short-stemmed press-fit humeral components have been developed in recent years for anatomic total shoulder arthroplasty (TSA) as well as reverse shoulder arthroplasty (RSA). Varying radiographic outcomes have been reported, with some studies reporting concerning rates of aseptic loosening. This study analyzed the radiographic findings of a press-fit convertible short-stemmed humeral component in both TSA and RSA. Methods There were 150 anatomic TSAs (group 1) and 77 RSAs (group 2) analyzed radiographically at a minimum follow-up of 2 years postoperatively. Plain radiographs were reviewed for stem loosening, alignment, signs of stress shielding, and the filling ratio. Results At final follow-up, 49% of group 1 and 65% of group 2 had no evidence for radiographic changes. In those with radiographic changes, low bone adaptions were found in 83% and high adaptions in 17% in both groups. Larger stem sizes with higher filling ratios were associated with high radiographic adaptions in both groups (P = .02). The overall filling ratios were higher in group 2 (P = .002). Cortical contact of the stem led to higher bone adaptions (P = .014). Conclusions The short humeral component analyzed in this study showed encouraging survival rates without aseptic loosening. Radiographic changes are associated with a higher filling ratio and cortical contact of the stem. Surgeons should aim to achieve fixation with the minimal required canal filling to minimize radiographic changes with the uncemented humeral component used in this study.

Background In patients with osteoarthritis (OA) and an intact rotator cuff, hemi-shoulder arthroplasty (HSA) can be a viable option as it offers the advantage of keeping the native glenoid intact. However, glenoid erosion has frequently been reported. The aim of this study was to report preliminary clinical results of HSA with a new pyrolytic carbon (pyrocarbon) humeral head. Methods This prospective multicenter study included a continuous series of 65 patients who underwent pyrocarbon HSA in 5 centers. Results At the time of analysis, 1 patient was lost to follow-up, 3 patients underwent revision, and 61 patients were evaluated at a mean follow-up of 25.9 ± 3.3 months. The mean age at index surgery was 57.9 ± 13.3 years. The indications were primary glenohumeral OA in 37 patients, osteonecrosis in 11, secondary OA in 11, and rheumatoid arthritis in 2. The mean Constant score increased from 31.0 ± 15.8 points at baseline to 74.6 ± 17 points at last follow-up. Radiographic analyses showed that 86% of glenoids remained unchanged whereas 14% evolved slightly. Conclusions Pyrocarbon HSA grants improvement in pain and function in patients with primary OA or secondary OA after instability but at a lower level in patients with post-traumatic sequelae (secondary OA or osteonecrosis). These preliminary clinical and radiologic results are encouraging, although they need to be confirmed by longer-term follow-up observations.

There is no consensus on outcomes of long versus short and uncoated versus coated uncemented stems in total shoulder arthroplasty (TSA). We reviewed the literature to compare revision rates and adverse radiographic observations at ⩾ 2 years of various uncemented humeral stem designs. We performed an electronic PubMed search for studies on uncemented primary TSA that reported one or more of the following observations at ⩾ 2 years for distinct stem designs: stem revision; subsidence; stress shielding; radiolucent lines; and humeral loosening. The search returned 258 records, from which 20 articles (22 cohorts) met the inclusion criteria. The most frequently reported designs were short uncoated stems (7/13 cohorts) at < 3 years and long uncoated stems (8/9 cohorts) at > 3 years. The incidences of revisions and adverse radiographic observations were lower for short coated designs, compared with short and long uncoated designs, but these findings should be confirmed by prospective studies with a longer follow-up. Cite this article: EFORT Open Rev 2019;4:70-76. DOI: 10.1302/2058-5241.4.180046.

Objectives: The aim was to report results of arthroscopic repair of 86 massive cuff tears and decided to assess whether or not clinical scores were maintained 5 years later. Methods: Of the initial series of 86 shoulders, 2 patients died, 16 were lost to follow-up and 4 had a repeat surgery. Therefore, it was possible to reevaluate 64 patients. Repairs were complete in 44 cases and partial in 20 cases. Seventeen shoulders were pseudoparalytic. Tears with fatty degeneration at stage 4 or higher according to the Goutallier classification were not eligible for repair. Preoperatively, the Constant Score (CS), shoulder strength, location of the tear, tendon retraction and degree of fatty infiltration were assessed. Patients were assessed at 8.1±0.6 years [7.1-9.3] using absolute and age- and sex-adjusted CS, the subjective shoulder value (SSV) and the simple shoulder test (SST). Results: The absolute CS was 80.0±11.7 at the first follow-up (at 2-5 years) and decreased to 76.7±10.2 at the last follow-up (at 7-10 years) (pConclusion: Partial and complete arthroscopic repair provide good long-term results in patients with massive rotator cuff tears, regardless of the location of the tear, the degree of fat infiltration (I to III according to the Goutallier classification) and even in case of a pseudoparalytic shoulder.

Hypothesis/background Arthroscopic rotator cuff repair most commonly results in good clinical outcomes, however understanding of predictive factors influencing the final clinical outcome is limited. Aim The purpose of our study was to evaluate clinical outcomes of patients with healed supraspinatus tendon after arthroscopic rotator cuff repair and to identify its pre- and peri-operative predictive factors of good clinical results. Methods A multi-center prospective study followed up 188 patients, who had a healed tendon after an arthroscopic repair of isolated supraspinatus tear. Inclusion criteria were: age under 70 years old, isolated supraspinatus tear, stage 0 or I of fatty infiltration, healed supraspinatus tendon at one year postoperatively and the same arthroscopic double row rotator cuff repair used in all patients. Clinical assessment used Constant Murley Score (CMS) and Subjective Shoulder Value (SSV) preoperatively and at one year postoperatively. Ultrasound (US) control checked tendon repair quality based on Sugaya classification. Types I-II-III were considered as healed. Results The average age of our cohort was 57.57 (range; 41 to 70) years and the female to male ratio was 1.14 (range; 100 to 87). The average preoperative CMS was 53.75 ± 13.50 (mean ± SD; range; 16 to 83). At final follow up, the average postoperative CMS was 79.95 ± 12.05 (mean ± SD; range; 28 to 100). 12.22% (23/188) of patients, who had a CMS score below 70, had a clinically significant difference compared to the average CMS, due to the fact that the minimal clinically significant difference (MCID) in CMS is 10. A statistical analysis has shown that in patients with lower scores there was only a significant dominance of females (p-value = 0.001). No difference was found in regards to age, preoperative CMS, fatty degeneration and other factors. Conclusion Our study showed that despite all patients had a healed repair of supraspinatus, not all of them experienced a good final clinical outcome. The only factor negatively influencing the final clinical outcome was a female gender. No other structural factors seemed to influence the final clinical results. Futures studies should focus more on analyzing which personality traits and other psychosocial factors play an important role in determining the final outcome after arthroscopic rotator cuff repair. Level of evidence III; retrospective cohort study.

To evaluate short-term clinical outcomes of shoulders treated for anterior instability by open Latarjet procedures (OLP) followed by immediate self-rehabilitation. The hypothesis was that patients would recover preoperative function at 3 months with no adverse events related to self-rehabilitation. The authors retrieved clinical and radiographic records of 307 consecutive shoulders treated by the same surgeon for anterior instability by OLP with immediate self-rehabilitation. Four shoulders did not meet eligibility criteria and 38 were lost to follow-up, leaving a study cohort of 265 shoulders. Patients performed self-rehabilitation exercises at home from the first postoperative day. Follow-ups at 1 and 3 months evaluated recurrence of instability, postoperative complications, pain, active forward elevation (AFE), passive forward elevation (PFE), external rotation (ER) and internal rotation (IR). The difference between mobility before surgery and at 3 months was 0° for AFE, 0° for PFE, 10° for ER, and 0 spine segments for IR. Thirteen shoulders (5%) which had not followed the self-rehabilitation protocol during the first month had significantly more pain and less improvements in mobility (p

Resume Introduction La radiographie standard de face de l’articulation acromio-claviculaire (AC), reste la reference pour evaluer la degenerescence arthrosique. Objectif A l’aide d’une etude radiographique standardisee de face d’une articulation AC, l’objectif de ce travail etait de determiner si cette incidence radiographique est fiable et reproductible pour l’evaluation de l’interligne articulaire AC. Methode Une scapula et la clavicule, sans arthrose AC, ont ete utilisees pour l’etude. La scapula a ete positionnee dans un support, puis sous controle scopique, radiographie de face stricte de l’AC a ete realisee. A partir de cette position 0, une radiographie a ete realisee en variant l’angle de 5°–10°–15° dans tous les plans de l’espace. Les cliches ont ete realises lors de la meme seance pour ne pas modifier la distance tube-scapula puis ont ete exportes vers Osirx pour l’analyse. Nous avons mesure : les distances superieure et inferieure de l’AC, et la surface de l’interligne articulaire. Resultats Nous n’avons retrouve aucune reproductibilite des mesures de l’interligne articulaire AC en fonction de l’inclinaison du rayon par rapport a la radiographie de face stricte. Conclusion La radiographie standard de face de l’interligne AC ne permet pas une analyse fine de la degradation arthrosique de cette articulation. Probablement que seuls le scanner ou l’IRM permettent d’analyser la degenerescence de cette articulation. Niveau de preuve IV, etude fondamentale.

Introduction Conventional radiography using an anteroposterior view of the acromioclavicular (AC) joint is the gold standard for evaluating arthritic degeneration. Objective Based on a standardised AP view of the AC joint, the objective of this study was to determine whether this radiographic view is reliable and reproducible for evaluating the AC joint space. Methods A cadaver scapula–clavicle unit, free of osteoarthritis, was used for this study. The scapula was positioned in a stand; and then with fluoroscopy guidance, a strict AP view of the AC joint was taken. Starting from this “0” position, a radiograph was taken by varying the angle by 5°, 10°, and 15° in every plane in space. All radiographs were taken during a single session to ensure the distance between the X-ray tube and scapula did not change. The images were then exported to OsiriX for processing; the superior and inferior AC distance and the joint area were measured. Results There was no reproducibility in the AC joint measurements as a function of the incidence angle relative to a strict AP view. Conclusion Conventional radiography using an AP view of the AC joint cannot be used to do a fine analysis of arthritic degeneration of this joint. It is likely that only CT scan or MRI is sufficient to analyse osteoarthritis in this joint. Level of evidence IV, basic science study.

Introduction Rotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes. Material and methods This was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol. Results At 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p = 0.04) and the SSV (86.5 vs. 90.1, p = 0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p = 0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p = 0.03), especially when more than 11 mm was resected (p = 0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p = 0.5). Conclusion Our hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair. Level of evidence I, prospective randomized simple blind study.

Introduction Subscapularis (SSC) tendons differ from supraspinatus tendons, although both have similar histologic structure comprising two layers with distinct collagen fiber organization. Hypothesis The partial/full-thickness tear classification for the supraspinatus based on tendon structure can be applied to the subscapularis tendon on objective criteria. Material and methods The present study used 100 films of arthroscopic rotator cuff repair involving SSC lesion. Lesions were reported on 3 objective criteria: horizontal superior tendon edge visibility, lesser tuberosity bone exposure, and lateral tendon edge visibility. Combining the three distinguishes deep, superficial or interstitial partial tear versus full-thickness tear. Degree of retraction was also noted. Results Forty-six of the 73 partial lesions involved the deep articular layer, which was often retracted, but conserving the horizontal superior tendon edge and thus misleadingly suggesting SSC integrity; 23 were interstitial, without detachment from the lesser tuberosity; 4 involved only the superficial layer. Full-thickness tears were always retracted, with loss of horizontal superior tendon edge, visibility of the lateral tendon edge and presence of comma sign. Inter- and intra-observer reproducibility was satisfactory. Discussion – conclusion Like in superior cuff tear, a structure-based classification can be made of SSC lesions on objective criteria. Level of evidence IV.

Scapular stress fractures after reverse shoulder arthroplasty (RSA) are a potentially serious complication with modern lateralized and onlay implants. The aim of this study was to report the scapular spine stress fracture rate after RSA with an onlay, 145° humeral stem, analyzing potential fracture risk factors and clinical outcomes in a large cohort of patients.A consecutive series of 485 RSAs were implanted with the Aequalis Ascend Flex stem. Data collection included preoperative and postoperative clinical and radiographic assessment findings (rotator cuff Goutallier grade; Hamada, Walch, and Favard classifications; range of motion; Constant score) and perioperative data. Patients with a scapular spine fracture following RSA were matched with nonfracture control patients, and preoperative variables were tested to determine whether they were predictive of a scapular spine fracture.A scapular spine fracture following RSA occurred in 21 patients (4.3%), with a mean time to diagnosis of 8.6 months (range, 1-34 months). No preoperative factor was found to be a significant predictor of scapular spine fracture. Both groups showed significant improvements in active mobility measurements and Constant scores from preoperatively to final follow-up (P .001). The control group scored significantly better than the scapular spine fracture group regarding the Constant score and forward flexion.Scapular spine fractures have shown an increased prevalence after onlay-design RSA. This series was not able to link any clear risk factors. Functional results are limited, regardless of the fracture management.

This study analyzed the radiographic results of a cemented all-polyethylene keeled glenoid component available in different sizes and multiple backside radiuses of curvature.The study group consisted of 118 cases (114 patients). There were 63 women and 51 men. Mean age at the time of arthroplasty was 68 years (range, 51-85 years). True anterior-posterior radiographs obtained postoperatively and at the final follow-up were analyzed for implant seating and the occurrence of radiolucent lines. Glenoid morphology and fatty infiltration of the rotator cuff muscles were examined using computed tomography scans. Mean follow-up was 38 months (range, 24-70 months).The mean radiolucent line score after surgery was 0.54 points (range, 0-3 points), and 90% had no or only 1 radiolucent line. At the final follow-up, the mean score was 1.06 points (range, 0-3 points), and 74% had no or only 1 radiolucent line. The score increased significantly over time (P .001). No component was at risk for loosening. No correlation was found between patient age, sex, hand dominance, glenoid morphology, or fatty infiltration of the rotator cuff muscles and the occurrence of radiolucent lines.In the short-term, the glenoid component analyzed in this study showed promising radiographic results, with a low number of radiolucent lines without failure. However, the mean radiolucent line score increased significantly over time, and long-term observations are necessary to confirm a possible advantage compared with older component designs.

Resume Les fractures de l’extremite superieure de l’humerus chez l’enfant et l’adolescent sont le plus souvent traitees orthopediquement, meme si elles sont deplacees initialement. Les fractures articulaires deplacees doivent etre reduites et osteosynthesees. Les fractures sur kyste essentiel sont frequentes. Les luxations sont rares en pediatrie; un premier episode doit etre traite medicalement. En cas de recidive, un traitement chirurgical peut etre propose. Les notions de laxite physiologique, pathologiques, hyperlaxite et instabilite sont fondamentales pour la comprehension des pathologies de l’epaule en pediatrie.

Resume Introduction La prise en charge chirurgicale de l’instabilite posterieure isolee de l’epaule reste controversee du fait de resultats insatisfaisants pour cette pathologie rare, dont le diagnostic est parfois meconnu. L’echec de la prise en charge reeducative, chez un patient jeune et sportif, conduit a proposer un geste chirurgical capsulolabrale ou une butee osseuse. L’objectif de notre etude etait de rapporter les resultats des patients operes uniquement par geste capsulolabrale et de rechercher des facteurs de risques d’echec. Materiel et methodes Nous avons analyse les resultats de 101 patients operes par gestes capsulolabrales, dont 83 inclus retrospectivement et 18 de maniere prospective. Les gestes etaient realises de facon isolee ou en association parmi retente capsulaire, reinsertion labrale, fermeture de l’intervalle et comblement de l’encoche. Le critere principal etait la survenue d’un echec defini par une recidive d’instabilite et/ou de douleurs. Nous avons egalement analyse les resultats des scores specifiques (Walch–Duplay, Rowe modifie) et non specifiques (score de Constant, reprise d’activites) de l’instabilite d’epaule. Resultats Les resultats etaient satisfaisants avec un taux d’echec eleve (35 % en retrospectif au recul de 4,8 ± 2,6 ans et 22 % en prospectif au recul de 1,1 ± 0,3 ans) avec un critere d’echec severe. Nous avons retrouve une amelioration significative des differents scores. La reprise du travail a ete possible dans 92 % des cas et du sport, au niveau competition, dans 80 % des cas. Quatre-vingt pour cent des patients etaient satisfait et tres satisfait en postoperatoire. Aucun facteur de risque n’a pu etre mis en evidence de facon significative, mais un âge eleve, la realisation d’un geste isole et les formes cliniques mal definies etaient plus representees dans le groupe des patients en echecs. Conclusion La chirurgie capsulolabrale pour le traitement de l’instabilite posterieure de l’epaule a permis d’obtenir de bons resultats cliniques avec un taux d’echec important. Niveau de preuve 4. Etude retrospective.

Resume Background La butee posterieure de l’epaule est une option therapeutique reconnue dans le traitement des instabilites posterieures de l’epaule. Le but de cette etude retrospective multicentrique etait d’evaluer les resultats cliniques et radiologiques des butees posterieures. Materiel et methodes Soixante-six patients, 55 hommes et onze femmes, d’âge moyen de 27,8 ans ont ete evalues cliniquement et radiologiquement en postoperatoire a l’aide d’un questionnaire standardise. Resultats On note une amelioration significative du score de constant preoperatoire (p Discussion et conclusion Cette etude multicentrique portant sur 66 patients montre que la butee posterieure est une technique efficace avec de bons resultats objectifs et subjectifs, qui presente cependant un taux de complication non negligeable. Serie clinique Niveau de preuve 4.

Resume Introduction Le traitement de l’instabilite glenohumerale posterieure reste controverse. C’est la raison pour laquelle la Societe francophone d’arthroscopie (SFA), dans un symposium dedie a l’instabilite posterieure, a decide de conduire une etude prospective multicentrique comparant les resultats du traitement chirurgical et du traitement fonctionnel. Materiel et methode Cinquante et un patients ont ete inclus prospectivement et suivis pendant 12 mois. Trois presentations cliniques etaient differenciees : luxation vraie ou subluxation recidivante, instabilite involontaire ou instabilite volontaire devenue involontaire, et epaule douloureuse instable. Dix-neuf patients ont ete traites fonctionnellement selon un protocole de reeducation en trois etapes. Trente-deux cas ont ete operes, soit par butee, soit par geste capsulaire et/ou labral, soit par comblement d’encoche. L’evaluation clinique a l’inclusion et au recul comprenait : Subjective Shoulder Value (SSV), score de Rowe, score de Walch-Duplay, et score de Constant. Resultats Il s’agissait de resultats preliminaires au recul de 12 mois. Le score de Constant etait de 78 points dans le groupe traitement fonctionnel contre 87 dans le groupe opere, et, respectivement, le score de Walch-Duplay etait de 69 et 82 points, le score de Rowe etait de 64 et 88 points. L’evaluation de ces differences etait statistiquement significative (p Discussion A notre connaissance, cette etude etait la premiere comparant les resultats d’un traitement fonctionnel et d’un traitement chirurgical d’une serie d’instabilites posterieures documentees. Conclusion Cette etude prospective rapportait de meilleurs resultats dans le groupe opere. Mais le recul etait d’un an, il s’agissait donc de resultats preliminaires. Niveau de preuve Etude de niveau III (case control study).

Resume Dans les cas d’instabilite posterieure de l’epaule (luxations recidivantes, subluxation posterieure involontaire ou subluxation volontaire devenue involontaire), en cas d’echec du traitement fonctionnel et en l’absence de contexte psychologique defavorable, un traitement chirurgical peut etre propose. La butee acromiale pediculee a un lambeau deltoidien decrite par J.F. Kouvalchouk offre aux patients une alternative a la butee iliaque. Elle permet un triple verrouillage de l’epaule par l’effet butee du bloc osseux, l’effet de hamac retentif du lambeau deltoidien et la reparation de la capsule posterieure. L’arthroscopie permet l’exploration articulaire et le diagnostic de lesions associees, l’ouverture et la preservation de la capsule posterieure. L’arthroscopie facilite grandement le positionnement de la butee et la reinsertion capsulaire. L’objectif de ce travail est de decrire en detail l’intervention. Niveau de preuve Note de technique.

Resume Background L’epaule douloureuse instable (EDI) posterieure est la moins frequente des trois entites cliniques de l’instabilite posterieure. Il s’agit d’une epaule exclusivement douloureuse sans ressentis d’instabilite avec des lesions anatomiques d’instabilite posterieure. Patient et methodes Vingt-cinq patients d’une etude multicentrique (23 patients retrospectifs avec un recul minimum des deux ans et 2 patients prospectifs) constituent une serie d’EDI posterieure. Cette pathologie concerne les sportifs. Tous les patients ont ete operes le plus souvent par reinsertion capsulolabrale sous arthroscopie. Resultats Quarante-trois pour cent des patients ont un excellent resultat, 43 % sont ameliores mais conserve des douleurs, 14 % sont des echecs sans amelioration voire aggravation. Les causes d’echecs sont les erreurs diagnostics avec une omarthrose subluxante posterieure, les erreurs techniques et les complications postoperatoires. La cause principale de persistance de douleur avec une amelioration incomplete est l’existence d’une lesion cartilagineuse associee. Conclusion En l’absence de lesions cartilagineuses, de lesions osseuses d’instabilite posterieure (Reverse Hill Sachs, erosion ou fracture glenoidienne posterieure) et d’erreurs techniques ou de complications postoperatoires, les resultats sont excellents.

Background To date, medical history and dedicated questionnaires are the fastest and easiest way to assess risks of joint metal hypersensitivity. No published studies determined the overall prevalence of hypersensitivity to metals in patients with shoulder pathologies. The purpose of this study was therefore to estimate the prevalence of metal hypersensitivity reported by patients with shoulder pathologies, and to identify patients at risk of joint metal hypersensitivity based on a dedicated questionnaire. Methods The authors prospectively asked all adult patients consulting for shoulder pathologies between September 2018 and February 2019 at 10 centers to fill in a form. The main outcome was “reported hypersensitivity to metals,” comprising belt buckles, coins, earrings, fancy jewelry, keys, leather, metallic buttons, piercings, spectacles, watch bracelets, or zips. Results A total of 3217 patients agreed to fill in the survey, aged 55 ± 16 (range, 18-101) with equal proportions of men (51%) and women (49%), and a majority of patients consulting for cuff pathology (55%). A total of 891 (28%) patients had professions considered at risk for metal hypersensitivity. The most frequently reported metal hypersensitivities were fancy jewelry (15%), earrings (13%), and watch bracelets (9%). A total of 629 (20%) patients, of which the vast majority were women, reported hypersensitivity to 1 or more metals. Conclusions This survey of 3217 patients identified 20% who reported metal hypersensitivities, though only 2.2% had done patch tests. Matching profiles of those with positive patch tests to those with no patch tests revealed that 9.4% of the total cohort had similar sex and self-reported metal hypersensitivities. Factors associated with a positive patch test were female sex, self-reported cutaneous allergy, and self-reported metal hypersensitivity. The clinical applicability of these estimates remains uncertain as there is insufficient evidence that allergy to metal implants can be predicted by questionnaires or patch tests.

Background Posterior shoulder instability is a rare pathology and accounts for 2–10% of all shoulder instabilities. The purpose of this study was to compare pain and functional scores following surgical treatment of traumatic and atraumatic PSI. Hypothesis The authors hypothesize that patients with traumatic PSI are at greater risks of residual pain and recurrent subluxation. Material and methods The records of 150 patients operated for PSI between 2000 and 2015 at 10 different centers were analysed. Inclusion criteria were symptomatic PSI (subluxation and/or pain) with radiographic signs of posterior glenoid erosion or fracture, posterior labral tears, or reverse Hill Sachs lesions. One hundred and seventeen patients were eligible, of which 84% presented symptoms of subluxation and/or dislocation, and 16% were painful without clinical symptoms of subluxation and/or dislocation. Patients were evaluated at 48 ± 33 months (range: 12–159) using the Constant, Walch–Duplay and Rowe scores, with pain on Visual Analogic Scale (pVAS). Results Compared to atraumatic PSI, traumatic PSI was more prevalent in men (84.4% vs 61.9%, p = 0.031), and tended to have fewer pain symptoms (15.8% vs 23.8%, n.s). Atraumatic PSI was more likely to affect the dominant arm, although the difference was not significant (81.0% vs 59.4%, n.s.). Traumatic PSI did not differ from atraumatic PSI in terms of preoperative lesional characteristics, procedures performed, or postoperative pain and instability. Although these differences were not statistically significant, it is worth noting that traumatic PSI patients experienced more recurrence of instability (15.6% vs 4.8%, p = 0.298), and lower pain on VAS (1.5 ± 2.3 vs 2.6 ± 3.0, n.s.) compared to atraumatic PSI. Discussion Functional scores did not significantly differ between traumatic and atraumatic PSI after surgery, although traumatic PSI patients tended to have a higher recurrence of instability, while atraumatic PSI patients tended to remain more painful. Level of evidence IV, retrospective cohort study.