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Purpose Patient-reported outcome measures (PROMS) are increasingly used for patient evaluation, as well as for scientific research. Few are used for practical purposes in the clinical setting, and few are reliable enough to allow proper feedback to physicians. Two of the most commonly used assessment tools in shoulder instability are the Walch–Duplay and the Rowe scores. The aim of this study was to evaluate the validity of self-administered versions of the Walch–Duplay and Rowe scores following shoulder stabilization procedure. Methods Between the months of May and December 2021, all patients who were followed in one of six institutions for shoulder instability were included. Patients were required to anonymously fill a self-administered version of Walch–Duplay and Rowe score. The classic scores were measured by the surgeon. Correlations between self-assessment and physician-assessment were then recorded. Results A total of 106 patients were evaluated during the study period. Using the Spearman coefficient for correlation, a strong correlation (r > 0.5) was found between the results of the self-administered questionnaire and the surgeon-measured score. The difference between surgeon- and patient-administered questionnaires was non-significant. Conclusion The self-administered version of the Walch–Duplay and Rowe questionnaires can reliably be used in the clinical setting for post-operative follow-up of patients undergoing shoulder stabilization procedures. Level of evidence Level II.

Management of irreparable posterosuperior rotator cuff tears (RCTs) presents a significant challenge to shoulder surgeons. Previous studies on latissimus dorsi transfer (LDT) have demonstrated good to excellent outcomes in younger patients, but this indication is debatable in the elderly. The main objective of this study was to compare the results of LDT in a group of patients aged ≤55 years vs. one of patients aged ≥75 years. We hypothesized that LDT could give equally good results in the elderly as in the younger population.Between 2014 and 2017, a total of 153 patients who underwent LDT either for irreparable posterosuperior RCT or for failed prior repair were enrolled. All LDTs were performed by a single surgeon, were arthroscopically assisted, and fixed onto the humeral head with 2 anchors. A retrospective comparative clinical study was conducted. Patients with a minimum of 24 months of follow-up were divided into 2 groups: group A (≤55 years old at surgery) and group B (≥75 years old at surgery). The age-adjusted Constant-Murley score (aCMS), Subjective Score Value (SSV), Simple Shoulder Test (SST), Activities of Daily Living requiring active External Rotation (ADLER) score, visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, patient's satisfaction, and rate of LD tendon rupture at last follow-up were compared.A total of 66 patients met inclusion criteria. Four in 66 patients (6%) were lost to follow-up. There were 31 patients in group A and 31 patients in group B. The mean age was 52 and 77 years for the respective groups. Preoperatively, the 2 groups were comparable with respect to other characteristics like the mean number of ruptured tendons, mean preoperative Hamada stage, mean SST, and mean aCMS. The mean follow-up was 33 and 31 months, respectively. At last follow-up, there was no significant difference in the scores evaluated between groups A and B with SSV (61 vs. 66.7 points), ADLER (23 vs. 26.4 points), VAS (2.8 vs. 2.2 points), and ASES (64.4 vs. 72.4 points), respectively, except for the aCMS (75 vs. 96.3; ±001) and the SST (6.2 vs. 8.3; P.001). Patient's satisfaction was not significantly different in both groups (81% of either satisfied or very satisfied patients in both groups). The rate of LD tendon rupture was higher in group A: 10 (33%) vs. 8 (26%).Posterior transfer of latissimus dorsi tendon could be an effective surgical option for the treatment of massive irreparable posterosuperior cuff tears in patients ≥75 years of age.

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.

Resume Introduction L’omarthrose avant l’âge de 50 ans est rare et sa prise en charge delicate. Si le traitement choisi est une prothese d’epaule, les risques evolutifs a long terme, plutot frequents avec un fort taux de revision, rendent l’indication discutable chez un patient jeune et actif. Le but de cette etude etait de connaitre les caracteristiques epidemiologiques des arthroses du patient de moins de 50 ans et d’evaluer les resultats cliniques des alternatives therapeutiques proposees. Hypothese L’hypothese principale etait qu’un traitement non chirurgical bien conduit pouvait retarder la mise en place d’une prothese. L’hypothese secondaire etait qu’une prothese totale anatomique restait le traitement a privilegier en cas d’echec des autres traitements. Materiels et methodes Il s’agit d’une etude multicentrique retrospective incluant les arthroses primitives (AP) ou post-instabilite (API) chez les patients âges de 50 ans ou moins au debut des symptomes. Ont ete exclues les arthroses post-traumatiques, les polyarthrites rhumatoides et les necroses. Ont ete inclus 266 patients (273 epaules) issus de 13 centres specialises dans la chirurgie de l’epaule. Deux traitements non chirurgicaux (28 PRP et 88 viscosupplementations), 73 arthroscopies et 150 protheses dont 62 hemiarthroplasties humerales (10 « hemi-metal », 24 « hemi-pyrocarbones », 28 hemi-resurfacages), 77 protheses totales anatomiques et 11 protheses inversees ont ete analyses. Le recul minimum etait de 12 mois pour le traitement non chirurgical, et de 24 mois pour les patients ayant beneficie d’une arthroplastie, certains ayant eu deux types de traitements. Les criteres d’evaluation suivants etaient analyses : score de Constant, Subjective Shoulder Value (SSV) et le nombre de complications/revisions. Resultats L’âge moyen au moment de la prise en charge etait de 43 ans (23–65), avec une predominance masculine (75 %). Le debut des symptomes etait plus precoce pour les API que pour les AP : 36 vs. 39 ans (20–50). PRP et viscosupplementation permettaient de retarder de 3,5 ans la pose d’un implant dans 86 % des cas et l’arthroscopie dans 56 %. La limitation de la RE1 etait le facteur le plus pejoratif. Au recul moyen de 74 mois pour les hemiarthroplasties et de 95 mois pour les protheses totales anatomiques, le score de Constant moyen etait significativement inferieur pour les hemiprotheses (56 vs. 67 ; p = 0,004), avec un taux plus eleve de complications (31 % vs. 11 % respectivement) et de changements de protheses (13 % vs. 9 % respectivement). Discussion/Conclusion PRP, viscosupplementation et arthroscopie peuvent retarder la mise en place d’une prothese avant que l’epaule ne devienne raide et douloureuse. En cas d’echec, la prothese totale anatomique reste la solution la plus efficace a moyen terme. Niveau d’evidence IV a, Therapeutic Studies - Investigating the Results of Treatment.

Background To compare latissimus dorsi tendon rupture rates after arthroscopic transfer for posterior superior rotator cuff tear using 3 different humeral head fixation techniques. Methods One-hundred fifty consecutive latissimus dorsi transfers were included. Inclusion criteria were massive irreparable posterosuperior rotator cuff tear with advanced fatty infiltration associated with persistent pain and limited range of motion after failed conservative treatments or surgery. All transfers were arthroscopically assisted and fixed in a transosseous tunnel with a cortical button (group 1, n = 59), “over the top” onto the footprint of the supraspinatus (group 2, n = 47), or posteriorly onto the footprint of the infraspinatus (group 3, n = 44) with 2 suture anchors. The tendons were marked with 3 metallic clips placed intraoperatively at a fixed distance of 2, 4, and 6 cm from the tip. Immediate postoperative standard anteroposterior radiographs were performed to confirm the position of the clips and to determine whether the clips displaced on subsequent radiographs during follow-up, indicating tendon rupture. Results Repeat radiographs at 3-month follow-up showed higher risk of latissimus dorsi transfer rupture rate in 27/59 patients in group 1 (46%), 11/47 in group 2 (24%), and 7/44 in group 3 (15%). Conclusion Posterior anchor fixation of the latissimus dorsi tendon onto the infraspinatus footprint had the lowest rupture rate.

Indications and techniques for tendon transfer in irreparable rotator-cuff tear have greatly progressed and are no longer restricted to external rotation deficit. The present article first reviews the various types of tear and corresponding tendon transfers and the biomechanics of the pseudoparalytic shoulder. The indication of choice for tendon transfer is iterative tear following failure of isolated long biceps tenotomy or partial repair. Latissimus dorsi, inferior trapezius and pectoralis major transfer are the 3 types to be used after failure of primary surgery. Latissimus dorsi transfer is indicated for partial loss of active limb elevation or isolated loss of internal rotation. Inferior trapezius transfer is best indicated for isolated active external rotation deficit. In pseudoparalytic shoulder with total loss of active elevation or combined loss of elevation and active external rotation, isolated transfer is insufficiently powerful to restore active range of motion and should be associated to reverse arthroplasty. We describe the various transfer techniques and report their results.

Resume Introduction Le conflit postero-superieur est la premiere cause de douleurs chroniques d’epaule chez le sportif avec arme ou lancer. Lorsque le traitement chirurgical est preconise, il n’y a pas de consensus sur les techniques utilisees et les series publiees ont peu de patients et de recul. L’hypothese principale de l’etude etait que le traitement chirurgical permettait la reprise du sport au meme niveau ou superieur. L’hypothese secondaire etait que certains facteurs epidemiologiques, anatomiques pre- et peroperatoires et certains gestes chirurgicaux permettaient un meilleur resultat sur la reprise du sport au meme niveau ou superieur. Methodologie Cent trente-cinq patients operes de l’epaule pour conflit postero-superieur sous arthroscopie avec l’un des gestes suivants : capsuloraphie anterieure, capsulotomie/ectomie posterieure, debridement du bourrelet postero-superieur, glenoidoplastie posterieure, debridement ou reparation d’une lesion des tendons de la coiffe des rotateurs, ont ete inclus de maniere retrospective dans l’etude avec un minimum de un an de recul. Ils ont ete separes en deux groupes : groupe A : reprise du meme sport au meme niveau ou superieur ; groupe B : reprise du meme sport a un niveau inferieur, changement de sport, arret du sport. Deux scores (KJOC et Constant) ont ete utilises pour l’analyse subjective et objective de la fonction de l’epaule. Resultats Le recul moyen etait de 7,9 ans. Quatre-vingt-dix pour cent des patients ont repris le sport dont 52 % a un niveau identique ou superieur. Les facteurs favorisant la reprise du sport au meme niveau etaient en analyse univariee et multivariee : le sexe masculin, l’existence d’une lesion de coiffe en peroperatoire et’l'absence de geode trochiterienne a l’imagerie preoperatore. Lee debridement de la lesion de coiffe etait un facteur favorisant uniquement en analyse univariee. La capsuloraphie anterieure etait associee a plus de douleurs postoperatoires. Discussion Le taux de retour au sport au niveau anterieur est peu comparable a celui des series de la litterature du fait de sports pratiques differents et de techniques chirurgicales tres variables. Le caractere favorisant de la presence d’une lesion de la coiffe des rotateurs est une notion qui va a l’encontre de la plupart des series publiees. Les differences entre les sports pratiques en Europe continentale et dans les pays de culture anglo-saxons pourraient expliquer certaines des differences retrouvees. Niveau de preuve IV.

Internal impingement of the shoulder (IIS) is a specific disorder of young overhead-throwing athletes that was first described in 1991. The many non-operative and surgical treatments suggested to date have produced mixed outcomes. The objective of this study was to compare the practices of surgeons in France versus other countries regarding the diagnosis and treatment of IIS.Diagnostic and therapeutic practices regarding IIS differ between surgeons in France and in other countries.A 21-item questionnaire in French and English was emailed to the 1300 members of the French Arthroscopy Society and to surgeons from countries other than France. The questionnaire collected information on knowledge about IIS (2 items), the frequency of IIS in clinical practice (2 items), the diagnosis of IIS (6 items), the non-operative and surgical treatment of IIS (3 and 5 items, respectively), and return-to-sports rates after treatment for IIS (3 items).The completed questionnaire was sent back by 261 surgeons, 206 in France and 55 in other countries, including 42 in Japan. Among the respondents, 90% knew about IIS. Experience with IIS in terms of number of patients seen or surgical treatments performed was greater in the international group (45% vs. 19% in France, p0.001). Posterior shoulder pain in the arm cocking position was the most widely recognised symptom (99% in France, 74% internationally, p0.001), followed by excessive external rotation during arm abduction (55% vs. 65%, p=0.23). The most commonly sought lesions were those of the postero-superior labrum and articular surface of the rotator cuff. Rotator cuff debridement was among the surgical options according to most respondents (74% vs. 70%). In contrast, postero-superior glenoidplasty was cited almost only by surgeons in France (67% vs. 4%, p0.001). The proportion of patients who are able to return to sports was estimated at 50% to 75% by most respondents.Most respondents had theoretical knowledge about IIS, but surgery was rarely performed in France. Only very few athletes in France play baseball, which is responsible for most sports injuries of the shoulder seen in Japan. This fact, combined with differences in the lesions or even the diagnoses, may have contributed to the differences in the responses to the survey items between the French and international groups.

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.

Resume Introduction La prise en charge des ruptures massives de la coiffe des rotateurs symptomatiques ne fait pas l’objet de consensus. L’objectif de cette etude etait de comparer le resultat clinique de differentes options therapeutiques d’une rupture massive de la coiffe des rotateurs. Hypothese Il existe une place pour la chirurgie arthroscopique dans le traitement des ruptures massives des tendons de la coiffe des rotateurs. Materiel et methode Il s’agit d’une etude prospective multicentrique non randomisee incluant les patients presentant une rupture massive de la coiffe des rotateurs, pris en charge par traitement medical (MED), tenotomie/tenodese arthroscopique isolee du long biceps (TLB), reparation tendineuse partielle arthroscopique (RPC), lambeau de grand dorsal (GD) ou prothese totale d’epaule inversee (PTEI). L’evaluation clinique etait basee sur le score de Constant, SSV et ASES a 3, 6 et 12 mois. Resultats Deux cent dix-huit patients (âge moyen 69 ans) ont ete analyses : 71 MED, 26 TLB, 61 RPC, 25 GD, 35 PTEI. Au recul de 12 mois, les scores moyens de constant, SSV et ASES etaient respectivement de 70 points, 68 %, et 73 points, avec un gain significatif quel que soit le traitement par rapport a l’etat preoperatoire. Seul le groupe PTEI presentait une amelioration sur l’ensemble des parametres du score de constant. L’elevation anterieure active progressait significativement pour le groupe MED (+25°), RPC (+26°), ainsi que PTEI (+66°). Seule la PTEI a permis une discrete amelioration de la rotation externe active (+10°, p = 0,046). Le gain en rotation interne etait significatif pour le groupe MED (+1,6 points) et RPC (+1,7 points). Conclusion Les techniques arthroscopiques (TLB, GD, RPC) de prise en charge des ruptures massive et irreparables des tendons de la coiffe des rotateurs permettent une amelioration fonctionnelle significative. Une reparation tendineuse partielle et une PTEI semblent apporter de meilleurs resultats qu’une la TLB isolee ou un lambeau de GD. Niveau de preuve III Etude prospective non randomisee.

Objectives: Complete rotator cuff tears in adolescents that require surgery are exceptional. The purpose of this work was to analyze the medium- and long-term results in adolescents who underwent arthroscopic or open repair of a complete rotator cuff tear. Methods: All surgeons who are members of the French Shoulder and Elbow Society (SOFEC) and the French Arthroscopy Society (SFA) were contacted. They were sent an electronic questionnaire asking whether they had had to surgically treat a traumatic complete rotator cuff tear in a child or adolescent. Of 233 surgeons, 90 responded to the questionnaire. Only 15 had actually had the opportunity to address one or more cases. Surgeons who responded positively to the questionnaire were contacted to retrieve complete medical data on their patient(s). Results: Nineteen records were reviewed. The mean age at the time of surgery was 14.7 years (12-17). A frequent injury mechanism was glenohumeral dislocation during contact sports (n = 7/19). The subscapularis muscle was involved in 100% of the cases. In 31% of the cases, the injury also involved the supraspinatus and/or infraspinatus. Open (n = 6/19) or arthroscopic (n = 13/19) surgery was performed. At a mean follow-up of 47 months (24 months - 18 years), 79% had resumed sports at the previous level. Two patients had a neurological complication, one of whom required a nerve graft surgery. In 14% of the cases, pseudarthrosis of the lesser tuberosity occurred, and the surgical revision did not affect the final result. Only one patient had recurrent anterior instability requiring a bone block surgery seven years after the initial surgery. Conclusion: Complete rotator cuff tears are exceptional in adolescents. Injuries are mainly in the subscapularis. Reinsertion, even if it is late, ideally performed by arthroscopy, provides good results with resumption of sports at the previous level in 79% of the cases

The purpose of the study is to report the results of reverse shoulder arthroplasty (RSA) after three types of initial treatment performed for complex proximal humeral fracture (PHF): conservative, reduction and internal fixation (RIF), or hemiarthroplasty. This is a retrospective study of 63 patients separated into three groups with a minimum follow-up of two years. Group I included 25 patients with an initial conservative fracture treatment, group II included 25 patients treated by RIF, and group III included 13 patients initially treated by hemiarthroplasty. Patients were assessed using the absolute Constant-Murley score, functional parameters, complications rate, and radiological follow-up. One patient died and five were lost to follow-up. All functional outcomes improved significantly post-operatively for the three groups (p < 0.005). The mean Constant-Murley score increased from 13.7 to 54.1 (group I); 16.6 to 48.5 (group II); and 22.6 to 48.2 (group III) (p < 0.001). The gain of Constant-Murley and SST scores was better for group I (p = 0.049 and 0.028, respectively), while post-operative pain was better in group III (p = 0.033). The complication rate was 38% in group III, 30% in group II, and 14.3% in group I. Reverse shoulder arthroplasty represents a good surgical option in complex proximal humeral fracture sequelae. Whatever the initial treatment, function and motion of the shoulder are improved. The final result is better if the initial treatment was conservative. The group initially treated with hemiarthroplasty had the most complications.

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

While initially developed to improve function in patients with chronic rotator cuff deficiency and because of its success, reverse total shoulder arthroplasty (RTSA) has led to expanding indications including fracture sequelae and revision of failed hemi- or total shoulder arthroplasty. Rates of complications in RSA are higher than in TSA or in hemiarthroplasty and higher in RTSA performed in a revision setting. Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss.

Many treatment options have been proposed for treatment of irreparable posterosuperior rotator cuff tears. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before development of glenohumeral arthritic changes, aiming at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The technique was recently adapted from open to arthroscopically assisted with numerous advantages. We propose a combined fully arthroscopic technique for transfer of latissimus dorsi and teres major in which the tendons are fixed in a flat manner at the junction of supraspinatus and infraspinatus to decrease failure rate.

Isolated ruptures of the subscapularis or combined with a supraspinatus tear are not as numerous as posterosuperior rotator cuff tears. Reconstruction of the anterosuperior tendons may not always be possible because of fatty infiltration or poor tendon quality. Tendon transfer may represent a surgical option for treatment. The pectoralis major tendon transfer is not the best biomechanical one to supply the deficient subscapularis, but it can be an acceptable salvage option to decrease pain even beyond a 10-year postoperative period but with limited function.

Severe glenoid bone loss remains a surgical challenge. This condition is known to be associated with high rates of glenoid component failure. The objective of this study was to evaluate clinical and radiological outcomes of a lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa in primary cases of reverse shoulder arthroplasty (RSA) for severe glenoid bone loss and in revision cases. Between January 2011 and December 2014, 51 shoulders (50 patients) underwent primary or revision RSA using this baseplate. Forty-five shoulders in 44 patients were followed for a minimum of two years (mean, 33 months; range, 24–60 months). The mean age of the patients was 76 years (range, 55–93 years). Outcome measures included pain, range of motion, Constant Score, and complications. The complication rate was 12% in primary cases and 25% in revision cases. One glenoid implant (4%) failed in primary cases and one glenoid implant (5%) failed in revision cases. Pain and range of motion were significantly improved in both groups. The mean Constant Score improved from 24 (± 7) to 62 (± 9) in primary cases and from 24 (± 10) to 58 (± 12) in revision cases. A lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa may provide satisfactory mid-term outcomes in patients with large glenoid bone defects where initial press-fit of a regular baseplate is impossible to obtain.

Resume Contexte Le conflit postero-superieur (CPS) est une pathologie specifique des jeunes sportifs avec lancer en arme, decrite en 1991. De nombreux traitements medicaux et chirurgicaux ont ete proposes avec des resultats mitiges. Objectif Comparer les pratiques diagnostiques et therapeutiques d’un groupe de chirurgiens francais avec un groupe de chirurgiens etrangers concernant le CPS. Methodes Un questionnaire comprenant 21 questions a ete produit en francais et en anglais et envoye par courrier electronique aux 1300 membres de la SFA (groupe France) et a des chirurgiens non francais (groupe Monde). Le sondage interrogeait sur la connaissance de la pathologie (2 questions), sa frequence en pratique clinique (2), son diagnostic (6), son traitement medical (3) et chirurgical (5), et les resultats du traitement sur la reprise du sport (3). Resultats Deux cent soixante et un chirurgiens (206 France, 55 Monde dont 42 du Japon) ont repondu au questionnaire. Quatre-vingt-dix pour cent d’entre eux avaient connaissance de la pathologie. Les chirurgiens nonfrancais sondes avaient une experience plus importante de la pathologie par le nombre de cas vus en consultation ou pour la pratique chirurgicale (19 % vs 45 %, p Discussion Le CPS est une pathologie connue sur le plan theorique par la majorite des interroges mais la chirurgie reste rare en France. La pratique du base-ball, tres rare en France mais responsable de la majorite de la pathologie sportive de l’epaule au Japon, ainsi que la presence de lesions voire de diagnostics differents pourraient expliquer certaines differences mises en evidence par ce sondage.

Background:It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation.Purpose:To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair.Study Design:Cohort study; Level of evidence, 3.Methods:A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test.Results:A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures.Conclusion:Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.

Management of massive irreparable posterosuperior rotator cuff tears is a surgical challenge, particularly in young active patients without any signs of osteoarthritis. Different surgical techniques have been described. To the three main deficits of active range of motion previously reported for a massive irreparable cuff tear, i.e., isolated loss of active elevation (ILEA), isolated loss of active external rotation (ILER), and combined loss of elevation and external rotation (CLEER), we add two new entities: isolated loss of active internal rotation (ILIR) and combined loss of active elevation and active internal rotation (CLEIR). We suggest that a combined deficit (CLEER or CLEIR) could lead to a new definition of a pseudoparalytic shoulder and propose a novel algorithm to redefine the role of latissimus dorsi transfer in each of these situations. We also describe a fully arthroscopic latissimus dorsi transfer technique that prevents any deltoid muscle insult, offers better visualization of the neighboring neurovascular structures at risk, and allows simultaneous management of biceps pathology and partial rotator cuff repair.

Instability is one of the major causes of failures in unconstrained anatomic total shoulder arthroplasty (TSA). This study reviewed the instabilities that may occur in an anatomic shoulder platform system to identify its potential predictors. We hypothesized that soft tissue deficiency was the main cause of instability and that the best treatment option would be conversion to a reverse shoulder arthroplasty (RSA).Between 2003 and 2013, we reviewed 27 patients who experienced postoperative instability, and the overall incidence was 5.07%. There were 8 hemiarthroplasties (HAs), 14 TSAs with metal-backed glenoid components, and 5 TSAs with cemented glenoid components.We reported 10 isolated subscapularis tears, 6 massive rotator cuff tears, 8 component malpositions, 2 component dissociations or loosening, and 1 humeral shortening. These dislocations occurred early, within the first 6 months postoperatively, in 20 patients and later in 7. Specific procedures were performed in 8 patients, 17 were converted successfully to a RSA, and no surgery was done in 2 patients. At the last follow-up (mean, 36.96 months) Constant scores, Subjective Shoulder Value, and Simple Shoulder Test scores improved significantly to 49.9, 56.4%, and 6.9 of 12, respectively (P .05). None of the 25 patients who were revised were categorized as failures. Patients who underwent conversion had a better outcome than those who had other specific procedures (P = .001).The major cause of instability in our series was soft tissue deficiency. Most of the patients required conversion, and the platform system we used made conversions easier.

Background There is a paucity of information on latissimus dorsi transfer (LDT) for subscapularis insufficiency. The purpose of this study is to report the outcome of LDT to reconstruct an irreparable subscapularis tear. Methods Excluding patients with prior failed Latarjet procedures, we examined 56 consecutive patients who underwent open (n = 14) or arthroscopic (n = 42) LDT. The average age was 53 years (range, 23-79), and 46 patients had a prior surgery. Outcome measures included visual analog scale score for pain, range of motion (ROM), subjective shoulder value (SSV), and Constant shoulder score (CSS). Results At a mean 13-month follow-up (7-51 months), patients had significant improvements in their pain, ROM, SSV, and CSS when compared to preoperatively. At final follow-up, 26% of patients continued to have proximal migration, and 11% of patients had anterior subluxation. The patients with frank anterior escape had a higher likelihood of having proximal migration and anterior subluxation, but this was not statistically significant. Stages of arthritis did not progress. Revision surgeries included 2 patients who revised to a reverse shoulder arthroplasty for rupture of the tendon transfer. Furthermore, 3 patients had LDT ruptures but did not elect to undergo further surgery. Conclusions LDT for irreparable subscapularis tears has the potential to lead to significant clinical improvements. Most patients improve in many of the signs of subscapularis insufficiency, including anterior and/or proximal subluxation, clinical examination maneuvers, and shoulder function. Overall, this transfer represents a reasonable option for this difficult pathology.

Background Internal impingement of the shoulder (IIS) is the leading cause of chronic shoulder pain in overhead throwing athletes. No consensus exists about which techniques are optimal when surgery is in order. The available studies are limited by small sample sizes and short follow-ups. The primary objective of this study was to assess return-to-sports (RtS) outcomes after surgical treatment for IIS. A favourable RtS outcome (RtS +) was defined as returning to the previous sport at the same or a higher level. Hypothesis The main hypothesis was that surgical treatment resulted in an RtS + outcome. The secondary hypothesis was that epidemiological factors, pre- and intra-operative anatomical factors, and specific surgical procedures were associated with higher RtS + rates. Material and methods A retrospective multicentre design was used. We included 135 patients with IIS managed arthroscopically using any of the following procedures: anterior capsulorrhaphy, posterior capsulotomy/capsulectomy, postero-superior labral debridement, posterior glenoidplasty, and rotator cuff tear debridement or repair. Follow-up was at least 1 year. The patients were divided into two groups based on whether they had an RtS + outcome as defined above or an RtS − outcome defined as a return to the previous sport at a lower level, a switch to another sport, or an inability to engage in any sport. The Kerlan-Jobe Orthopaedic Clinic (KJOC) and Constant's score were used to evaluate subjective and objective shoulder function. Results Mean follow-up was 7.9 years. Of the 135 patients, 120 (90%) returned to sports after surgery including 70 (52%) to the previous sport at the same level (RtS + outcome). By univariate analysis, the following factors were associated with an RtS + outcome: male sex, rotator cuff tear documented intra-operatively, absence of a greater tuberosity cyst on pre-operative imaging studies, and cuff tear debridement. Anterior capsulorrhaphy was associated with worse post-operative pain. Discussion The RtS + rate in this study differed from previously reported values, due to differences in the sports practiced by the patients and to considerable variability in the surgical techniques used. The positive association between presence of a rotator cuff tear and an RtS + outcome is at variance with most of the previously published data. Some of the apparent discrepancies between our results and those from other countries may be ascribable to differences in the most popular sports. Level of evidence IV.

Background There is limited evidence on clinical outcomes of arthroscopic partial repair (APR) and latissimus dorsi tendon transfer (LDTT) for posterosuperior massive rotator cuff tears (mRCTs). We aimed to compare clinical outcomes of APR and LDTT for partially repairable posterosuperior mRCTs and to determine whether outcomes differ among tears that involve the teres minor. Methods We retrieved the records of 112 consecutive patients with mRCTs deemed partially repairable due to fatty infiltration (FI) stage ≥3 in one or more rotator cuff muscles. Of the tears, 12 involved the subscapularis, 32 were managed conservatively, 14 were treated by reverse shoulder arthroplasty, and 7 were treated by stand-alone biceps tenotomy. Of the remaining 47 shoulders, 26 underwent APR and 21 underwent LDTT. At a minimum of 12 months, we recorded complications, active forward elevation, external rotation, the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Simple Shoulder Test (SST) score. Results No significant differences between the APR and LDTT groups were found in terms of follow-up (23.4 ± 3.5 months vs. 22.1 ± 4.1 months, P = .242), Constant-Murley score (64.8 ± 13.7 vs. 58.9 ± 20.0, P = .622), ASES score (78.3 ± 19.3 vs. 74.4 ± 14.5, P = .128), active forward elevation (158.1° ± 19.4° vs. 142.8° ± 49.1°, P = .698), or external rotation (33.3° ± 17.4° vs. 32.2° ± 20.9°, P = .752). By contrast, the APR group had a higher SSV (73.3 ± 17.5 vs. 59.5 ± 20.0, P = .010), and SST score (8.3 ± 2.4 vs. 6.4 ± 3.0, P = .024). Univariable analysis revealed that advanced FI of the teres minor compromised Constant-Murley scores (β = –25.8, P = .001) and tended to compromise ASES scores (β = –15.2, P = .062). Multivariable analysis corroborated that advanced FI of the teres minor compromised Constant-Murley scores (β = –26.9, P = .001) and tended to compromise ASES scores (β = –16.5, P = .058). Conclusion Both APR and LDTT granted similar early clinical outcomes for partially repairable posterosuperior mRCTs, regardless whether the teres minor was intact or torn. Advanced FI of the teres minor was the only independent factor associated with outcomes, as it significantly compromised Constant-Murley scores and tended to compromise ASES scores.

For posterosuperior tears, even though these are not absolute contraindications, the following preoperative variables have been found to significantly correlate with poorer outcomes when performing a latissimus dorsi tendon transfer (or possibly even other tendon transfers, but very few data are ava

Introduction Osteoarthritis (OA) of the shoulder in under-50 year-olds is rare, and treatment is delicate. Shoulder replacement incurs frequent long-term risk of progression and a high revision rate, making it unsuited to young active patients. The aim of the present study was to determine the epidemiology of shoulder OA in under-50 year-olds and to assess the clinical results of the various treatment options. Hypothesis The main study hypothesis was that well-conducted non-operative treatment can allow shoulder replacement to be postponed. The secondary hypothesis was that anatomic total shoulder arthroplasty (TSA) is the treatment of choice when other options fail. Materials and methods A multicenter retrospective study included primary (POA) and post-instability osteoarthritis (PIOA) in patients aged ≤ 50 years at symptom onset. Exclusion criteria comprised post-traumatic OA, rheumatoid arthritis and necrosis. Two hundred and sixty-six patients for 273 shoulders were included from 13 shoulder surgery centers: 2 types of non-operative treatment (28 by platelet-rich plasma [PRP] and 88 by viscosupplementation), 73 arthroscopies, and 150 implantations (62 humeral hemiarthroplasties [HA], comprising 10 hemi-metal, 24 hemi-pyrocarbon and 28 hemi-resurfacing; 77 anatomic total prostheses, and 11 reverse prostheses). Minimum follow-up was 12 months for non-operative treatment and 24 months for arthroplasty (some patients having both). Endpoints comprised Constant score, Subjective Shoulder Value (SSV) and number of complications/revision procedures. Results Mean age at treatment was 43 years (range, 23–65 years), with 75% male predominance. Symptom onset was earlier in PIOA than in POA: 36 vs. 39 years (range, 20–50 years). PRP and viscosupplementation postponed implantation by a mean 3.5 years in 86% of cases, as did arthroscopy in 56%. ER1 restriction was the most negative factor. At 74 months’ follow-up for HA and 95 months for TSA, mean Constant score was significantly lower for HA (56 vs. 67; p = 0.004), with higher rates of complications (31% vs. 11%) and implant exchange (13% vs. 9%). Discussion/conclusion PRP, viscosupplementation and arthroscopy allow implantation to be postponed until the shoulder becomes stiff and painful. In case of failure, TSA is the most effective solution in the medium-term. Level of evidence IV a; therapeutic study – investigating the results of treatment.

Resume Peu de procedures de revision ont ete decrites apres echec de Weaver et Dunn. Nous avons suppose qu’il etait possible d’effectuer sous arthroscopie une revision avec un tendon conjoint vascularise et retourne dans la clavicule distale resequee (procedure de Vargas) « augmente » par un ligament coraco-claviculaire artificiel. Deux patients ont ete operes. Une longueur minimum de tendon conjoint proximal de 3 cm a ete dissequee sous controle arthroscopique. La moitie laterale du tendon a ete prelevee, laissant son extremite proximale attachee a la coracoide. Tout en etant encore vascularisee avec la pointe de la coracoide, le tendon a ete tubularise, retourne puis transfere dans la partie distale de la clavicule. Un ligament coraco-claviculaire artificiel a « augmente » le transfert. Aucune complication n’a ete decrite. Apres un minimum de deux ans de suivi, il n’y avait pas de recidive de l’instabilite acromio-claviculaire et il y avait mobilite normale ; les deux patients ont repris le sport. Niveau de preuve : niveau IV-A, serie de cas.

Background No consensus exists about the management of massive and symptomatic rotator cuff tears (RCTs). The objective of this study was to compare the 12-month clinical outcomes of various treatment options for massive RCTs. Hypothesis Arthroscopic surgery has a role to play in the treatment of massive and apparently irreparable RCTs. Material and methods A prospective multicentre non-randomised study was performed in patients with massive RCTs managed non-operatively (NONOP) or by arthroscopic tenotomy/tenodesis of the long head of biceps (aTLB), arthroscopic partial tendon repair (aPTR), arthroscopic latissimus dorsi transfer (aLDT), or reverse shoulder arthroplasty (RSA). Clinical outcomes were evaluated based on the Constant score, Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) score after 3, 6, and 12 months. Results The 218 included patients (mean age, 69 years) were distributed as follows: NONOP, n = 71; aTLB, n = 26; aPTR, n = 61; aLDT, n = 25; and RSA, n = 35. After 12 months, the mean Constant score, SSV, and ASES score values were 70, 68%, and 73, respectively, and had improved significantly versus the preoperative values in all treatment groups. RSA was the only treatment followed by improvements in all Constant score items. Active forwards elevation improved significantly in the NONOP (+25°), aPTR (+26°), and RSA (+66°) groups. An improvement in active external rotation was seen only in the RSA group, where it was small (+10°, p = 0.046). Significant increases in internal rotation were seen in the NONOP (+1.6 points) and aPTR (+1.7 points) groups. Conclusion Arthroscopic techniques (aTLB, aPTR, and aLDT) for managing massive irreparable RCTs produce significant functional gains. Partial tendon repair (aPTR) and RSA may provide better outcomes than isolated aTLB or aLDT. Level of evidence III, non-randomised prospective study.

Removal of a cemented glenoid component often leads to massive glenoid bone loss, which makes it difficult to implant a new glenoid baseplate. The purpose of this study was to demonstrate the feasibility of revisions with a completely convertible system and to report clinical and radiographic results of a retrospective review of 13 cases. Between 2003 and 2011, 104 primary total shoulder arthroplasties (TSAs) were performed with an uncemented glenoid component in our group. Of these patients, 13 (average age, 64 years) were revised to reverse shoulder arthroplasty (RSA) using a modular convertible platform system and were included in this study. Average follow-up after revision was 22 months. Outcome measures included pain, range of motion, Constant-Murley scores, Simple Shoulder Tests, and subjective shoulder values. Active flexion increased significantly from a mean of 93° (range, 30°-120°) to 138° (range, 95°-170°) (P = 0.021), and active external rotation increased significantly from 8° (range, -20°-15°) to 25° (range, -10°-60°). Mean pain scores significantly improved from 4.2 to 13.3 points. The mean Constant Scores improved from 21 (range, 18-32) to 63 (range, 43-90). Subjectively, 12 patients rated their shoulder as better or much better than preoperatively. This retrospective study shows that a complete convertible system facilitates conversion of TSAs to RSAs with excellent pain relief and a significant improvement in shoulder function.

CASE Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome. CONCLUSION Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.

Introduction Actuellement aux Etats-Unis pret de 90 % des procedures de stabilisation d’epaule font appel a une reparation de Bankart. A l’inverse en France 90 % des procedures de stabilisation sont realise par l’operation de Latarjet. Les taux de recidives de la reparation de Bankart apparaissent plus eleves dans la litterature mais les taux de complications postoperatoires sont plus faibles. Aux Etats-Unis l’approche est plutot de reserver la chirurgie par technique de Latarjet aux echec de Bankart. Neanmoins, aucune etude ne compare les resultats de la technique de Latarjet avec ou sans reparation Bankart prealable. L’objectif de cette etude etait d’evaluer les resultats cliniques du Latarjet avec ou sans reparation de Bankart prealable. Methodes Tous les patients ayant recu une butee selon Latarjet entre 2012 et 2015 dans 6 centres specialises en chirurgie de l’epaule ont ete inclus. Les dossiers ont ete extraits retrospectivement pour identifier les patients ayant presente ou non une reparation de Bankart prealable. L’âge, le score ISIS, le IMC, l’activite sportive et le delai avant la chirurgie ont ete collecte retrospectivement. Les resultats cliniques ont ete collectes prospectivement avec notamment le Simple Shoulder Test, l’EVA douleur, le Walch Duplay, la survenue de recidive et l’evaluation subjective de la stabilite de l’epaule par le patient. Resultats Un total de 311 patients a ete inclus dont 21 ayant presente une reparation de Bankart au prealable. Le recul moyen etait de 3,4 ± 0,8 ans. Le taux de perdus de vue etait de 28 %. Les deux groupes etaient comparables en preoperatoire. Le taux de recidive etait de 3 % pour la population globale. Une difference significative apparaissait entre les deux groupes avec des scores de Walch Duplay plus faible dans le groupe ayant eu une reparation de Bankart au prealable (51,9 ± 25 versus 72,1 ± 25,2) et des douleurs au dernier recul plus elevees (2,5/10 versus 1,2/10). Le Simple Shoulder Test etait comparable dans les deux groupes. Conclusion Il apparait que les resultats de la prise en charge de l’instabilite anterieure d’epaule par technique de Latarjet sont moins bon en cas de reparation de Bankart prealable.

The long head biceps tenodesis (LHBT) is an alternative to tenotomy in order to prevent Popeye sign.Biomechanical studies showed that interference screw(IFS) was the strongest fixation but there might be complications and cost. What's more, the analyses of tenodesis failures are undervalued because they only take visible deformations of the arm into account. The purpose of this study was to compare a modified arthroscopic "keyhole" LHBT (modified @KH) with an arthroscopic IFS LHBT(@IFS) using an objective method. We hypothesized that modified @KH gave similar clinical outcomes as @IFS without its hassles or drawbacks.We present a 12-month prospective comparative study (modified @KH versus @IFS) performed by two experienced orthopedic surgeons. Modified @KH was performed on one hundred and nine patients versus @IFS that was performed on one hundred and two. A radiopaque marker was placed into the tendon. The review was conducted in the sixth month with clinical examination and plain standard X-ray to objectify the potential migration of the marker.Modified @KH showed 2.4 % visible deformity without any Popeye sign but 3.4 % radiographic metallic marker migrations. No complications were noted. @IFS showed 5.8 % visible deformity with 2.9 % Popeye sign and with 10.3 % radiographic metallic marker migrations;pain at tenodesis location was noted in 2 %. P value (0.13) indicates that there were no statistically significant differences.We confirm the hypothesis that the modified@KH gives clinical and radiographic outcomes at least similar to @IFS without any complications and cost. The establishment of the radiopaque marker allows us to know the exact number of failures.Level of evidence Consecutive prospective comparative clinical, Level II-1 studies.

Purpose The main objective of this retrospective study was to analyze the rate and modes of failure of latissimus dorsi transfer (LDT). The secondary objective was to evaluate whether a rupture of the transfer was associated with a worse outcome. Methods During a 2-year period, we performed consecutive LDTs either for irreparable posterior-superior rotator cuff tears (RCTs) or for failed prior repair. All the LDTs were performed by a single surgeon. All transfers were arthroscopically assisted and fixed as a tubularized LD tendon in a bone tunnel inside the humeral head. Three metal clips were placed systematically intraoperatively in the tubularized tendon at a fixed distance of 2, 4, and 6 cm from the tip of the tendon. Immediate postoperative standard anteroposterior radiographs were performed and the position of the metal clips was compared with their position on radiographs performed at 6 weeks and 3 and 24 months postoperatively. Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Activities of daily living requiring active external rotation (ADLER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores and patient's subjective satisfaction (assessed by self-questionnaire) at last follow-up were compared between patients who had a rupture of the transfer and those who did not. Results Sixty-six patients were included. Six of 66 patients (9%) were lost to follow-up. There were 11 complications (18.3%) in the global series (10 hematoma and 1 subscapularis retear). At a mean 35.2 months (range 24-50 months), there were 23/60 cases of rupture (38%). The 7 scores and the satisfaction reported were significantly lower for patients who had a rupture of the transfer versus those who had an intact transfer: Constant score, 42.8 versus 68.7 ( P = .001); SSV, 48.9 versus 71.6 ( P = .001); SST, 4.8 versus 8.4 ( P = .012); ADLER, 19.7 versus 26.7 ( P = .005); VAS, 3.7 versus 2.3 ( P = .082); ASES, 55.4 versus 74.8 ( P = .056); and 13% of either satisfied or very satisfied patients versus 78% ( P Conclusions The rate of rupture of LDT is high (38%). With complete healing of LDT, the outcome is significantly lower in those with rupture compared with those without rupture, showing that LDT can efficiently treat massive and irreparable RCT. Level of Evidence Level IV, case series treatment study.