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Rotator cuff repair is a common orthopedic procedure. Techniques have evolved from open procedures to an arthroscopic (assisted) procedure in many patients. Tendon healing is anticipated, but complications may occur. There is approximately 90% patient satisfaction with index surgery, but imaging studies reveal defect recurrence in approximately one-third of the larger tears. For patients who are limited by pain, revision surgery is considered. Newer techniques of stabilizing the damaged structures, combined with delay in rehabilitation, improved the number of successful surgeries. Revision surgery for pain relief is promising when causes of persistent pain have been identified. Strength deficits may persist, particularly if permanent atrophy and fatty infiltration within the cuff muscles are demonstrated preoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder arthroscopy continues to use minimally invasive techniques to diagnose and treat the athlete's shoulder. Instability can result from trauma or repetitive forceful movements. Arthroscopy stabilization includes multiple quadrant surgery, proper capsular tensioning, and allows dynamic evaluation of the anatomic repair without disruption of the subscapularis.Methods/materials: Bone deficits may limit soft tissue stabilization procedures. The arthroscope is helpful in determining the amount of glenoid bone loss, Hill-Sachs impression, positions of engagement, and associated soft tissue laxity that may compromise or alter treatment.Results: A series of 450 patients are presented to review repairs-including 20 first-time dislocators, 24 revision surgeries, 330 suture anchor repairs, and 120 capsular repairs. Successful stabilization occurred in 93% of the patients studied.Conclusion: Successful management of the unstable athlete's shoulder includes early intervention, near-normal range of motion, absent apprehension, and normal strength and function. Anatomic repairs provide the best opportunity for the athlete to return to their sport. [ABSTRACT FROM AUTHOR]

The author offers a commentary on the role of physicians and surgeons in bringing value to patient care. The author highlights the importance of measuring the progress of patient's health, a brief overview on the prevalence of shoulder osteoarthritis, and discusses the importance of using multiple assessment strategies to provide an accurate measurement of the patients health state.

Surgical repair of the unstable shoulder begins with reattachment of the detached capsulolabral complex. The degree of damage to the glenohumeral articulation can be variable and is often related to the degree of trauma, duration of dislocation, and the number of instability events. There have been many surgical procedures proposed for the treatment of shoulder instability in the athlete, ranging from soft-tissue repair to coracoid transfer or the addition of a bone graft. The arthroscope provides an opportunity to visualize and repair the injured structures, returning the shoulder to maximal range of motion and permitting functional improvement. Indications for arthroscopic anterior stabilization include a first-time dislocation, patients with apprehension following dislocation, and recurrent dislocation and subluxation prior to creating advanced bone loss. If there is advanced bone loss, an augmented repair or a procedure other than arthroscopic stabilization has been recommended. Mobilization of the anterior capsule and fixation to recreate the proper anterior tension will limit translation and potential recurrence of instability. The steps of the arthroscopic anterior stabilization include: Perform examination under anesthesia to identify the directions and degree of humeral translation relative to the glenoid. Position the patient with the shoulder 30° abducted and 20° flexed. Create proper portals, including a posterior viewing portal, dual anterior portals, and accessory portals for suture anchor placement. Perform a diagnostic arthroscopy to determine the damaged structures and how they relate to shoulder positions that may invite future dislocations. Perform capsule and labrum mobilization to permit anatomic relocation of the injured ligament. Place a series of suture anchors along the anterior and inferior glenoid margin. Utilize suture hooks to retrieve the sutures placed through the capsule to advance the capsule superiorly to the glenoid margin. Assess glenoid deficiency and place an autograft anterior to the damaged glenoid rim in selected cases. Tenodese the posterior capsule and infraspinatus to a large Hill-Sachs lesion on the posterosuperior aspect of the humeral head in selected cases. Repair additional labral structures superiorly and posteriorly if they contribute to glenohumeral instability. The anticipated outcome is a return to sport and high-demand activities. Bracing is available, but the internal repair is the most reliable technique to protect the glenohumeral articulation. Additional techniques can be implemented when added trauma has resulted in severe bone loss of the glenoid, humeral head, or anterior capsular structures. A return to high-risk activities can be anticipated in 4 to 7 months. [ABSTRACT FROM AUTHOR]

The author comments on a report within the issue, "Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events," by Brett D. Owens and colleagues. The study looked at traumatic shoulder dislocation and subluxation injuries in military patients. Topics include surgical evidence of bone lesions, the effectiveness of arthroscopic stabilization of subluxation injuries, and the comparison of radiographic and magnetic resonance imaging of glenoid and labral injuries.