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Background: Coracoid graft positioning, fixation, and bone union are key factors affecting the clinical outcomes of Bristow and Latarjet procedures. We developed an arthroscopic "inlay" Bristow procedure based on the "mortise-tenon" joint structure concept using suture button fixation to achieve more stable fixation and better bone union of the graft., Purpose: To evaluate the positioning of the coracoid graft, bone union rate, and clinical outcomes of this arthroscopic inlay Bristow procedure with suture button fixation., Study Design: Case series; Level of evidence, 4., Methods: A total of 62 patients who received the arthroscopic inlay Bristow procedure with suture button fixation between June 2015 to June 2016 were eligible for inclusion, and 56 patients who met the inclusion criteria were enrolled in this study. Radiological assessment on 3-dimensional computed tomography scan was performed preoperatively, immediately after the operation, and postoperatively at 3 months, 6 months, 1 year, and the final follow-up. Pre- and postoperative clinical results were also assessed., Results: A total of 56 patients were included in this study. The mean ± SD follow-up time was 36.1 ± 3.7 months. Coracoid grafts (middle point) were positioned at 4 o'clock (range, 123.8°± 12.3°) in the sagittal view. In the axial view, 94.6% (53/56) of the graft positioning was measured as flush and 5.4% (3/56) as medial. Neither lateral nor too medial positioning was noted. The bone union rate was 96.4% at final follow-up. The mean visual analog scale score for pain during motion, American Shoulder and Elbow Surgeons score, and Rowe score all improved significantly after surgery-from 4.8 ± 2.6 to 1.1 ± 1.0, 69.2 ± 12.5 to 92.5 ± 7.0, and 33.5 ± 12.1 to 96.0 ± 4.9 at last follow-up, respectively. Almost all patients (98%; 55/56) returned to sports within 1 year after surgery at the same or higher level as compared with their preinjury performance. The mean subjective value for sports participation was 90.3% ± 7.1% (range, 70%-100%) as compared with the normal shoulder. The overall complication rate was 3.6%. No degenerative changes were noted in any patients., Conclusion: This study reported the first series of an inlay Bristow procedure with suture button fixation for recurrent shoulder dislocation, providing a satisfactory union rate and excellent graft positioning with a low complication rate. The mortise-tenon joint structure can provide excellent graft fixation and healing, while using suture button fixation instead of screw fixation could reduce osteolysis and complications related to hardware implantation.

Purpose: To investigate the accuracy of preoperative 1.5 T magnetic resonance imaging (MRI) interpreted with standardized procedure for diagnosing subscapularis (SSC) tears identified by arthroscopy. The diagnostic accuracy of MRI for different types of SSC lesions was also evaluated., Methods: Two-hundred and seventy-two consecutive patients with rotator cuff tears identified by arthroscopy were included into this study. All patients had preoperative MRI scans with 1.5 T strength. Totally, seven different signs of SSC tears were evaluated on MRI scans. The diagnostic value of MRI was evaluated, respectively, according to two classifications of SSC lesions. The definitive diagnosis for SSC lesions was based on the arthroscopic findings., Results: Among the 272 patients in this study, 107 (39 %) had SSC tears confirmed by arthroscopy. The surgeons correctly diagnosed 88 of 107 patients with SSC tears. The overall sensitivity was 82.2 %. The sensitivity of MRI for types I, II, III, IV and V was 70, 82.4, 96, 100 and 100 %, respectively, based on the classification by Lafosse. The sensitivity of MRI for partial-thickness and partial-width, full-thickness and partial-width, full-thickness and full-width tear was 75.3, 96.2, 100 %, respectively, according to the classification by Kim., Conclusions: The sensitivity of MRI in predicting SSC tears preoperatively was improved with the current procedure. Understanding of certain MRI characteristics of SSC tears could increase the accuracy for diagnosing SSC lesions. 1.5 T MRI of the SSC was not reliable for predicting partial thickness and especially less than 1/3 width tears., Level of Evidence: III.

Background: There have been few studies using magnetic resonance imaging (MRI) to evaluate the clinical outcomes and structural results after arthroscopic repair of bursal-side partial-thickness rotator cuff tears (PTRCTs)., Methods: From 2009 to 2012, 73 consecutive patients with bursal-side PTRCTs underwent arthroscopic repair. Fifty-nine of them were retrospectively evaluated as Ellman classification grade 2 (group A, n = 11) or grade 3 (group B, n = 48). All repairs were performed with a technique that preserved the intact articular fibers and repaired the avulsed bursal flap. The University of California-Los Angeles (UCLA) score and Constant score were assessed before the operation and at the final follow-up. Postoperative cuff integrity was determined with MRI following Sugaya's classification., Results: At the 2-year follow-up, the average UCLA score increased from 17.3 ± 3.7 to 33.3 ± 2.2, and the Constant score increased from 65.3 ± 12.9 to 93.9 ± 5.1 (P < .001). Forty-nine patients received follow-up MRI examinations at an average of 10.3 months after surgery. Of these 49 patients, 41 patients (83.7%) had a healed tendon and 8 patients had partial tears. Neither the clinical scores nor the retear rates on follow-up MRI were significantly different between the 2 groups., Conclusions: Arthroscopic repair of bursal-side PTRCTs achieved good functional and structural outcomes at a minimum of 2 years after surgery., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objective: To discuss and evaluate the diagnose and surgical techniques of rotator cuff tear with arthroscopic repair and its clinical results., Methods: From November 2006 to April 2008, 22 patients with rotator cuff tear were treated by arthroscopic repair using 5 different methods. There were 13 males and 9 females, aged 28-51 years old (mean 37.9 years old). The locations were left shoulder in 6 cases and right shoulder in 16 cases. Eleven cases underwent shoulder joint injury and other 11 cases had no inducement. According to Bigliani acromion classification, there were 12 cases of type II and 10 cases of type III. There were 5 bursa-side tear, 3 articular-side tear, and 14 full thickness tear. The disease course was 5 months to 6 years (mean 16.6 months). After all the patients underwent acromioplasty, 4 cases were treated by debridement of rotator cuff, 7 cases by single roll suture anchor, 4 cases by double suture anchors, 3 cases by triple suture anchors, and 4 cases by transosseous technique suture., Results: Incision healed by first intention and no complications occurred in all patients. Twenty-two cases were followed up 12-26 months (mean 15.6 months). The active forward flexion and abduction at the last follow-up were over 150 degrees in 21 cases, 90-120 degrees in 1 case. Postoperatively, the forward flexion strength was grade 5 in 20 cases and grade 4 in 2 cases. The score of University of California Los Angeles, the pain score, the function score, the forward flexion score, the forward flexion strength were improved significantly when compared with preoperation (P < 0.05). The results were excellent in 13 cases and good in 9 cases, the excellent and good rate was 100%., Conclusion: Depending on the correct diagnoses, 5 different methods of rotator cuff repair are used according to the different changes of shoulders, the outcome is good in all cases.

Background: Some studies have advocated the use of suture button fixation during Bristow-Latarjet surgery to reduce complications associated with screw fixation. However, data comparing these fixation methods are relatively incomplete. Purpose: To investigate the efficacy of modified arthroscopic Bristow-Latarjet surgery and compare the clinical and radiographic outcomes using screw versus suture button fixation. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 136 patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow-Latarjet surgery between June 2015 and February 2018. Of these patients, 117 who met the inclusion criteria were enrolled at a mean follow-up of 3.3 ± 0.7 years. Shoulders were separated into 2 groups based on fixation technique: screw fixation (group A; n = 63) or suture button fixation (group B; n = 54). Computed tomography imaging findings and clinical results were assessed preoperatively; immediately after operation; and postoperatively at 3 months, 6 months, 1 year, and final follow-up. Results: There were no significant differences between the groups in terms of postoperative clinical scores, the level of return to sports, range of motion, graft position, or reoperation rates. Bone healing was observed in 97.4% of the cases overall (114/117), with 98.4% bone union in group A and 96.3% in group B at final follow-up. Bone absorption was more common in group A (n = 30; 47.6%) compared with group B (n = 10; 18.5%) (P =.003). There were no hardware-related complications in group B, compared with 7.9% of patients in group A (P =.034). One patient in group B had a recurrent dislocation due to an unexpected event, and there were no recurrent dislocations in group A. Conclusion: After the modified arthroscopic Bristow-Latarjet procedure, both suture button and screw fixation methods demonstrated high bony healing rates and low risk of recurrence. Less coracoid graft resorption and no hardware-related complications were seen with suture button fixation. [ABSTRACT FROM AUTHOR]

Background: Avulsion fracture of the lesser tuberosity (AFLT) of the humerus has traditionally been treated with open reduction internal fixation using screw fixation. The clinical outcomes of arthroscopic repair with suture anchors remains unknown. Hypothesis: It was hypothesized that arthroscopic fixation with suture anchors would result in good clinical outcomes for the treatment of AFLT. Study Design: Case series; Level of evidence, 4. Methods: This study included 15 patients who underwent arthroscopic repair of AFLT of the humerus between January 2014 and October 2017. All patients had 3-dimensional computed tomography scans and magnetic resonance imaging to evaluate the avulsed fracture and concomitant injuries before surgery. The arthroscopic double-row and suture-bridge techniques were used based on the morphology of the avulsion fractures. Functional outcomes were assessed with range of motion, the visual analog scale (VAS) for pain, the Subjective Shoulder Value (SSV), the American Shoulder and Elbow Surgeons (ASES) score, and the University of California, Los Angeles (UCLA) shoulder score. The bear-hug test, liftoff test, and internal rotation resistance test at 90° abduction and external rotation (IRRT 90°) were used to evaluate subscapularis tendon integrity. Results: The mean follow-up time was 3.5 years (range, 3-5 years). Comminuted fractures with 1 large part and ≥1 small pieces were seen in 12 cases, partial tear of the supraspinatus in 2 cases, Bankart lesion in 2 cases, and superior labrum anterior to posterior injury in 2 cases. There was a statistically significant improvement from the baseline to the final follow-up in the VAS (from 6.9 ± 1.5 to 1.1 ± 1), SSV (from 30.7 ± 5.1 to 90.5 ± 11.6), ASES (from 28.5 ± 7.7 to 92.3 ± 4.5), and UCLA (from 29.5 ± 6.3 to 94.2 ± 8.3) scores (P <.001 for all). All patients showed full range of shoulder motion and bilateral symmetric strength on physical examination with the bear-hug test, liftoff test, and IRRT 90° test. Conclusion: The arthroscopic repair of AFLT resulted in excellent reduction and healing of the displaced fragment. At the final follow-up, clinical and functional results were good. Associated injuries occurred in 40% of patients but did not affect outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of nonunion after the Latarjet procedure remains high. The purpose of the present study was to investigate healing and clinical outcomes after a novel arthroscopic coracoid process transfer procedure.Methods: Sixty-three patients who underwent the arthroscopic inlay Bristow procedure combined with Bankart repair were identified, and 51 patients who met the inclusion criteria were enrolled in this study. The key feature of this technique was that the coracoid process was trimmed and fixed into a trough (5 to 10 mm deep) in the glenoid neck with a metal screw. Bone graft union and positioning accuracy were assessed with use of postoperative computed tomography (CT) imaging. Clinical examinations, return to sport, and functional scores (American Shoulder and Elbow Surgeons [ASES] and Rowe scores) were recorded.Results: The mean duration of follow-up (and standard deviation) was 41.5 ± 7.7 months (range, 36 to 48 months). Postoperative CT scans showed that the position of coracoid graft was at 4:10 (from 3:50 to 5:00) (referencing the right shoulder) in the sagittal view. The α angle was 16.4° ± 9.5°, with 4 (7.8%) of 51 screws being over-angulated (α > 25°). On the axial view, the graft position was considered to be flush in 33 patients (64.7%), medial in 11 (21.6%), congruent in 7 (13.7%), and lateral or too medial in none. At 1 year, the coracoid graft had healed in 49 patients (96.1%) and had failed to unite in 2 patients. CT scanning, performed for 47 patients, showed grade-0 osteolysis in 9 patients, grade-1 osteolysis in 21 patients, and grade-2 osteolysis in 17 patients. At the time of the latest follow-up, there was a significant increase in the Rowe score (from 35.5 ± 8.3 to 95.7 ± 7.2) and the ASES score (from 71.2 ± 9.7 to 91.5 ± 4.4), and 87.0% of patients were able to return to sport. No arthropathy was observed in any patient.Conclusions: After a minimum 3-year follow-up, the arthroscopic inlay Bristow procedure resulted in a high rate of graft healing, excellent clinical outcomes, and a high rate of return to sports.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]