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Objectives: Bankart lesion is one of the most common lesions of the glenohumeral joint. Several double‐row suture methods were reported for Bankart repair, which could provide more stability, yet more motion limitation and complications. Therefore, we introduced a new double‐row Bankart repair technique, key point double‐row suture which used one anchor in the medial line. The purpose of this article is to investigate the clinical outcomes of this new method and to compare it with single‐row suture. Methods: Seventy‐eight patients receiving key point double‐row suture or single‐row suture from October 2010 to June 2014 were collected retrospectively. The basic information including gender, age, dominant arm, and number of episodes of instability was collected. Before surgery, the glenoid bone loss was measured from the CT scan. The visual analogue scale, American shoulder and elbow surgeons, the University of California at Los Angeles shoulder scale, and subjective shoulder value were valued before surgery and at the last follow‐up. Results: Forty‐four patients (24 patients receiving single‐row suture and 20 patients receiving key point double‐row suture) were followed up successfully. The follow‐up period was 9.2 ± 1.1 years (range, 7.8–11.4 years). At the last follow‐up, no significant differences were detected for any of the clinical scores. The recurrence rate was 12.5% for the single‐row group and 10% for the double‐row group, respectively (p = 0.795) 14 patients (31.8%) in the single‐row group and nine patients (26.5%) in the double‐row group were tested for active range of motion. A statistically significant difference was found only for the internal rotation at 90° abduction (48.9° for single‐row and 76.7° for key point double‐row, p = 0.033). Conclusion: The key point double‐row sutures for Bankart lesions could achieve similar long‐term outcomes compared with single‐row suture, and one medial anchor did not result in a limited range of motion. The low recurrence rate and previous biomechanical results also indicate the key point double‐row suture is a reliable method. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The rate of nonunion observed among the variety of Bristow-Latarjet procedures reportedly ranges from 9.4% to 28%1. In Chinese timber buildings, the mortise-tenon joint is commonly utilized to connect beams to columns. Drawing inspirations from this concept, we created a bone trough in the glenoid neck to serve as a mortise and trimmed the coracoid graft to serve as a tenon, then fixed this mortise-tenon joint with a metal screw. Compared with a standard Bristow-Latarjet procedure, the key feature of this technique was that the coracoid process was placed into a trough (5 to 10 mm deep) in the glenoid neck, which substantially increased the bone contact area between the graft and glenoid neck. We called this surgical technique the Chinese unique inlay Bristow (Cuistow). Description: Specific instruments have been designed to improve the safety and accuracy of the arthroscopic inlay Bristow procedure (Weigao, Shangdong, China). The posterior portal (A), superolateral portal (B), and 3 anterior portals (i.e., proximal [C], inferolateral [D], and inferomedial [E]) were utilized. General anesthesia and an interscalene block were administered with the patient in the beach-chair position. The surgical technique can be divided into 6 steps: (1) evaluation of the shoulder joint; (2) coracoid preparation, drilling, and osteotomy; (3) subscapularis splitting and labrum detachment; (4) glenoid preparation and drilling; (5) coracoid retrieval, trimming, transfer, and fixation; and (6) Bankart repair. Alternatives: Soft-tissue capsulolabral repairs or bone reconstruction procedures are commonly performed for the treatment of anterior glenohumeral instability2. The arthroscopic Bristow-Latarjet procedure is increasingly popular for the treatment of anterior shoulder instability with a substantial osseous defect of the glenoid3. Defects that are too large to be restored with the coracoid process can be treated with use of the Eden-Hybbinette procedure or a distal tibial allograft4,5. Rationale: This procedure was inspired by the structure of mortise-tenon joints, resulting in a modified version of the Bristow-Latarjet technique in which the coracoid process is trimmed and placed into a trough (5 to 10 mm deep) in the glenoid neck. This procedure substantially increases the contact area between the fresh bone surface and the coracoid and glenoid neck. Another important advantage of this technique is that it can facilitate accurate positioning of the coracoid on the glenoid. This procedure resulted in a high rate of graft healing, excellent functional outcomes (Rowe and American Shoulder and Elbow Surgeons Shoulder scores), and a high rate of return to sport6. Currently, indications of this procedure are (1) participation in high-demand sports (i.e., collision and overhead) combined with the presence of a glenoid defect involving <25% of the glenoid, or (2) any glenoid defect involving 10% to 25% of the glenoid. Expected Outcomes: Increased bone-contact area and accurate positioning of the graft helped to facilitate osseous union, with a union rate of 96.1% at 12 months postoperatively. The clinical outcomes were excellent, with a high rate of return to sport (87%) at a minimum of 3 years of follow-up6. Important Tips: When the coracoid is retrieved through portal D (the inferolateral portal), there is a risk of stretching the musculocutaneous nerve. Trimming the coracoid graft could lead to stretching of the graft and the surrounding soft tissue, resulting in overstretching of the musculocutaneous nerve. To minimize the risk of musculocutaneous nerve injury, (1) the graft should be gently retrieved through portal D, (2) the graft should be trimmed with caution without overstretching it and surrounding soft tissue, and (3) a cannula should be utilized when driving the screw to fix the graft in order to avoid the surrounding soft tissue. Acronyms & Abbreviations: RHD = right-hand dominant MRA = magnetic resonance angiography 3D-CT = 3-dimensional computed tomography PDS = polydioxanone suture MCN = musculocutaneous nerve [ABSTRACT FROM AUTHOR]

Purpose: A new clinical test for evaluating subscapularis (SSC) integrity was described, and its diagnostic value was compared with the present SSC tests (the lift-off, belly-press, IRLS and bear-hug tests). The new test is called internal rotation resistance test at abduction and external rotation (IRRT). The test is performed at maximal 90° of abduction and maximal external rotation. Methods: Two hundred and thirty-five consecutive patients suffering from rotator cuff injury were evaluated preoperatively. Six tests were performed to assess the function of the SSC: the lift-off, belly-press, IRLS, the bear-hug, IRRT at 0° abduction and 0° external rotation (IRRT0°) and IRRT at maximal 90° abduction and maximal external rotation (IRRTM). Arthroscopic findings were the reference for diagnosing of SSC lesions. Results: The IRRTM test showed the greatest sensitivity (76.5 %), and IRLS (31.6 %) test had the lowest sensitivity. The IRRTM had the highest accuracy (79.0 %), and lift-off had the lowest accuracy (65.3 %). Positive IRRTM, bear-hug, belly-press, IRRT0° tests indicate that about one-third of the SSC is torn, and a positive lift-off and IRLS tests predict a severe tear at least two-thirds of the SSC. Conclusions: The IRRTM represents a sensitive diagnostic test for SSC lesions and improves the chance of finding the upper part of the SSC tears. When the IRRTM is positive, the surgeon should pay particular attention to detecting the SSC tendon during arthroscopy. Level of evidence: Diagnostic study, Level I. [ABSTRACT FROM AUTHOR]