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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.

Medial clavicle excision is a rarely indicated procedure and may be performed in different pathologies affecting the medial clavicle. Excessive medial clavicle resection with an injury to the costoclavicular ligament often leads to poor postoperative results. The exact surgical treatment used in this kind of pathology when conservative treatment is unsuccessful remains unclear. The aim of this Technical Note is to describe our preferred surgical technique to treat this condition., Technique Video Video 1 Surgical technique demonstration of reconstruction of the SCJ after excessive medial clavicle resection. An iliac crest autograft is first harvested. The size of the graft is determined by the size of the clavicle defect. A 1/3 tubular plate can be applied after graft harvest onto the iliac crest to prevent cosmetic deformity. An incision is made over the medial clavicle and sternum, and the medial clavicle is exposed. It is revitalized with an oscillating saw and rongeur. The sternal portion of the SCJ is exposed, preserving the capsule. The first rib is exposed and two strands of Ethibond 5 are passed through it. Two tunnels are drilled from the anterior sternal edge to the sternal articular surface. The iliac crest bone graft is shaped to the defect size, with a horizontal tunnel drilled through it to pass the gracilis allograft. The iliac crest bone graft is fixed to the native clavicle with a 3.5mm limited-contact dynamic compression plate. The sutures from the first rib are passed around the clavicle. The gracilis allograft ends are introduced into the sternal tunnel in a figure-of-eight configuration. The joint is reduced, and the graft is sutured onto itself. The sutures from the first rib are tied around the clavicle for the final costoclavicular stabilization. Pooled saline solution is used to check for pneumothorax. The capsule and platysma are approximated and closed.

Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%. A ‘problem’ is defined as an intraoperative or postoperative event that is not likely to affect the patient’s final outcome, such as intraoperative cement extravasation and radiographic changes. A ‘complication’ is defined as an intraoperative or postoperative event that is likely to affect the patient’s final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement. Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature. High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications. The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient’s final outcome, and their prevalence has dramatically decreased. With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040

Background: Traumatic rotator cuff tears can result in retraction of the tendon and may be associated with muscle edema, which may be confused with fatty infiltration as seen on magnetic resonance imaging (MRI). Purpose: To describe the characteristics of a type of edema associated with acute retraction of the rotator cuff tendon (termed “edema of retraction”) and to highlight the risk of mistaking it with pseudo–fatty infiltration of the rotator cuff muscle. Study Design: Descriptive laboratory study. Methods: A total of 12 alpine sheep were used for analysis. On the right shoulder, osteotomy of the greater tuberosity was performed to release the infraspinatus tendon; the contralateral limb acted as the control. MRI was performed immediately after surgery (time zero) and at 2 and 4 weeks postoperatively. T1-weighted, T2-weighted, and Dixon pure-fat sequences were reviewed for hyperintense signals. Results: Edema of retraction resulted in hyperintense signals around or within the retracted rotator cuff muscle on both T1- and T2-weighted imaging, but there was an absence of hyperintense signals on Dixon pure-fat imaging. This represented pseudo–fatty infiltration. Edema of retraction created a characteristic “ground glass” appearance of the muscle on T1-weighted sequences and was often found in either the perimuscular or intramuscular location of the rotator cuff muscle. Compared to time zero values, a decrease in the percentage of fatty infiltration was observed at 4 weeks postoperatively (16.5% ± 4.0% vs 13.8% ± 2.9%, respectively; P < .005). Conclusion: The location of edema of retraction was often peri- or intramuscular. Edema of retraction presented as a characteristic “ground glass” appearance of the muscle on T1-weighted sequences and led to a decrease in the fat percentage because of a dilution effect. Clinical Relevance: Physicians should be aware that this edema can result in a form of pseudo–fatty infiltration, as it is associated with hyperintense signals on both T1- and T2-weighted sequences, and it can be mistaken for fatty infiltration.

There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p &lt, 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017, ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient.

The purposes of this study were to investigate a radiographic sign found on coronal magnetic resonance imaging (MRI) sequences in subscapularis (SSC) pathology, reporting interobserver reliability data and sensitivity and specificity; and to correlate the preoperative assessment of SSC pathology with intraoperative assessment of the SSc during shoulder arthroscopy.A consecutive series of patients undergoing arthroscopic rotator cuff repair from January 2020 to December 2020 were examined. The positive diagnosis of a subscapularis tendon tear was prospectively determined and confirmed by arthroscopy. The "digitation sign" was assessed by 3 independent shoulder-trained fellows when evaluating the SSC in the coronal plane on T2-weighted images.Of the 132 patients included, 74 (56%) had SSC tendon tears confirmed during arthroscopy. Interobserver agreement for digitation sign was substantial (k= 0.640). Sensitivity for digitation sign only was 74.3%; for criteria of Adams et al. (Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy;Preoperative systematic MRI evaluation by shoulder surgeons can diagnose subscapularis lesions by using the digitation sign in the coronal plane along with Adams et al. criteria, leading to good sensitivity. This easy-to-apply sign can be helpful in the initial MRI evaluation in the coronal plane, with improved sensitivity when combined with a systematic approach.II, study of diagnostic test.

Objective To present our technique and early results using the Masquelet technique. Design Retrospective cohort study. Patients/participants Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014. Intervention A Masquelet technique was used to manage the open fractures. Main outcome measure Infection and union rate. Results The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases. Conclusions The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: This study aims to report the rate of biceps-related complications after LHB tenotomy, investigating related risk factors and their influence on the outcome. The hypothesis is that these complications have a limited clinical influence. Methods: A single-center prospective observational study was performed between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically and radiologically evaluated preoperatively, at six months and one year, and screened for postoperative popeye deformity, cramps, and bicipital discomfort. Each complication was analyzed for the following risk factors: age, sex, body mass index (BMI), dominant arm, manual work, tear patterns, and tendon healing. Finally, the clinical outcome was compared between patients with and without complications. Results: 207 patients were analyzed. Cramps, popeye deformity, and discomfort, were respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at six months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at one year. Cramps were associated with lower age (p = 0.0005), higher BMI (p = 0.0251), single tendon tear (p = 0.0168), manual work (p = 0.0086) at six months and manual work (p = 0.0345) at one year. Popeye deformity was associated with male sex at six months (p < 0.0001). Discomfort was associated with lower age (p = 0.0065), manual work (p = 0.0099), popeye deformity (p = 0.0240) at six months and manual work (p = 0.0200), single tendon tear (p = 0.0370), popeye deformity (p = 0.0033) at one year. Patients without complications showed a significant higher Constant score, pain and subjective shoulder value (SSV) (75.3 vs. 70.4, p = 0.00252; 0.9 vs. 1.9, p < 0.00001; 80.2 vs. 76.4; p = 0.00124) at six months and pain and SSV (0.6 vs. 2.0; p = 0.00044; 91.1 vs. 77.8; p ≤ 0.00001) at one year. Conclusions: Younger age, male sex, higher BMI, manual work, and single tendon tears are risk factors associated with the development of biceps-related symptoms during the first year after tenotomy in association with rotator cuff repair. Nevertheless, the clinical influence of these symptoms on shoulder outcomes is limited.

(1) Background: Postoperative recovery of external rotation after reverse shoulder arthroplasty (RSA) has been reported despite nonfunctional external rotator muscles. Thus, this study aimed to clinically determine the ideal prosthetic design allowing external rotation recovery in such a cohort. (2) Methods: A monocentric comparative study was retrospectively performed on patients who had primary RSA between June 2013 and February 2018 with a significant preoperative fatty infiltration of the infraspinatus and teres minor. Two groups were formed with patients with a lateral humerus/lateral glenoid 145° onlay RSA—the onlay group (OG), and a medial humerus/lateral glenoid 155° inlay RSA—the inlay group (IG). Patients were matched 1:1 by age, gender, indication, preoperative range of motion (ROM), and Constant score. The ROM and Constant scores were assessed preoperatively and at a minimum follow-up of two years. (3) Results: Forty-seven patients have been included (23 in OG and 24 in IG). Postoperative external rotation increased significantly in the OG only (p = 0.049), and its postoperative value was significantly greater than that of the IG by 11.1° (p = 0.028). (4) Conclusion: The use of a lateralized humeral stem with a low neck-shaft angle resulted in significantly improved external rotation compared to a medialized humeral 155° stem, even in cases of severe fatty infiltration of the infraspinatus and teres minor. Humeral lateralization and a low neck-shaft angle should be favored when planning an RSA in a patient without a functional posterior rotator cuff.

Surgical treatment of anterior glenohumeral joint instability can be challenging and carries the inherent risk of recurrent instability, dislocation arthropathy, and postoperative loss of external rotation. In the current manuscript, a technique for combined reconstruction of anterior labrum and capsule, with concomitant reduction of the humeral head during anterior capsule reconstruction in open Latarjet procedure, is presented. Analogous to other techniques, the coracoid graft is fixed on the anteroinferior part of the glenoid between 3 and 5 o'clock. However, for this technique, reattachment of the labrum is performed between the native glenoid and the bone graft. Additionally, during the reconstruction of the anterior capsule on the coracoacromial ligament, while the operated arm is held in external rotation to avoid the postoperative rotational deficit, the humeral head is reduced posteriorly in the center of the glenoid during adduction, slight anterior forward flexion, and a posterior lever push. By doing so, the inherent theoretical risks of persistent instability and dislocation arthropathy are believed to be decreased. Further studies are needed to clarify the long-term consequences of this surgical technique in the clinical setting., Technique Video Video 1 After a 4- to 5-cm incision distal to the tip of the coracoid process, Richardson retractors are used to bluntly open the deltopectoral interval until the tip of the coracoid is exposed. A Hohmann retractor is placed on the base of the coracoid to gain its full exposure. The arm is put in abduction and full external rotation to improve visualization of the coracoacromial (CA) ligament, which is then released approximately 1.5 cm lateral from its attachment. Then, the pectoralis minor is released while the arm is internally rotated and adducted. A 90° angled saw blade is used to perform a coracoid process osteotomy just anterior to the attachment of coracoclavicular ligaments, and a chisel is meticulously used to complete the osteotomy. The coracoid process is rotated for 180° being held with a grasper and is attentively released until the muscle belly is uncovered. Its undersurface is first cleaned with electrocautery and is then flattened and slightly decorticated with a saw blade to create a healthy bleeding surface that will precisely conform to the later prepared anterior glenoid. The length of the coracoid is measured. Two central holes are drilled equally distant from the base and the tip, 1 cm apart and 8 to 9 mm laterally from the coracoacromial ligament insertion. Electrocautery is used to mark the entry holes. The coracoid is placed safely under the pectoralis major. The arm is put in abduction and external rotation. The subscapularis split between the upper two thirds and lower one third of the subscapularis is performed by sharply introducing the scissors toward the anterior glenoid neck. A Hohman retractor is placed between the blades on the medial side of the anterior glenoid neck. The subscapularis split is slightly increased laterally to improve visualization. A Gelpi retractor is placed deep below the subscapularis. The exact location of the glenohumeral joint is exposed by reducing the anteriorly dislocated humeral head, and a vertical incision is performed. A Trillat retractor is used next. The arm is put in adduction and internal rotation, and the Trillat retractor is introduced into the joint to get a better view of the anterior labrum. After the labrum is horizontally incised at 3 o’clock and released inferiorly, 2 sutures are passed through the released labrum. The Hohmann retractor is positioned on the inferior part of the glenoid neck, and a wide glenoid retractor is exchanged with the Hohmann retractor on the medial side of the anterior glenoid to improve the visualization. A curved osteotome is used to slightly decorticate the anteroinferior part of the glenoid. The position of the inferior hole is marked with a K-wire that is put 8 to 9 mm posteriorly to the glenoid face. The inferior screw is passed through the predrilled coracoid and glenoid hole to position the coracoid process on the anterior glenoid neck. The same is done for the superior screw. The screws are not fully tightened. A distinction between the CA ligament and the labrum, which is positioned posteriorly to the CA ligament, is made before the labrum is fixed on the coracoid process. Here, the Bankart repair was already performed. This is the CA ligament, and this is the anterior labrum that is fixed on the coracoid process. Then the sutures are passed through the CA ligament and through the anterior capsule. The operated arm is held in external rotation to avoid the postoperative rotational deficit. The humeral head is reduced posteriorly during adduction, slight anterior forward flexion, and a posterior lever push. At that time the knots of the anterior capsular reconstruction are tightened. Only then, an adequate capsular tension is expected. The lateral tendinous part of the subscapularis is repaired. The length of the incision ranges between 4 and 5 cm. A postoperative radiograph in the anteroposterior, Neer, and Bernageau views shows well-positioned graft and the 2 screws.

To evaluate the short-term outcomes of the arthroscopic dynamic anterior stabilization (DAS), which is a transfer of the intra-articular portion of the long head biceps through the subscapularis split and fixation on the anterior glenoid, combined with a Bankart repair.A retrospective evaluation was performed of DAS and a minimum of 2-year follow-up. Inclusion criteria were the presence of anteroinferior instability, a positive apprehension test at 90° of abduction and external rotation, and subcritical glenoid bone loss (less than 20%). Exclusion criteria were severe (≥20%) glenoid bone loss, presence of biceps lesions or rupture (spontaneous or biceps tenotomy), pre-existing glenohumeral osteoarthritis, multidirectional or voluntary instability, previous arthroscopic stabilization procedure, and epilepsy. Outcomes included the Rowe score, range of motion (ROM), and recurrence.Twenty-three patients were treated with DAS and arthroscopic Bankart repair during the study period. One person was lost to follow-up, leaving 22 patients available at last follow-up. Those 22 patients had an average age of 31.9 ± 12.3 years (range, 18-68) and were evaluated at an average follow-up of 3.2 ± 0.7 years (range, 1.2-4.2). The Rowe score increased from 36.1 ± 16.2 (range, 10-70) preoperatively to 89.8 ± 20.1 (range, 30-100) postoperatively (P.001) with almost all patients (90.9%) improving their score beyond the minimal clinically important difference of 9.7 points. Postoperatively, ROM was maintained. Three patients (13.6%) analyzed at final follow-up demonstrated recurrence, one was successfully treated conservatively, but two revised with a Latarjet. No postoperative Popeye deformity, biceps cramping, or other complication were reported.The DAS procedure may be an option for augmentation of a Bankart repair in patients with anterior shoulder instability and subcritical bone loss. ROM is maintained without evidence of postoperative Popeye deformity or biceps cramping.Level IV, retrospective study.

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.

Patellar instability with recurrent dislocation prevents most patients from returning to regular physical and sports activities. For acute pattelar dislocation, conservative treatment is mainly the first choice of treatment. However, the redislocation rate is high. Anatomical and biomechanical studies show that the medial patellofemoral ligament (MPFL) is the primary restraint to lateral patellar translation between 0 and 30° of knee flexion. Patellar stabilization with MPFL reconstruction is a successful treatment option for patellar instability. It is a mini-invasive surgical procedure associated with low postoperative complications.

Posterolateral corner of the knee is an anatomically complex region with variable formation of tendons and ligaments which provide important posterolateral stability of the knee. Injury of this region is often a high-energy multi-ligament injury that rarely happens in isolation. The three posterolateral structures that are biomechanically and surgically most important are fibular collateral ligament, popliteus tendon muscle, and popliteofibular ligament. A thorough physical examination combined with stress radiographs and magnetic resonance imaging is critical to accurately define the injured structures. Diagnostic arthroscopy further enhances our surgical decision-making in choosing the proper reconstruction technique. The most appropriate posterolateral corner surgical reconstruction should be used based on the careful grading of each injury. The aim of different surgical reconstructions is to restore the normal knee biomechanics. Surgical techniques have progressed and range from the classical wide-open approach, to minimally invasive approach with two mini-open incisions and percutaneous posterolateral corner reconstruction to arthroscopic popliteus bypass reconstruction. Posterolateral reconstruction is usually involved in complex knee reconstruction and mostly combined with posterior or anterior cruciate ligament reconstruction. High tibial osteotomy is used in chronic cases of varus malalignment in knees with posterolateral injury. Posterolateral corner reconstructions are technically demanding procedures. Complications after such procedure can arise in large part due to the complex anatomy and injury pattern of this region combined with a surgeon’s lack of experience and thus require a highly skilled and experienced surgeon to perform them.

Objectives: Many studies have investigated the differences between tenotomy and tenodesis, while only a few have specifically examined the results of tenotomy associated with rotator cuff repair (RCR). Our aim is to report the rate of biceps-related complications after long head of biceps (LHB) tenotomy associated with RCR. Methods: A single-center prospective observational study was conducted between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically evaluated preoperatively, at 6 months (also by ultrasound) and 1 year, and screened for postoperative Popeye deformity, cramps and bicipital discomfort. Each complication was analyzed for the following risk factors: age, gender, BMI, dominant arm, manual work, type of tear, tendon healing. Finally, clinical outcome was compared between patients with at least one complication and those with none. Results: 207 patients were analyzed. Cramps, Popeye deformity, and discomfort, were, respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at 6 months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at 1 year. Cramps were associated with lower age (1 year-increase OR = 0.88-95% CI, 0.81-0.96-), higher BMI (1 point-increase OR = 1.1-95% CI, 1.02 -1.23-), single tendon tear (P = 0.0168), manual work (OR = 5.0-95% CI, 1.5-16.0-) at 6 months and manual work (OR = 2.9-95% CI, 1.1-8.3-) at 1 year. Objective Popeye deformity was associated with male gender at 6 months (OR = 6.9-95% CI, 3.0-15.5-). Discomfort was associated with lower age (OR = 0.94-95% CI, 0.90-0.98-), manual work (OR = 2.3 -95% CI, 1.2-4.3-), Popeye deformity (OR = 2.3-95% CI, 1.1-4.9-) at 6 months and manual work (OR = 2.8-95% CI, 1.1-6.6-), single tendon tear (OR = 4.9 -95% CI, 1.1-21.3-) and Popeye deformity (OR = 3.4 -95% CI, 1.1-10.7-) at 1 year. Patients without complications showed a significantly higher Constant, pain and SSV score (75.4 vs 70.4, P = .00252; 0.9 vs 1.9, P Conclusion: Younger age, higher BMI, manual work and single tendon tears are risk factors associated with biceps-related symptoms during the first year. Popeye deformity occurs more frequently in males and is associated with discomfort. Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited.

A combination of massive rotator cuff tear and recurrent shoulder instability is uncommon and represents a complex problem to treat. The significant range of shoulder motion is achieved due to the lack of bony constraints which sets the stage for pathologic instability. The balance between shoulder mobility and stability is related to a complex combination of dynamic and static stabilizers around the shoulder joint. One of the main dynamic stabilizers is represented by the rotator cuff, which centers the humeral head in the glenoid fossa through concavity compression mechanism. Disruption of the balance between dynamic and static stabilizers due to their loss of integrity may lead to instability. In patients who complain of pain and weakness for up to 3 weeks after an anterior dislocation a rotator cuff lesion should be suspected and further investigation should be taken. There are no clear guidelines as to whether either the rotator cuff tear or the anterior capsulolabral complex injury or both should be treated surgically if they occur simultaneously in a patient with recurrent anterior shoulder dislocation. A case example of a combined massive rotator cuff and recurrent shoulder instability in a 63-year-old female is presented.