The purpose of this study was to review the results of biceps tenodesis and biceps reinsertion in the treatment of type II SLAP lesions.

We conducted a retrospective cohort study of a continuous series of patients. Only isolated type II SLAP lesions were included: twenty-five cases from January 2000 to April 2004. Exclusion criteria included associated instability, rotator cuff rupture and previous shoulder surgery. Ten patients (ten men) with an average age of thirty-seven years (range, 19–57) had a reinsertion of the long head of the biceps tendon (LHB) to the labrum with two suture anchors. Fifteen patients (nine men and six women) with an average age of fifty-two years (range, 28–64) underwent biceps tenodesis in the bicipital groove. All patients were reviewed by an independent examiner.

In the reattachment group, the average follow-up was thirty-five months (range, 24–69); three patients underwent subsequent biceps tenodesis for persistent pain, three others were disappointed because of an inability to return to their previous level of sport, and the remaining four were very satisfied. The average Constant score improved from sixty-five to eighty-three points. In the tenodesis group, the average follow-up was thirty-four months (range, 24–68). No patient required revision surgery. Subjectively, one patient was disappointed (atypical residual pain), two were satisfied and twelve were very satisfied. All patients returned to their previous level of sports, and the average Constant score improved from fifty-nine to eighty-nine points.

The results of labral reattachment were disappointing in comparison to biceps tenodesis. Thus, arthroscopic biceps tenodesis can be considered as an effective alternative to reattachment in the treatment of isolated type II SLAP lesions. By moving the origin of the biceps to an extra-articular position, we eliminated the traction on the superior labrum and the source of pain; furthermore, range of motion and strength are unaltered allowing for a return to a pre-surgical level of activity.

The purpose of this study is to report the results of arthroscopic Bankart repair following failed open treatment of anterior instability.

We performed a retrospective review of twenty-two patients with recurrent anterior shoulder instability (i.e. subluxations or dislocations, with or without pain) after open surgical stabilization. There were seventeen men and five women with an average age of thirty-one years (range, 15–65). The most recent interventions consisted of sixteen osseous transfers (twelve Latarjet and four Eden-Hybinette), three open Bankart repairs and three capsular shifts. The causes of failure were additional trauma in twelve patients and complications related to the bone-block in thirteen (poor position, fracture, pseudarthrosis or lysis). All patients were noted to have distension of the anterior-inferior capsular structures. Labral re-attachment and capsulo-ligamentous re-tensioning with suture anchors was performed in all cases with an additional rotator interval closure in four patients and an inferior capsular plication in twelve patients; the bone block screws were removed in eight patients.

At an average follow-up of forty-three months (range, twenty-four to seventy-two months), nineteen patients were evaluated by two independent observers. One patient had recurrent subluxation, and two patients had persistent apprehension. Anterior elevation was unchanged, and loss of external rotation (RE1) was 6°. Nine patients returned to sport at the same level; all patients returned to their previous occupations, including the six cases of work-related injury. Eighty-nine percent were satisfied or very satisfied; the subjective shoulder value (SSV) was 83% ± 23%; the Walch-Duplay, Rowe and UCLA scores were 85 ± 21, 81 ± 23 and 30 ± 7 points respectively. The number of previous interventions did not influence the results. Eight patients (42%) were still painful (six with light pain and two with moderate pain).

Arthroscopic revision of open anterior shoulder stabilization gives satisfactory results. The shoulders are both stable and functional. While the stability obtained with this approach is encouraging, our enthusiasm is tempered by some cases of persistent pain.

The objective of this study is to report the epidemiology and results of treatment of deep infection after a reverse shoulder arthroplasty.

This is a multicenter retrospective study involving 457 reverse prostheses performed between 1992 and 2002. Fifteen patients (3%) (mean age 71 ± 9 years) presented with a deep infection. Eight were primary arthroplasties and seven were revision procedures. There were five associated peri-operative fractures and three early postoperative complications requiring surgical treatment. Infection was treated by debridement (n=4), prosthetic resection (n=10) or two-stage revision (n=1).

The infection rate was 2% (8/363) for a primary reverse arthroplasty and 7% (7/94) for revisions. The infection was diagnosed at a mean of seventeen months (range, one to fifty-seven) post-operatively, corresponding to two acute, five sub-acute and eight chronic infections. The most common pathogen was P. acnes in six cases (40%). At a mean follow-up of thirty-four ± nineteen months, there were twelve remissions (80%) and three recurrent infections. The two acute infections (one debridement and one resection) and the eight chronic infections (seven resections and one two-stage revision) were in remission. Among the five sub-acute infections, the two resections were in remission, whereas the three debridements recurred. Overall, the ten resections were in remission with seven patients disappointed and three satisfied, a mean Constant score of thirty-one ± eight points and a mean active anterior elevation of 53 ± 15°. The two-stage exchange was in remission but remained disappointed with a Constant score of twenty-seven points and an active anterior elevation of 90°.

Infection compromises the functional results of the reverse prosthesis whatever the treatment performed. Acute infections appear to be satisfactorily treated by debridement or resection. Both resection and two-stage revision can successfully treat sub-acute and chronic infection; however, debridement alone is ineffective and not recommended. There is a high rate of infection when the reverse prosthesis is used in revision arthroplasty. Prevention, by looking for such infection before surgery and by performing a two-stage procedure is recommended in the case of any uncertainty.

Purpose of the study: Arthroscopic reinsertion of SLAP lesions is the most commonly used approach. Tenodesis of the long biceps could be proposed as an alternative to reinsertion. The purpose of our study was to report the results of tenodesis and reinsertions for the treatment of type II SLAP lesions.

Material and methods: This was a consecutive monocentric comparative series analyzed retrospectively. Isolated type II SLAP lesions treated arthroscopically were retained for study: 25 cases treated from January 2000 to May 2004. Exclusion criteria were: associated instability, associated cuff tears, history of surgery. The long biceps tendon was reinserted on the glenoid tubercle using two threads mounted on resorbable anchors in ten patients (all men), mean age 27.5 years (range 19–57 years). Tenodesis of the long biceps in the gutter was performed in fifteen patients (six women and nine men), mean age 52.2 years (range 28–64 years). All patients were reviewed by an independent observer.

Results: In the reinsertion group, mean follow-up was 35 months (range 12–57 months). Three patients had revision tenodesis due to persistent pain and three others were disappointed because they were unable to resume their former sport. Four others were very satisfied. The mean Constant score improved from 65 to 83 points. Force was 16 kg in flexion and 5 kg in supination. In the tenodesis group, mean follow-up was 34 months (range 12–56 months). There were no revision procedures in this group. Subjectively, one patient was disappointed (atypical pain), two were satisfied and 12 very satisfied. The mean Constant score improved from 59 to 89 points. Force was 14.5 kg in flexion and 4.8 kg in supination.

Discussion: This series showed that results obtained with reinsertions can be disappointing: three revisions and three disappointed patients among ten procedures. In the tenodesis group, 14 of 15 patients were satisfied or very satisfied. Tenodesis of the long head of the biceps can be considered as an alternative to reinsertion for the treatment of type II SLAP lesions, particularly in older athletes.

Purpose of the study: Depending on the series, fractures of the anteroinferior glenoid labrum have been reported in 3% to 90% of patients with anterior shoulder instability. These fractures disrupt the physiological glenoid concavity and shorten the effective length of the glenoid arch. Indications for treatment depend on the size of the fragment and range from osteosynthesis to resection or suture. We hypothesized that these lesions could be treated arthroscopically (Bankart procedure with fragment suture). The purpose of this work was to analyze clinical and radiological outcome observed in nine patients with anterior instability associated with significant glenoid fracture.

Material and methods: This was a monocentric study of a continuous series of nine glenoid fractures associated with anteromedial dislocation in nine patients (three women and six men), mean age 35.5 years (range 17–75 years). Preoperatively, all of the fractures were considered to involve more than 25% of the glenoid surface. After detaching the capsulolabral lesion with the bony fragment and avivement of the anterior border, the Bankart procedure was performed with anchors and resorbable sutures. The shoulder was strapped for six weeks with passive rehabilitation (pendulum movements) initiated early.

Results: Mean follow-up was 27 months (range 12–48 months). There were no cases of recurrent instability. Seven patients were very satisfied and two were satisfied. Eight patients were able to resume their sports activities at the same level. Apprehension developed in all patients. At last follow-up, joint motion was normal for eight of the nine patients, the Duplay score was 100 for eight patients and 45 for one. All bony lesions healed in an anatomic position (six analyzed with plain x-rays and three with CT scan).

Discussion and conclusion: This short series demonstrates that glenoid fractures can be treated arthroscopically with concomitant treatment of the capsulolabroligament complex in order to reconstruct the glenoid arch, an essential element for restoring shoulder stability. It is thus necessary to identify bony lesions preoperatively to determine the most appropriate therapeutic approach. A long-term follow-up will be useful to assess the rate of recurrent instability and validate this therapeutic option.

Purpose: Evaluate outcome after isolated intra-articular ACL graft in patients aged 40 to 60 years using patellar bone-tendon and gracilis grafts.

Material and methods: This retrospective comparative study included 30 consecutive patients who underwent arthroscopic surgery between September 1996 and September 1999 performed by the same operator: 14 patellar bone-tendon grafts and 16 gracilis grafts. The indication for surgery was knee instability in everyday or sports activities. Exclusion criteria were associated peripheral ligament plasty or bone procedures. The two populations were strictly identical except for gender and follow-up: patellar bone-tendon group: mean age 49 years, 12 men, follow-up 46 months, 6 associated menisectomies; gracilis series: mean age 48 years, 13 women, mean follow-up 30 months, 6 associated menisectomies. The IKDC score, laximetry (KT 2000), x-rays (AP, single stance lateral, 30° flexion) were used by two operators different from the operating surgeon to assess outcome.

Results: At last follow-up, there was a significant difference between functional and anatomic outcome in the two groups. 83% of the patients were classed IKDC A or B. Subjectively, 90% of the patients were satisfied or very satisfied. The pivot test was negative in 24 (80%), doubtful in 5 and positive in 1. 86% of the patients had a differential laxity less than 3 mm. In the gracilis group, two patients developed chronic hamstring pain. In the patellar bone-tendon group, two patients developed persistent patellar pain. Two patients underwent a second procedure for meniscectomy. At last follow-up the x-rays demonstrated early signs of degeneration in 20% of the patients and signs of medial femorotibial degeneration in 10%.

Discussion: Gracilis and patellar bone-tendon grafts provide strictly identical results; residual pain is not more prevalent after patellar graft; control of laxity is not less satisfactory after hamstring graft. In our series, ACL graft in patients over 40 years of age provided functional, laximet-ric, and radiographic results comparable to those in patients undergoing ACL grafts before the age of 40 years.

Conclusion: 1) ACL graft can be indicated after the age of 40 years for patients with knee instability bothersome for everyday or sports activities. 2) Functional and anatomic results are identical with those obtained in younger subjects. 3) Irrespective of the graft used, patellar or hamstring, outcome is satisfactory and morbidity is not different.