The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous reverse shoulder prostheses characterized by unsatisfactory results and a high glenoid implant failure rate, the Grammont design has immediately shown good clinical outcomes. This semiconstrained prosthesis solved the issues of the very first designs by medializing and distalizing the CoR with an increased stability of the replacement of the component. The indication was initially limited to Cuff Tear Arthropathy (CTA). It has then been expanded to irreparable massive cuff tears and displaced humeral head fractures. The most frequent problems of this design are a limited postoperative external rotation and scapular notching. Different modifications to the original Grammont design have been proposed with the aim of decreasing the risk of failure and complications and improving the clinical outcomes. Both the position and version/inclination of the glenosphere and the humeral configuration (e.g. Neck Shaft Angle) influence the RSA outcomes. A lateralized glenoid (whether with bone or metal) and a 135° Inlay system configuration leads to a moment arm which is the closest to the native shoulder. Clinical research will focus on implant designs reducing bone adaptations and revision rate, strategies to prevent more effectively infections. Furthermore, there is still room for improvement in terms of better postoperative internal and external rotations and clinical outcomes after RSA implanted for humeral fracture and revision shoulder arthroplasty.

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

Purpose: To adapt the current D. Dejour trochlear dysplasia classification (v2.0) to only rely on quantitative magnetic resonance imaging (MRI) measurements (v3.0) to maximize objectivity and repeatability.Methods: A consecutive series of adult knee MRIs were divided into objective patellar instability (OPI, n = 127) or controls (n = 103; isolated meniscal tears) and postprocessed with multiplanar reconstruction (MPR) to standardize the sagittal plane and ensure true lateral views. Thresholds for sulcus angle, lateral trochlear inclination (LTI) and central bump were established using regression tree models to distinguish OPI from controls. The sensitivity and specificity of sulcus angle and LTI combinations to diagnose OPI were then evaluated, and the combination yielding the highest sensitivity was selected as basis for trochlear dysplasia classification. Finally, sulcus angle and LTI measurability and presence of a central bump >5 mm were used to grade dysplasia as low, moderate or high.Results: The regression tree models produced thresholds of ≥157° for sulcus angle and <14° for LTI to distinguish OPI from controls. ‘Sulcus angle ≥157° OR LTI < 14°’ yielded the highest sensitivity (87%) to diagnose OPI. The quantitative MRI classification was sulcus angle <157° AND LTI ≥ 14° for Type 0 (No dysplasia); (sulcus angle ≥ 157° OR LTI < 14°) AND central bump <5 mm for Type 1 (Low‐grade dysplasia); (sulcus angle OR LTI are ‘unmeasurable’) AND central bump <5 mm for Type 2 (Moderate‐grade dysplasia); (sulcus angle ≥ 157° OR ‘unmeasurable’ OR LTI < 14° OR ‘unmeasurable’) AND central bump ≥5 mm for Type 3 (High‐grade dysplasia).Conclusion: This MRI classification depends exclusively on quantitative measurements, has excellent interobserver agreement, and yields high sensitivity to diagnose OPI. The MRI imaging protocol with MPR mode and standardized measurements could be quickly adopted and correctly applied by clinicians worldwide in any type of institution to determine the ideal treatment plan.Level of Evidence: Level III.

Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT–TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The ‘menu à la carte’ approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.