Background: The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier–controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant. Hypothesis: The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint. Study Design: Case series; Level of evidence, 4. Methods: Thirty-seven consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study. The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up. Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability. Results: Twenty-eight patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months). The interval from trauma to surgery averaged 7.3 days (range, 0-18 days). The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100). The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side ( P < .05). Radiographic signs of posterior instability were noted in 42.9% of cases. Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI ( P < .05). Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed. Conclusion: The combined arthroscopically assisted and image intensifier–controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

Background: Postoperative subscapularis muscle insufficiency after open shoulder stabilization procedures represents an unrecognized condition. Hypothesis: Primary and revision open shoulder stabilization using the inverted L-shaped tenotomy approach impairs subscapularis muscle recovery and affects final clinical outcome. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five patients who underwent primary (group 1: n = 13; mean age, 36.5 years; follow-up, 48 months) or revision (group 2: n = 12; mean age, 34.2 years; follow-up, 52 months) open shoulder stabilization procedures were followed up clinically (clinical subscapularis tests and signs, Constant score, and Rowe score) and by magnetic resonance imaging (tendon integrity, defined muscle diameters, and signal intensity analysis [ratio infraspinatus/upper subscapularis muscle and infraspinatus/lower subscapularis muscle]). A third group (group 0) of 12 healthy volunteers served as a control. Results: Clinical signs for subscapularis muscle insufficiency were present in 53.8% of cases in group 1 and 91.6% of cases in group 2. There were no significant differences between groups with regard to Constant and Rowe scores (P >. 05). On magnetic resonance imaging, no complete tendon ruptures were found. The mean vertical diameter of the subscapularis muscle and the mean transverse diameter of the upper subscapularis muscle portion were significantly greater in group 0 than in group 1 and greater in group 1 than in group 2 (P <. 05). The mean transverse diameter of the lower subscapularis muscle was comparable in all groups (P >. 05). The signal intensity analysis revealed the infraspinatus/upper subscapularis muscle ratio was greater in group 0 than in group 1 and greater in group 1 than in group 2 (P <. 05). The infraspinatus/lower subscapularis muscle ratio was lower in group 0 than in groups 1 and 2 (P <. 05). Conclusion: Open shoulder stabilization using an inverted L-shaped tenotomy approach may lead to atrophy and fatty infiltration, particularly of the upper part of the subscapularis muscle, resulting in postoperative subscapularis muscle insufficiency. Revision procedures using the same approach may further compromise clinical subscapularis muscle function and structure. The lower portion of the subscapularis muscle seems to have a compensating effect that may, in addition to a meticulous capsulolabral reconstruction, account for the uncompromised overall clinical outcome.

Background: Currently there are no prospective data available that compare the different tenodesis techniques of the long head of the biceps tendon with regard to their clinical and structural results.