Background: Arthroscopic repair of anterior dislocation of the shoulder can fail. We hypothesized that patients who are at higher risk for redislocation following repair could be recognized preoperatively on the basis of their clinical history. The purpose of the present study was to identify the risk factors for recurrence in a community-based population of patients with traumatic unidirectional instability that was treated with a single arthroscopic technique. Methods: From January 2000 to December 2003, 625 patients with anterior unidirectional instability were managed with an arthroscopic Bankart technique, and 385 met the criteria for inclusion in the study. Demographic data were collected, and clinical follow-up was performed at three, six, twelve, twenty-four, and thirty-six months. Results: At thirty-six months, thirty-one patients (8.1%) had experienced a redislocation; the rate was 13.3% among patients who were twenty-two years of age and younger and 6.3% among older patients. Age at the time of the first dislocation, male sex, and the time from the first dislocation until surgery were significant risk factors for recurrence (p < 0.05 for all). Conclusions: Patients who are more likely to have a redislocation following arthroscopic repair of an anterior shoulder dislocation can be identified preoperatively on the basis of sex, age, and the time from the first dislocation to surgery. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Background: There are not many reports in the literature about the long-term outcomes in terms of recurrence and degenerative changes after arthroscopic capsulolabral reconstruction for anterior shoulder instability. Purpose: The aim of this study was to evaluate long-term follow-up (minimum 10 years) of arthroscopic suture-anchor repair for traumatic unidirectional anterior instability, with special emphasis on the radiological evidence of arthritis and clinical outcome. Study Design: Case series; Level of evidence, 4. Methods: Forty-two patients (43 shoulders) treated at our institute from 1995 to 1997 were included in the study. Thirty patients (31 shoulders) were available for clinical and radiological examination (71%). The mean follow-up was 10.9 years (range, 9.8-14.3 years). Patients were evaluated preoperatively and after surgery using the University of California, Los Angeles (UCLA), Simple Shoulder Test (SST), and Rowe score. Patient satisfaction was determined by asking the patients if they would do this operation again. Radiological outcome was used to evaluate the incidence and grade of arthritis according to the Samilson-Prieto classification. Results: At the final follow-up examination, 5 patients (16%) reported an atraumatic recurrent instability, while 2 recurrences (7%) occurred after a major injury. Three of the 7 recurrences occurred 6 years after surgery. All of the patients in the recurrence group except 1 were contact or overhead athletes. Twenty-six patients were satisfied (84%) with the outcome. The SST showed an improvement of shoulder function in 23 cases, the UCLA score improved from 21.8 to 32.1, and the Rowe score showed excellent or good results in 77.3% of cases. Twenty-two patients (71%) were able to return to their preoperative sports level. Radiographic findings showed 9 cases with mild arthritis (29%) and 3 cases with moderate arthritis (10%). Conclusion: The recurrence rate deteriorated with time. Involvement in contact sports and overhead activities appears to be a risk factor for recurrence of instability, although this could not be proved statistically with the numbers available, whereas age, gender, and number of preoperative dislocations did not reveal any correlation with recurrence. Degenerative changes of the glenohumeral joint were noted but had no significant effect on the clinical outcomes.

Complex proximal humeral fractures are very difficult to treat particularly in patients older than 65 years with an osteoporotic bone and tuberosities compromised. The goal of this paper is to evaluate radiological outcomes at mid-term follow-up of proximal humerus fractures treated with reverse shoulder arthroplasty using a dedicated fracture stem. The study population included 98 patients who underwent reverse shoulder with a dedicated fracture stem for an acute proximal humerus fracture; 87/98 patients were available for analysis. There were 62 female and 25 male patients, and the mean age was 76.2 years at the time of surgery (range 61–90 years). Clinical and radiological outcomes were evaluated at a mean follow-up of 27 months after surgery. Average active elevation was 137.7°, external rotation 29.1°, and internal rotation 40.7°. Overall, the tuberosity healing rate was 75 %. There was a significant increase in active anterior elevation, external rotation, and internal rotation among patients who demonstrated radiographic evidence of tuberosity healing. All tuberosity nonunions (21 cases) occurred preferentially in females, but this number did not reach statistical significance. RSP using a dedicated stem is a very viable solution to treat complex humerus proximal fracture. Reliable restoration of elevation can be expected. However, in patients in whom tuberosity healing occurs, a better active elevation other than restoration of active rotational movement can be observed.