Objective: To determine if microfracture is successful in treating chondral lesions of the shoulder. Design: Case series. Setting: Tertiary referral practice. Patients: From June 2005 to November 2006, eight patients underwent shoulder arthroscopy with arthroscopic microfracture to treat full-thickness chondral lesions of less than 4 cm ² size. The study group consisted of six men and two women. The mean age at surgery was 37 years (range: 27-55 years). One patient (12.5%) had an isolated chondral defect and seven patients (87.5%) had associated conditions treated simultaneously: two patients had arthroscopic subacromial decompressions, two had capsular plications for multidirectional instability, and three had anterior stabilization done (one with an associated superior labrum anterior to posterior repair and one with repair of a small rotator cuff tear). Five patients had humeral head defects and three had glenoid defects. Intervention : Microfracture. Main outcome measures: Constant score and Oxford score. Results: The mean follow-up period was 15.4 months, with a range of 12-27 months. The mean preoperative Constant score was 43.88 (range: 28-70) and at final follow-up the mean Constant score was 90.25 (range: 85-100); this difference was significant ( P <0.005). The mean preoperative Oxford score was 25.75 (range: 12-37) and the mean postoperative Oxford score at final follow-up was 17 (range: 11-27); the difference was significant ( P <0.005). There were no complications. Two patients underwent reoperation which allowed assessment of the lesion; in both cases the lesions showed good filling with fibrocartilage. Conclusion : Microfracture has been shown to be a reliable method of treatment for chondral lesions within the knee. We believe that this technique may also be applied to the shoulder; however, further study is required to assess its efficacy in this joint. Level of evidence: IV

Detachment of the deltoid muscle and tendon is a rare complication that is reported to result in poor outcome after rotator cuff surgery. We performed a delayed primary repair of the detached deltoid in a 53-year-old female patient who underwent an open acromioplasty procedure. A successful result was achieved after surgical restoration of the deltoid muscle origin back to the acromion. At 25 months' follow-up the patient had recovered almost the full range of motion of the glenohumeral joint and was free of pain. Due to lack of literature on this rare condition, there are no well-defined treatment principles for the management of deltoid muscle detachments that develop as a complication of rotator cuff surgery. This paper describes a repair procedure for the management of deltoid muscle detachments. In addition, it discusses the importance of the guidelines that have to be followed during primary rotator cuff surgery.

Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. We present a novel operative technique to stabilize a shoulder hemiarthroplasty that we used in the treatment of a chronic posterior dislocation of a shoulder with an acute four-part fracture of the proximal humerus.