Purpose: To describe the technique and short-term results of arthroscopic repair of irreparable rotator cuff tears using a GraftJacket® allograft. Although current rotator cuff repair techniques offer excellent results in most cases, there are still many instances where tendon repair is not possible. Allograft substitutes offer the advantages of saving bone stock, while maintaining anatomic integrity within the shoulder. Materials and Methods: Between March 2003 and February 2004, 16 patients with massive, contracted immobile rotator cuff tears were treated with arthroscopic placement of a GraftJacket® allograft by a single surgeon. Patients were followed for 1-2 years. All were evaluated preoperatively and postoperatively using the modified University of California Los Angeles (UCLA) scoring system, Constant score and Simple Shoulder Test. MRI was performed postoperatively at 3 months and 1 year. Results: At mean follow-up time of 26.8 months (range, 12-38 months), 15 of 16 patients were satisfied with the procedure. The mean UCLA score increased from 18.4 preoperatively to 30.4 postoperatively ( P = 0.0001). The Constant score increased from 53.8 to 84.0 ( P = 0.0001). Statistically significant improvements were seen in pain, forward flexion and external rotation strength. Thirteen displayed full incorporation of the graft into the native tissue, as documented on magnetic resonance imaging. There were no complications in this cohort of patients. Conclusions: Our study supports GraftJacket® allograft as a viable solution for surgical salvage in select cases of massive irreparable rotator cuff pathology.

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Subscapularis dysfunction after open instability repair has recently received increasing attention. Various clinical studies indicate that surgical approaches using partial or complete subscapularis tendon takedown techniques might impair subscapularis recovery and can negatively influence the final clinical outcome. This review article will focus on the potential pathogenesis, diagnosis, and clinical impact of the unrecognized condition and summarizes the currently available literature.

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We have developed an arthroscopic technique to reinforce the torn inferior glenohumeral ligament and the elongated strained capsule, with no need for hardware implants: the arthroscopic capsuloplasty. We have assessed early results of arthroscopic capsuloplasty on seven active athletes, observed for a painful unstable shoulder. All cases presented with anterior inferior capsular distension and a strained or ruptured IGHL; these are indications for this technique, independent of the presence of a Bankart lesion. Cases where a Bankart lesion was also repaired were not considered in these preliminary results. As with an open standard Neer capsular shift, an arthroscopic capsular re-tightening is performed, by means of a shift of the anteroinferior capsule incised one centimeter from the glenoid rim. Results with an average follow-up of 12 months were appraised following the Walch-Duplay score. The global result was bad for one patient with a retractile capsulitis after 6 months and good for another at 13 months after surgery. The remaining five patients had excellent global results and have resumed sports at the same level as before. The authors consider this technique to be an alternative to thermal capsular shifts and open procedures, although the series is limited and follow-up short, yet with quite encouraging results. Level of evidence : Case Series (level IV).

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The authors are analysing the radiological and clinical significance of radiolucent lines and their relationship with cemented glenoid component loosening in total shoulder arthroplasty (TSA). The difficulties in radiological interpretation and evaluation of radiolucency are explained. In the literature different factors were analyzed clinically or biomechanically and proposed as potential causes of radiolucency and glenoid loosening. In this paper, the influence of surgical technique and glenoid implant are analyzed. The authors draw the conclusion that cause of the glenoid loosening is probably multifactorial and if meticulous attention is given to the surgical technique for TSA, the incidence of component loosening should decrease. Greater the reliability of initial glenoid fixation, probably greater is the chance the glenoid component has to resist the negative factors promoting glenoid loosening.

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Surgeons are often reluctant to support regional anesthesia for shoulder surgery and other orthopaedic surgery. This is because the sometimes true, but usually perceived "slowing down" of operating room turnover times, and the perceived potential for added morbidity. The former (time issue) can only be solved by proper management, while the potential for added morbidity can be minimized by doing appropriate blocks for appropriate surgery at the correct times, when really indicated, with the correct equipment and techniques, and avoiding situations that are prone to causing morbidity. This article discusses in detail when it is appropriate to do blocks for shoulder surgery, but more important, when is it not appropriate to do blocks, and how to carefully calculate a risk-benefit ratio and avoid added morbidity.

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Arthroscopic repair of retracted adhesed rotator cuff tear is complicated by the fact that standard capsulotendinous releases seldom provide enough additional lateral excursion of the tendons for repair to bone. However, the stepwise incorporation of anterior interval slides, double interval slides, and interval slide in-continuity can dramatically increase the lateral excursion up to 5 cm., allowing for tension free repair to bone. This paper details the author's indications and techniques for performing these releases.

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