Background: The purpose of this study is to assess the incidence of acromial stress fractures in a population of reverse shoulder arthroplasties (RSA) and determine potential risk factors for fracture. Patients and Methods: Between August 2004 and December 2013, 1082 primary RSA were performed at a single institution. Twelve (1.11%) patients were diagnosed with a postoperative acromial stress fracture. This group was casematched to a control group of 48 shoulders. Clinical and radiographic risk factors for fracture were assessed. Results: Compared to controls, fractures were less satisfied with their outcome despite equivalent American Shoulder and Elbow Surgeons scores, pain scores, and range of motion. Osteoporosis was significantly associated with acromial fractures (P ¼.027). A smaller lateral offset of the greater tuberosity, greater arm lengthening, and a thinner acromion were more common in the fracture group (P ¼.026, P ¼.004, and P ¼.008, respectively). Conclusions: In summary, postoperative acromial stress fractures appear to be incidental lesions with little influence on the outcome after RSA. The combination of a thin acromion and superior migration of the humeral head increase the risk of acromial fracture. Lateralized designs that do not excessively verticalize the deltoid line of pull on the acromion may decrease the risk of postoperative acromial fractures.

Background: Preoperative factors that most influence postoperative outcomes of both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are unknown. The purpose of this study was to identify the preoperative parameters that significantly influence postoperative outcomes of aTSA and rTSA. Methods: The outcomes of 1089 aTSA patients and 1332 rTSA patients (mean follow-up period, 49 months) from an international registry with a single platform system were analyzed. A multiple linear regression model with backward stepwise selection identified the preoperative parameters that were significant predictors of postoperative clinical outcome metric scores and motion measures for both rTSA and aTSA. Results: For both aTSA and rTSA patients, numerous preoperative parameters that influence postoperative outcomes were identified. Greater postoperative range of motion (ROM) was significantly influenced by greater preoperative ROM. For aTSA, greater postoperative American Shoulder and Elbow Surgeons (ASES) scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, and the presence of greater preoperative active external rotation. For rTSA, greater postoperative ASES scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, no history of tobacco use, less preoperative passive external rotation, and greater preoperative active external rotation. Conclusions: This study quantified the preoperative predictors of postoperative clinical outcome metric scores and ROM for both aTSA and rTSA. Numerous significant associations were identified, including demographic and comorbidity risk factors. These associations may be helpful for surgeons to consider when counseling patients regarding aTSA versus rTSA and to establish more accurate expectations prior to surgery.

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Background: The preoperative number of dislocations has been previously proved to be a major factor influencing the results after Bankart repair with more preoperative dislocations correlated with higher recurrence rates and more reoperations. This could possibly be because of the lower quality of the tissue repaired during the procedure after multiple dislocations. On the other hand, the Latarjet procedure does not ''repair'' but rather reconstructs and augments the anterior glenoid.Purpose/Hypothesis: The main objective was to report the clinical outcomes of patients undergoing a Latarjet procedure after 1 dislocation versus multiple (2) dislocations. The hypothesis was that the preoperative number of dislocations would not influence clinical results.Study Design: Cohort study; Level of evidence, 3.Methods: Patients older than 18 years who had undergone a primary Latarjet procedure for shoulder instability with at least 2 years of follow-up were included. Three different techniques were used: a mini-open technique using 2 screws, an arthroscopic technique using 2 screws, and an arthroscopic technique using 2 cortical buttons. Patients were evaluated and answered a questionnaire to assess the number of episodes of dislocation before surgery, the time between the first dislocation and surgery, recurrence of the dislocation, revision surgery, the Walch-Duplay score, the Simple Shoulder Test score, and the visual analog scale (VAS) score for pain.Results: A total of 308 patients were included for analysis with a mean follow-up of 3.4 6 0.8 years. Of that, 83 patients were included in the first-time dislocation group and 225 in the recurrent dislocation group. At last follow-up, the rates of recurrence and reoperation were not significantly different between groups: 4.8% in the first-time dislocation group versus 3.65% in the recurrent dislocation group and 6.1% versus 4.0%, respectively. The overall Walch-Duplay scores at last follow-up were also comparable between the 2 groups, 67.3 6 24.85 and 71.8 6 25.1, even though the first-time dislocation group showed a lower pain subscore (15.0 6 8.6 vs 18.0 6 7.5; P = .003). The VAS for pain was also significantly higher in the first-time dislocation group compared with the recurrent dislocation group (1.8 6 2.3 vs 1.2 6 1.7; P = .03). Conclusion:The number of episodes of dislocation before surgery does not affect postoperative instability rates and reoperation rates after the Latarjet procedure. However, patients with first-time dislocations had more postoperative pain compared with patients with recurrent dislocations before surgery.

Background: It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. Purpose: To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. Results: A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. Conclusion: Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.