Modified Putti-Platt procedure for recurrent anterior shoulder instability.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability

Background:

• Traumatic anterior shoulder instability is a common condition.
• The Putti-Platt procedure is a classic surgical technique for addressing shoulder instability.
• Modifications to existing surgical techniques are often explored to improve outcomes.

Purpose of the Study:

• To evaluate the clinical results of a modified Putti-Platt procedure.
• The modification involved suturing the lateral subscapularis tendon to the capsule.
• This study focused on patients with traumatic anterior shoulder instability.

Main Methods:

• A modified Putti-Platt procedure was performed on 450 shoulders in 434 patients.
• Patients had traumatic anterior shoulder instability.
• Outcomes were assessed using the Rowe score, Japan Shoulder Society Shoulder Instability Score (JSS-SIS), recurrence rates, Instability Severity Index Score (ISIS), external rotation, return to sports, and osteoarthritis.

Main Results:

• Significant improvements were observed in the mean Rowe score (26 to 90) and JSS-SIS (51 to 88).
• Recurrence of instability was low (3%), with 97% of patients remaining stable at minimum two years follow-up.
• External rotation was limited at 6 months, and 14% of patients could not return to their previous sports level. Osteoarthritis progression was minimal over long-term follow-up.

Conclusions:

• The modified Putti-Platt procedure demonstrates good efficacy in reducing recurrence for traumatic anterior shoulder instability.
• The technique may not be suitable for throwing athletes due to potential limitations in external rotation.
• It represents a viable surgical option for patients at high risk of recurrent instability.