Putti-Platt
Concept
Plication subscapularis & capsule
Problems
Loss ER
Secondary OA if ER < 0°
Contraindication
MDI
- will force head out posteriorly
Technique
Divide SSC 2.5cm from insertion
- may divide capsule in same plane
- re-attach lateral flap to convenient medial soft tissue eg under surface of capsule
- double breast medial muscle over lateral stump
- limit ER to neutral
Results
Kiss et al J Should Elbow Surg 1998
- 70 Putti platts assessed clinically and with xray at average 9 years
- 11% redislocation rate
- 29% moderate and with 1 severe OA
- 11% pain at rest
- average loss of ER 23o
- 83% fully satisfied
Magnusson-Stack
Concept
Lateral advancement of SSC and capsule
- transfer of subscapularis from LT
- across bicipital groove to GT
- Magnusson recommended distal transfer as well to allow subscapular sling
Bone Block Procedure
Concept
Transfer of bone graft to anterior glenoid rim
- Eden-Hybinette & Oudart procedures
Problem
Worse results than Putti-Platt with high incidence OA >10%
Osteotomy Humeral Head / Glenoid
No evidence to support either in most circumstances
- Glenoid neck osteotomy high rate of serious complications
Indication
- malunion post fracture
