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Modified Putti–Platt procedure for recurrent anterior shoulder instability

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The classic Putti–Platt technique was modified by suturing the lateral subscapularis tendon to the capsule instead of the anterior glenoid edge. We report the clinical results of a modified Putti–Platt procedure in patients with traumatic anterior shoulder instability.


The study reports results in 434 patients (450 shoulders) with traumatic anterior shoulder instability. The patients comprised 322 men and 122 women with a mean age of 22 years. Clinical results were evaluated by the Rowe score, Japan Shoulder Society Shoulder Instability Score (JSS-SIS); recurrence of instability, instability severity index score (ISIS), restriction of external rotation, return to sports activities, and osteoarthritis on plain radiographs and MRI were examined.


The mean Rowe score improved from 26 to 90 points, and the mean JSS-SIS improved from 51 to 88 points. Altogether, 419 patients (97%) had no recurrence at a minimum of two years of follow-up, even though the study included 87 patients with an ISIS of ≥ 7 points. External rotation was limited at 6 months, and 33 of 228 patients (14%) could not return to the same level of sports activities. Among 44 patients at the follow-up extending to ten to 27 years, external rotation was still limited but no plain radiography showed osteoarthritis more than stage 2.


This modified Putti–Platt procedure was not appropriate for throwing athletes but could be a surgical option for patients with high risk of recurrence.

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We are grateful to all the staff of our hospital who helped us evaluate and treat the patients in this study.

Author information

Conception and design of the study H.I.; K.N.

Analysis and interpretation of data H.I.

Collection and assembly of data K.N.

Drafting of the article H.I.

Final approval of the article K.N.

Correspondence to Hiroaki Inui.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (J180) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Inui, H., Nobuhara, K. Modified Putti–Platt procedure for recurrent anterior shoulder instability. International Orthopaedics (SICOT) (2020).

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  • Shoulder dislocation
  • Putti–Platt
  • Osteoarthritis
  • External rotation