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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Levy DM, Cole BJ, Bach BR Jr (2016) History of surgical intervention of anterior shoulder instability. Journal of Shoulder and Elbow Surgery 25(6):e139–e150. https://doi.org/10.1016/j.jse.2016.01.019
Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 16(7):677–694
Balg F, Boileau P (2007) The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. The Journal of bone and joint surgery British 89(11):1470–1477. https://doi.org/10.1302/0301-620x.89b11.18962
Ahmed I, Ashton F, Robinson CM (2012) Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. The Journal of bone and joint surgery American volume 94(14):1308–1315. https://doi.org/10.2106/jbjs.j.01983
Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones MH, Bishop JY, Miniaci A (2013) Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. Journal of Shoulder and Elbow Surgery 22(2):286–292. https://doi.org/10.1016/j.jse.2012.09.009
Osmond-Clarke H (1948) Habitual dislocation of the shoulder; the Putti-Platt operation. The Journal of bone and joint surgery British 30b(1):19–25
Hawkins RJ, Angelo RL (1990) Glenohumeral osteoarthrosis. A late complication of the Putti-Platt repair. The Journal of bone and joint surgery American 72(8):1193–1197
Lusardi DA, Wirth MA, Wurtz D, Rockwood CA Jr (1993) Loss of external rotation following anterior capsulorrhaphy of the shoulder. The Journal of bone and joint surgery American 75(8):1185–1192. https://doi.org/10.2106/00004623-199308000-00008
Leach RE, Corbett M, Schepsis A, Stockel J (1982) Results of a modified Putti-Platt operation for recurrent shoulder dislocations and subluxations. Clinical Orthopaedics and Related Research 164:20–25
Symeonides PP (1989) Reconsideration of the Putti-Platt procedure and its mode of action in recurrent traumatic anterior dislocation of the shoulder. Clinical Orthopaedics and Related Research 246:8–15
Salomonsson B, Abbaszadegan H, Revay S, Lillkrona U (2009) The Bankart repair versus the Putti-Platt procedure: a randomized study with WOSI score at 10-year follow-up in 62 patients. Acta Orthopaedica 80(3):351–356. https://doi.org/10.3109/17453670902988345
Iordens GI, Van Lieshout EM, Van Es BC, Schep NW, Breederveld RS, Patka P, Den Hartog D (2013) Outcome after modified Putti-Platt procedure for recurrent traumatic anterior shoulder dislocations. Strategies in trauma and limb reconstruction (Online) 8(3):141–147. https://doi.org/10.1007/s11751-013-0171-x
Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. The Journal of Bone and Joint Surgery. American Volume 60(1):1–16
listed Na Japan Shoulder Society. Evaluation Sheet for Shoulder Instability (JSS Shoulder Instability Score, JSS-SIS). http://www.j-shoulder-s.jp/downroad/
Tokish JM, Decker MJ, Ellis HB, Torry MR, Hawkins RJ (2003) The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. Journal of Shoulder and Elbow Surgery 12(5):427–430. https://doi.org/10.1016/s1058-2746(03)00047-8
Bessiere C, Trojani C, Carles M, Mehta SS, Boileau P (2014) The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair. Clinical Orthopaedics and Related Research 472(8):2345–2351. https://doi.org/10.1007/s11999-014-3550-9
Gagey O, Bonfait H, Gillot C, Hureau J, Mazas F (1987) Anatomic basis of ligamentous control of elevation of the shoulder (reference position of the shoulder joint). Surgical and Radiologic Anatomy 9(1):19–26
Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. The Journal of Bone and Joint Surgery. American Volume 65(4):456–460
Walch G, Badet R, Boulahia A, Khoury A (1999) Morphologic study of the glenoid in primary glenohumeral osteoarthritis. The Journal of Arthroplasty 14(6):756–760
Gagey OJ, Gagey N (2001) The hyperabduction test. The Journal of Bone and Joint Surgery British 83(1):69–74
Turkel SJ, Panio MW, Marshall JL, Girgis FG (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. The Journal of Bone and Joint Surgery. American Volume 63(8):1208–1217
Speer KP, Deng X, Borrero S, Torzilli PA, Altchek DA, Warren RF (1994) Biomechanical evaluation of a simulated Bankart lesion. The Journal of Bone and Joint Surgery. American Volume 76(12):1819–1826
Urayama M, Itoi E, Sashi R, Minagawa H, Sato K (2003) Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. The American Journal of Sports Medicine 31(1):64–67. https://doi.org/10.1177/03635465030310012201
Aboalata M, Plath JE, Seppel G, Juretzko J, Vogt S, Imhoff AB (2017) Results of arthroscopic Bankart repair for anterior-inferior shoulder instability at 13-year follow-up. The American Journal of Sports Medicine 45(4):782–787. https://doi.org/10.1177/0363546516675145
Mizuno N, Denard PJ, Raiss P, Melis B, Walch G (2014) Long-term results of the Latarjet procedure for anterior instability of the shoulder. Journal of Shoulder and Elbow Surgery 23(11):1691–1699. https://doi.org/10.1016/j.jse.2014.02.015
We are grateful to all the staff of our hospital who helped us evaluate and treat the patients in this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Inui, H., Nobuhara, K. Modified Putti–Platt procedure for recurrent anterior shoulder instability. International Orthopaedics (SICOT) (2020). https://doi.org/10.1007/s00264-020-04509-w
- Shoulder dislocation
- External rotation