Arthroscopic management of proximal humerus malunion with tuberoplasty and rotator cuff retensioning.

PURPOSE: To report the mid- to long-term results of arthroscopic tuberoplasty and rotator cuff retensioning for proximal humerus malunion.

METHODS

Between August 2001 and October 2009, 9 patients with a mean age of 49 years underwent shoulder arthroscopy with tuberoplasty and rotator cuff advancement for malunion of the proximal humerus and were included in this study. The mean delay between the initial fracture and our surgery was 19 months. We developed a systematic technique to take down the rotator cuff over the malunited proximal humerus, perform a tuberoplasty, and then retension and repair the rotator cuff by advancing it on the greater tuberosity. The mean follow-up was 50 months (range, 12 to 108 months).

RESULTS

Patients showed mean active forward elevation of 164° (range, 90° to 180°; gain of 43°), recovery of mean active external rotation of 45° (range, 30° to 60°; gain of 16°), and a mean pain score of 1.8 points (range, 0 to 5 points; reduction of 3.8 points). The overall functional results according to the University of California, Los Angeles score were excellent in 3 cases, good in 3, and fair in 3. No patient required additional surgery. Of the 9 patients, 8 (89%) were able to return to their previous sports or activities. All patients declared themselves as being satisfied with the result.

CONCLUSIONS

Arthroscopic tuberoplasty and rotator cuff retensioning for proximal humerus malunion comprise a viable alternative to traditional open methods, particularly in young patients. A comprehensive approach is recommended that addresses stiffness, associated pathology, and impingement, and re-establishes rotator cuff function. Although the technique is technically demanding, it allows preservation of the native humeral head, is associated with a very low complication rate, and avoids concerns about long-term prosthetic survival in young patients.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.