An 82-year-old woman presenting with an acute, 4-part proximal humerus fracture-dislocation after a ground-level fall was treated with reverse total shoulder arthroplasty using a novel FiberTape cerclage tuberosity fixation technique. Surgery was done within 24 hours of injury using a deltopectoral approach. The reconstruction technique incorporated a standard metaphyseal press-fit stem, autologous bone graft, and a modified Six-Tec-based suture tuberosity repair combined with a tension-band construct derived from a prophylactic humeral shaft FiberTape cerclage (Arthrex) anchored distal to fracture. The patient progressed from shoulder pendulums and active-assisted forward elevation in the scapular plane immediately postoperative to active range of motion at 6 weeks and removal of all restriction at 12 weeks. Simple Shoulder Test and QuickDASH scores were 10 and 9.09, respectively, at 96 weeks postoperatively with the patient reporting the ability to touch the back of her head and reach her buttock for self-hygiene. Active forward elevation was 140° at 1 year and 140° at 2.4 years with 30 degrees of external rotation. Tuberosity union was achieved by 3 months with minimal displacement. The patient did not experience any postoperative complications such as dislocation, implant failure, periprosthetic fracture, infection, humeral stem lucency, heterotopic ossification, or revision surgery.

Does the size of a Hill-Sachs lesion (HSL) matter? Since its original description in 1940, understanding of the HSL's contribution to recurrent shoulder instability has evolved from a binary engaging/nonengaging framework under the glenoid track concept to more nuanced concepts of bipolar bone loss on a continuum. Although much attention has been centered on glenoid bone loss, the contribution of an HSL and, perhaps more importantly, the distance to dislocation of the HSL have gained increasing attention. How to evaluate at-risk patients with chronic shoulder instability and multiple, recurrent instability events remains problematic, especially when their shoulder fits a classic on-track, nonengaging biomechanical profile. Do patients with chronic and recurrent instability events have worse, larger, or more medialized HSL? Should we do more than isolated arthroscopic Bankart repair in these patients? The paradigm appears to shift along with the location of the HSL.

Background: Reconstruction with megaprostheses is an important limb-salvage option in cases of bone tumors and metastases, as it allows extensive bone resection while preserving the limb. However, postoperative shoulder instability remains a frequent complication. Although implant instability is one of the leading causes of treatment failure, the factors contributing to it are still not clearly defined. This study analyzes the correlation between resection length, implant type, and involvement of the deltoid and rotator cuff in relation to postoperative instability and the risk of postoperative dislocation. Methods: Twenty-five patients treated at our institution between 2014 and 2025 who underwent proximal humerus replacement with a megaprosthesis were included. Patients were divided into two groups: those with postoperative dislocation (Group A) and those without (Group B). Functional outcomes were assessed using the MSTS and DASH scores. The mean follow-up was 20.38 ± 11.87 months. Results: Of the twenty-five patients included, six (24%) experienced instability and subsequent dislocation (Group A). Rotator cuff invasion was present in 100% of Group A and 36.8% of Group B (p < 0.001), while deltoid invasion was present in 83.3% of Group A and 21% of Group B (p = 0.001). The mean resection length was 14.4 ± 2.2 cm in Group A and 13.7 ± 3.7 cm in Group B (p = 0.636). No significant differences were found between the groups in DASH and MSTS scores. Conclusions: In this cohort, rotator cuff and deltoid involvement were significantly associated with postoperative shoulder instability following proximal humerus megaprosthetic reconstruction. These findings suggest that careful preoperative assessment of rotator cuff and deltoid involvement may help identify patients at higher risk of postoperative instability and optimize surgical planning. Future studies should focus on preoperative planning and the development of a risk score to identify patients at higher risk of instability, potentially allowing for additional procedures such as latissimus dorsi flap reconstruction.

As the most mobile joint in the body, the shoulder is prone to both macro- and micro-instability. Throwing a baseball overhead requires a complex synchronization of the anterior and posterior stabilizers of the shoulder. Injuries to the anterior shoulder can be particularly devastating to an overhead athlete because the throwing motion requires significant external rotation and a sudden and powerful transition to internal rotation, to generate force and velocity. Multiple structures in the anterior shoulder are notable when injured in an overhead athlete; these include the subscapularis, the anterior capsule, and the labrum. Injuries can occur on a spectrum, from gradual laxity and microinstability to traumatic laxity and gross instability. This review article review the management of injuries to these commonly injured anterior shoulder structures. Level of Evidence: Expert opinion: Level V.