Risk analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review : A study performed by the Early-Osteoarthritis group of ESSKA-European Knee Associates section.

PURPOSE: Intra-articular corticosteroid injection is widely used for symptomatic relief of knee osteoarthritis. However, if pain is not improved which consequences a total knee arthroplasty (TKA), there is a potential risk of post-operative periprosthetic joint infection (PJI). The aim of this study is to investigate whether the use of preoperative intra-articular corticosteroid injection increases the risk of PJI and to investigate a time frame in which the risk of subsequent infection is significantly increased. METHODS: A systematic search was performed in PubMed (Medline), Scopus, and the Cochrane Library. Inclusion criteria were original studies investigating the rate of PJI in patients receiving pre-operative intra-articular corticosteroid injection compared to controls. RESULTS: A total of 380 unique articles were screened. Six studies met the inclusion criteria with 255,627 patients in total. Overall, no statistical significance was observed in the intra-articular infection rate in corticosteroid compared to controls groups. However, intra-articular corticosteroid injections within 3 months prior to TKA were associated with a significantly increased risk of infection (OR: 1.52, 95% CI 1.37-1.67, p < 0.01); this was not observed in the 6 month period (OR: 1.05, 95% CI 0.80-1.39, p = 0.72). CONCLUSIONS: Performing an intra-articular corticosteroid injection within 3 months prior to TKA is associated with a significantly increased risk of PJI. The current evidence supports the safe use of intra-articular corticosteroid injection more than 6 months before TKA. However, additional studies are needed to clarify the risk of PJI after TKA implantation between 3 and 6 months after the last corticoid injection. LEVEL OF EVIDENCE: IV.

Frozen shoulder or shoulder stiffness from Parkinson disease?

PURPOSE: To understand the role of camptocormia (increased kyphosis) and postural alteration in Parkinson's disease in the development of shoulder pathology, with a special concern for adhesive capsulitis and shoulder stiffness. METHODS: A preliminary online search was carried out, with combination of keywords including "Parkinson," "Shoulder stiffness," "Frozen shoulder," "Adhesive capsulitis," "Postural alteration," "Camptocormia". The retrieved papers were screened by title and abstract and those considered relevant to the aim of the review were read in full text and included. Relevant information were extracted and reported into text. RESULTS: Due to a severe impairment of posture, patients affected by PD show an increased thoracic kyphosis (camptocormia) and decreased mobility of the trunk that can yield a humeroacromial impingement syndrome and capsulitis, resulting in inflammation of the bursa, shoulder pain and reduction of movement. Furthermore, kinematic of the shoulder is allowed by the combined movement of the humerus, the scapula, the clavicle, the thoracic wall and thoracic spine. The thoracic spine and wall mobility are severely impaired in the parkinsonian patient, thus limiting the shoulder motion. CONCLUSION: The postural alteration observed in PD is the primum movens for shoulder pathology, since anterior tilt of the scapula, which occurs with the increment of thoracic kyphosis, yields to a subacromial impingement. A closed loop is then created, as the rigidity of the shoulder causes further alteration in the posture, which worsens the impingement syndrome and so on.

[Rotator cuff repair: single- vs double-row. Clinical and biomechanical results]. / Rekonstruktion der Rotatorenmanschette: Single-row oder Double-row. Klinische und biomechanische Ergebnisse.

BACKGROUND: The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique. OBJECTIVES: The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques. MATERIALS AND METHODS: The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair. RESULTS: In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques. CONCLUSIONS: Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.

Effect of single- and double-row rotator cuff repair at the tendon-to-bone interface: preliminary results using an in vivo sheep model.

INTRODUCTION: The clinical superiority of the double-row technique is still a subject of controversial debate in rotator cuff repair. We hypothesised that the expression of different collagen types will differ between double-row and single-row rotator cuff repair indicating a faster healing response by the double-row technique. MATERIALS AND METHODS: Twenty-four mature female sheep were randomly assembled to two different groups in which a surgically created acute infraspinatus tendon tear was fixed using either a modified single- or double-row repair technique. Shoulder joints from female sheep cadavers of identical age, bone maturity, and weight served as untreated control cluster. Expression of type I, II, and III collagen was observed in the tendon-to-bone junction along with recovering changes in the fibrocartilage zone after immunohistological tissue staining at 1, 2, 3, 6, 12, and 26 weeks postoperatively. RESULTS: Expression of type III collagen remained positive until 6 weeks after surgery in the double-row group, whereas it was detectable for 12 weeks in the single-row group. In both groups, type I collagen expression increased after 12 weeks. Type II collagen expression was increased after 12 weeks in the double-row versus single-row group. Clusters of chondrocytes were only visible between week 6 and 12 in the double-row group. CONCLUSIONS: The study demonstrates differences regarding the expression of type I and type III collagen in the tendon-to-bone junction following double-row rotator cuff repair compared to single-row repair. The healing response in this acute repair model is faster in the double-row group during the investigated healing period.

Mechanical testing of different knot types using high-performance suture material.

PURPOSE: This laboratory study aimed to evaluate the loop security, knot security, cyclic loading resistance and load-to-failure rate of three different knot types with establishing a new experimental set-up. Additionally, the mode of failure of each knot was evaluated. METHODS: With the use of nonabsorbable, braided polyethylene sutures, USP size No. 2 [Hi-Fi®; ConMed Linvatec], the arthroscopic knot types Dines, SMC as well as the surgeon's knot were tested using a material testing machine. The knots were tied openly as well as arthroscopically. The set-up enables testing of knot configurations while eliminating friction between knot loop and its suspension points. Including all test procedures, a total of 216 knots were tested. RESULTS: All openly tied knot types and ten of each type of arthroscopically tied knots resisted against cyclic loading of 1,000 cycles. With subsequent load-to-failure testing, openly tied knot types achieved significantly higher values of tensile strength than arthroscopically tied knots. Regarding clinical failure, defined as an elongation of 3 mm, Dines knot reached highest loop as well as knot security. Knot slippage was the most common failure mechanism at an elongation of 3 mm, whereas suture breakage was evaluated most at an elongation of 6 mm. CONCLUSIONS: The new experimental set-up confirms the loop security of arthroscopic knot types. Using a knot pusher clinically is a key factor to attain this as compared to openly hand-tied techniques. The Dines knot presented the highest reliability. It may provide a secure tissue healing during rehabilitation and consequently can be recommended for clinical application.

[Treatment of locked chronic posterior dislocation of the shoulder]. / Therapie der verhakten chronischen hinteren Schulterluxation.

INTRODUCTION: The posterior locked shoulder dislocation is a rare injury that is often associated with an impression fracture of the anteromedial aspect of the humeral head. The majority of posterior shoulder dislocations are missed on the initial examination. METHODS: We demonstrate the case of an athlete, who presented with a posterior shoulder dislocation after a trauma two months ago. RESULTS: The patient was treated with a M. subscapularis transfer in the reverse-hill-sachs-lesion. DISCUSSION: The diagnosis of the posterior shoulder dislocation remains a problem in the clinical setting. Treatment is based on the size defect of the anteromedial humeral head. Different treatment options are still controversially discussed. CONCLUSION: To diagnose a posterior shoulder dislocation correctly a standard clinical and radiological assessment is necessary.

Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor.

Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. This report represents the first published case of an intraosseous foreign body granuloma in the humeral head after arthroscopic rotator cuff tear fixation with a poly-L: -lactide (PLLA) suture anchor. A 48-year-old female patient presented with pain in her right shoulder. A refixation of her right supraspinatus tendon with a biodegradable suture anchor was performed 11 months ago at an external hospital. Laboratory tests showed normal values for C-reactive protein, leukocytes and the erythrocyte sedimentation rate. No signs of infection or instability were noted. The visual analogue scale (VAS) was 8, the simple shoulder test (SST) was 4 and the American shoulder and elbow surgeons score (ASES) was 44. Plain radiographs showed high lucency in the area of the tuberculum majus. MRI showed an intra- and extraosseous mass surrounded by fluid in this area. Surgical care involved arthroscopic debridement and removal of the suture anchor. Histological examination revealed a foreign body granuloma. At the 18-month follow-up the patient was nearly pain-free. The VAS was 2, SST was 10 and ASES was 88. Foreign body granulomas are a well known but rarely described complication that arises after the use of biodegradable suture anchors in shoulder surgery. Every patient presenting with shoulder pain after usage of a biodegradable fixation material should be evaluated closely. Orthopaedic surgeons should be aware of the possibility of delayed foreign body reactions, especially after using PLLA anchors.

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair.

AIM: This experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated. METHOD: In 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason-Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine. RESULTS: Group 4 showed lowest load-to-failure result with 155.7 +/- 31.1 N compared to group 1 (293.4 +/- 16.1 N) and group 2 (397.7 +/- 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 +/- 7.3 N/mm) and lowest in group 4 (84.4 +/- 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001). CONCLUSIONS: A double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used.

Arthroscopic evaluation of the ACL double bundle structure.

In order to describe the arthroscopic presence of the double bundle structure and to evaluate the value of different portals in knee arthroscopy, we assessed the AM and PL bundle anatomy. We prospectively examined the knees of 60 patients undergoing arthroscopic surgery for pathology unrelated to the ACL. Arthroscopy was performed in a two portal technique using an anterolateral (ALP) and an anteromedial (AMP) portal. With the arthroscope in the ALP, we could distinguish an AM and PL bundle in 28%. Switching the arthroscope to the AMP, differentiation of the bundles was possible in 67%. In all remaining cases visualization of the PL bundle was possible after retraction of the AM bundle. Use of AMP increased visualization of the PL bundle. It seems reasonable to perform arthroscopy for ACL reconstruction with the arthroscope in the AMP and to establish an additional medial working portal to increase the visualization of the femoral ACL insertion sites for optimal femoral tunnel placement.

Cell biological and biomechanical evaluation of two different fixation techniques for rotator cuff repair.

Our objective was to evaluate the cell biology and biomechanical aspects of the healing process after two different techniques in open rotator cuff surgery - double-loaded bio-absorbable suture anchors combined with so-called arthroscopic Mason-Allen stitches (AAMA) and a trans-osseous suture technique combined with traditional modified Mason-Allen stitches (SMMA). Thirty-six mature sheep were randomized into two repair groups. After 6, 12, or 26 weeks, evaluation of the reinsertion site of the infraspinatus tendon was performed. The mechanical load-to-failure and stiffness results did not indicate a significant difference between the two groups. After 26 weeks, fibrocartilage was sparse in the AAMA group, whereas the SMMA group showed the most pronounced amount of fibrocartilage. We found no ultrastructural differences in collagen fiber organization between the two groups. The relative expression of collagen type II mRNA in the normal group was 1.11. For the AAMA group, 6 weeks after surgery, the relative expression was 55.47, whereas for the SMMA group it was 1.90. This in vivo study showed that the AAMA group exhibited a tendon-to-bone healing process more favorable in its cell biology than that of the traditional SMMA technique. Therefore, the AAMA technique might also be more appropriate for arthroscopic repair.

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material.

The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason-Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P < 0.001). The ultimate tensile strength in double-row specimens was significantly higher than in others (P < 0.001). There was no significant variation in using different suture material (P > 0.05). Double-row suture anchor repair with arthroscopic Mason-Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason-Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason-Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.

Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis.

Frozen shoulder is said to be a self-limiting entity but full recovery often takes more than 2 years. For that, most patients are unwilling to tolerate painful restriction while awaiting resolution. We prospectively investigated 30 patients (16 women, 14 men) for the outcome of arthroscopic capsular release in idiopathic frozen shoulder. Results were determined by the assessment of subjective and objective parameters to estimate both shoulder function and general health status. Symptoms persisted without improvement for a minimum of 6 months of conservative treatment. Preoperative average American shoulder and elbow surgeons score (ASES) was 35, visual analog scale (VAS) to measure pain was 7, and simple shoulder test (SST) was 4. Mean scores of the physical component of SF-36 were considerably reduced. Mean forward elevation was 85 degrees , average abduction was 70 degrees , mean internal rotation was 15 degrees , and mean external rotation was 10 degrees . Patients were followed-up at 6 weeks, 3, 6, 12 months and by a mean of 36 months. Range of motion for all planes improved (P < 0.05). Median VAS reduced to 2, average ASES increased to 91, and SST enhanced to a mean of 10 (P < 0.05). We stated improvement of the physical components in the SF-36 questionnaire in particular bodily pain and the role-physical score. There were no significant differences between the measurements in the early postoperative phase compared to the mid-term follow-up (P > 0.05). Our results demonstrate that arthroscopic release of refractory idiopathic frozen shoulder combined with a gentle manipulation provides reliable expectations for improvement in both clinical and general health status for most patients. We recommend the use of a limb-specific and a general-health-status questionnaire to conclude the benefit of the surgical intervention and contribute the optimization of a therapy concept more effectively.

The double-bundle technique for anterior cruciate ligament reconstruction: a systematic overview.

In traditional anterior cruciate ligament reconstruction, there is a subset of patients complaining of knee instability, especially rotational instability, and athletes not able to return to their preinjury level of sports activity. Currently, controversy exists over the usefulness of the double bundle technique (DBT) in addressing these problems. In order to evaluate the DBT, we completed a literature review from 1969 to February 2006 focusing on anatomy, magnetic resonance imaging, graft incorporation, biomechanics, kinematics, surgical techniques, complications and outcome. The DBT is not a standardized technique, which makes it difficult to compare results. Cadaver studies have proven biomechanical advantages with respect to ap-stability, but assessing the rotational stability remains difficult. There is a lack of available outcome studies with sufficient follow-up to demonstrate the potential advantages of DBT. The theoretical advantages of DBT require careful evaluation with outcome, biomechanical and kinematic studies. In addition, studies are needed to address issues such as graft incorporation and complications. An advantage offered by DBT is the possibility to identify rupture patterns that can lead to surgical preservation of an intact and augmentation of an injured bundle. The approach of augmentating a single bundle technique reconstruction with adequate anterior-posterior but poor rotational stability is promising.

Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation.

INTRODUCTION: Traditional anterior cruciate ligament (ACL) surgery has demonstrated good results, but there is still a subset of unsatisfactory outcomes. Trends in reconstruction technique have changed from bone-patella-tendon-bone to hamstring refixation, and the next step appears to be the double bundle concept. METHODS: We examined six fresh-frozen cadaver knees to evaluate the double bundle structure, dynamic motion characteristics and the relationship of knee flexion and relative position of the femoral insertion sites of the ACL. RESULTS: In all knees, we identified an anteromedial (AM) and posterolateral (PL) bundle. The motion pattern demonstrated that the AM and PL bundles are oriented near parallel with the knee extended, and twist around each other as the knee is flexed. The visualization of the femoral footprint anatomy differs with knee flexion. DISCUSSION: The double bundle model facilitates restoration of the original footprint anatomy and biomechanics more easily than the concept of the ACL as a one-bundle structure and the use of the o'clock position. It is essential to be aware of the degree of knee flexion when drilling the femoral tunnels. PERSPECTIVE: Anatomic ACL reconstruction is a concept, not a technique, and allows a more refined surgical approach to ACL reconstruction including revision cases and partial ACL tears.

[Orthopaedic surgery residency: comparison between the German and the North American system]. / Orthopädisch-unfallchirurgische Facharztweiterbildung im deutschen und US-amerikanischen Vergleich.

AIM: On the way to the unification of the European Union (EU), Germany has passed a new medical professional education system at the 106 (th) German medical board in Cologne in 2003. The medical board has established a new residency programme for the specialty of orthopaedic surgery, which was previously separated into orthopaedic and trauma surgery. An exchange of orthopaedic surgeons within the EU is therefore less complicated. For an exchange outside the EU, an international comparison especially with the USA is warranted. METHOD: We analysed and compared the German "Assistenzarzt System" with the residency programme of the USA regarding the specialty of orthopaedic surgery and further sub-specialisation programmes. RESULTS: After evaluation of both systems, a high conformity in the basic training for orthopaedic surgery was demonstrated. However, there is a difference between the two systems regarding specialisation after residency training with the German "Oberarzt" on the one side and the American fellow system on the other side. CONCLUSION: This study demonstrates that the German orthopaedic training matches well with the American residency programs. There is potential for acknowledgement of the German title "Orthopaedic surgeon" in the USA. In some states, such as Pennsylvania, European medical specialists are given institutionally restricted work permission for limited periods of time. It remains, however, questionable if there is a general political intent for the USA to acknowledge German or European residency programs.

[Current status of wrist arthrodesis]. / Stellenwert der Arthrodese des Handgelenkes.

AIM: In order to ascertain the value and future of wrist arthrodesis we assessed the results of 47 wrist arthrodeses performed at the Departments of Orthopaedic and Trauma Surgery of the University of Goettingen between 1980 and 1998. METHOD: In a retrospective analysis we examined the patients clinical and radiological records. Evaluating the results we used the score described by Lohmann and Buck-Gramcko in order to consider function, pain, strength and assessment of the patient him/herself. RESULTS: 93.6 % of all cases could be examined. We found a wrist arthrodesis in posttraumatic arthritis in 22 cases and in rheumatoid arthritis in 25 cases. Plate (n = 30) and Rush-Pin osteosynthesis (n = 17) were used as surgical procedures. In all patients we found a successfully stabilised wrist, although in 3 trauma cases a further surgical procedure was necessary. A better function of the wrist was reached in every patient. The majority of the patients had no pain and an acceptable strength. The results obtained showed good and excellent results in 86.4 % of the wrist arthrodesis for post-traumatic arthritis and in 90.9 % for rheumatoid arthritis. CONCLUSION: The increase in quality of life, especially in patients suffering from rheumatoid arthritis, shows the procedure of wrist arthrodesis to be a still worthwile surgery.

Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction.

Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.

Autologous chondrocyte transplantation for treating cartilage defects of the talus.

BACKGROUND: Despite its highly specialized nature, articular cartilage has a poor reparative capability. Treatment of symptomatic osteochondral defects of the talus has been especially difficult until now. METHODS: We performed autologous chondrocyte transplantation in twelve patients with a focal deep cartilage lesion of the talus. There were seven female and five male patients with a mean age of 29.7 years. The mean size of the lesion was 2.3 cm(2). All patients were studied prospectively. Evaluation was performed with use of the Hannover ankle rating score, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a visual analogue scale for pain, and magnetic resonance imaging. RESULTS: All patients were available for follow-up at a mean of sixty-three months. There was a significant improvement in the Hannover score, from 40.4 points preoperatively to 85.5 points at the follow-up examination, with seven excellent results, four good results, and one satisfactory result. The AOFAS mean score was 88.4 points compared with 43.5 points preoperatively. Magnetic resonance imaging showed a nearly congruent joint surface in seven patients, discrete irregularities in four, and an incongruent surface in one. The patients who had been involved in competitive sports were able to return to their full activity level. CONCLUSIONS: The promising clinical results of this study suggest that autologous chondrocyte transplantation is an effective and safe way to treat symptomatic osteochondral defects of the talus in appropriately selected patients.

Treatment option in a SLAP-related ganglion cyst resulting in suprascapular nerve entrapment.

INTRODUCTION: Our report shows a rare case of suprascapular nerve palsy due to a SLAP-related ganglion cyst resulting in isolated weakness of the infraspinatus muscle. CASE REPORT: We report on a 31-year old volleyball player with severe shoulder pain. A ganglion cyst was excised in an open procedure and was completely resolved in a postoperative magnetic resonance imaging (MRI). But the patient again had pain and disability 7 months after this procedure. A renewed MRI scan showed a cystic mass in the spinoglenoid notch. An electromyography revealed an isolated lesion of the suprascapular nerve. The patient was treated by shoulder arthroscopy with refixation of a type-II-SLAP-lesion and drainage of the cyst formation. At latest follow-up 29 months after surgery, the patient's pain and shoulder function improved with a constant score of 94 points. A MRI scan documented complete cyst resolution. CONCLUSIONS: Treatment options for ganglion cysts at the spinoglenoid notch are various and can be handled in conservative and operative ways. We believe that the arthroscopic concept with the management of a SLAP lesion as the cause of cyst formation, and the drainage of the ganglion is an effective way with low surgical morbidity that shows good postoperative results.