Reconsideration of the Putti-Platt Procedure and Its Mode of Action in Recurrent Traumatic Anterior Dislocation of the Shoulder

The Putti-Platt procedure and its mode of action were investigated clinically and by work on anatomic specimens. The clinical work comprised 72 cases (Group A) of recurrent traumatic anterior dislocation of the shoulder operated on by the classic Putti-Platt technique from 1961 to 1985 and 92 cases (Group B) treated by the simplified operation from 1966 to 1979. Sixty-five patients from Group A and 83 (85 shoulders) from Group B were reexamined. There were two recurrences in Group A and three in Group B. In Group A, lateral rotation of the arm was restored in 19 of the 65 patients; it was increased in 44 patients by 60° to 70° compared with immediate postoperative rotation, which was 20° to 30° from the neutral position. On anatomic specimens in which the classic Putti-Platt technique was used, lateral rotation could not reach neutral without disruption of the lateral stump from the labrum. Since the lateral stump of the subscapularis is tendinous and inelastic, the postoperative increase in lateral rotation among Group A patients could be explained if the lateral stump had become gradually detached from the labrum. Therefore, it seems that this difficult part of the classic Putti-Platt procedure may be omitted, rendering the operation simpler and shorter than the original technique but just as successful. Furthermore, this work suggests that the mode of action of the Putti-Platt procedure seems to be restoration of normal length to the traumatically stretched subscapularis, the creation of a double layer of muscle and capsule in front of the joint, and the fact that a wider part of the subscapularis is brought in front of and below the humeral head.