Walch summarizes career-long lessons from systematic patient follow-up across all major shoulder surgery domains. The paper covers anterior and posterior instability, rotator cuff tears, anatomic arthroplasty, and reverse arthroplasty. Recommendations are derived from honest analysis of both successes and failures — not theory.
Several high-stakes clinical decisions in shoulder surgery lack a single landmark trial — they are guided by accumulated expert experience, and Walch's systematic follow-up over four decades is among the most cited sources for these rules.
When evaluating a rotator cuff repair candidate, fatty infiltration on MRI is your most important variable. It predicts function better than tear size and cannot be reversed by repair. A patient with Stage 3-4 infraspinatus infiltration needs a realistic conversation about what surgery can and cannot restore.
When planning reverse arthroplasty, prioritize glenoid lateralization over humeral lateralization. Humeral lateralization alone does not drive outcomes. And if a patient needs revision reverse, prepare them: the complication rate is 3× higher than primary.
The Latarjet is the go-to for recurrent anterior instability. But screen for contraindications. Operating on voluntary dislocators or patients with seizure disorders will produce failures that soft-tissue and bone-block procedures alike cannot fix.
Walch summarizes career-long lessons from systematic patient follow-up across all major shoulder surgery domains. The paper covers anterior and posterior instability, rotator cuff tears, anatomic arthroplasty, and reverse arthroplasty. Recommendations are derived from honest analysis of both successes and failures — not theory.
Several high-stakes clinical decisions in shoulder surgery lack a single landmark trial — they are guided by accumulated expert experience, and Walch's systematic follow-up over four decades is among the most cited sources for these rules.
When evaluating a rotator cuff repair candidate, fatty infiltration on MRI is your most important variable. It predicts function better than tear size and cannot be reversed by repair. A patient with Stage 3-4 infraspinatus infiltration needs a realistic conversation about what surgery can and cannot restore.
When planning reverse arthroplasty, prioritize glenoid lateralization over humeral lateralization. Humeral lateralization alone does not drive outcomes. And if a patient needs revision reverse, prepare them: the complication rate is 3× higher than primary.
The Latarjet is the go-to for recurrent anterior instability. But screen for contraindications. Operating on voluntary dislocators or patients with seizure disorders will produce failures that soft-tissue and bone-block procedures alike cannot fix.