Aims: The aim of this study is to compare open Bankart procedure and arthroscopic extra-articular stabilization of the shoulder in patients with anterior instability. Material and Methods: 236 patients with recurrent anterior shoulder instability were treated surgically between 1992 and 2002. Open Bankart procedure was performed in 177 patients, mean age 29 years (range 17–67), and arthroscopic extra-articular stabilization in 59 patients, mean age 27 years (range 14–45). Single surgeon was performed all surgery. Follow-up for open surgery was from 2 to10 years, and for arthroscopic stabilization from 12 to 60 months. Results: Constant score for Bankart procedure was 90 points and for arthroscopic stabilization was 96 points. Five patients (2.8%) had re-dislocation after open procedure and three patients (5,1%) after arthroscopic stabilization. Conclusion: Open Bankart is more reliable than arthroscopic stabilisation of the shoulder. However, arthroscopic stabilisation has more advantages; better ROM, better function and cosmesis, lesser morbidity and small violation of normal anatomy

The purpose of the study was to evaluate the functional outcome and recurrent dislocation rate in patients who have undergone arthroscopic shoulder stabilization with a bioabsorbable fixation device, Suretac (Acufex Microsurgical). The role of thermal capsular shrinkage was also investigated. Between June 1996 and June 2000, 78 consecutive patients (80 shoulders) at our hospital underwent arthroscopic stabilization with Suretac fixator by our senior author (DM). Twenty-one performed for acute post-traumatic dislocation (defined as first time dislocation), 41 for recurrent dislocations, 14 for SLAP lesions and four atraumatic multidirectional instability. Patients were followed up by an independent observer (FL) after a mean of 35 months (range: 9–62 months). The follow up examination included the modified Rowe and Zarins score, the American Shoulder and Elbow Surgeons score and the Constant score. The strength of lateral elevation as advocated in the Constant score was measured by the Nottingham Mecmesin Myometer. The overall re-dislocation rate after surgery was 14% (11 patients). This occurred after an average period of 23 months (range: 12–37 months) following the initial stabilization procedure. One patient also reported recurrent subluxation though without frank dislocation. The re-dislocation for patients with acute dislocation was 9%, 15% for recurrent dislocation, 14% for SLAP lesions and 25% for those with atraumatic multidirectional instability. 3 of the 19 patients who underwent arthroscopic stabilization and thermal capsular shrinkage also re-dislocated. Four of the 10 patients who were aged 18 or under at the time of surgery, re-dislocated after an average period of 18 months following the operation. Our study shows that the functional outcome and recurrence rate of Suretac stabilization compare favorably to other arthroscopic repair techniques using nonabsorbable suture anchors. The results appear to be better in patients with acute post traumatic dislocation. We do not recommend its use in younger patients (18 or under) especially with multidirectional instability. There is not enough evidence in our study to support the theoretical benefits of thermal capsular shrinkage

Purpose: Arthroscopic stabilization for post-traumatic anterior glenohumeral instability is designed to minimize soft tissue dissection while achieving similar or improved outcomes relative to open techniques. This study’s purpose was to determine the rate of post-operative recurrent instability and evaluate health related quality of life (HRQL) and shoulder range of motion (ROM) following arthroscopic Bankart repair using a bioabsorbable knotless implant. Method: Forty-three patients were prospectively evaluated following arthroscopic anterior stabilization to assess for recurrent instability, HRQL, and shoulder ROM. Assessments were performed pre-operatively and 3, 6 and 12–24 months postoperatively. The HRQL measures included the Western Ontario Shoulder Instability Index (WOSI), the American Shoulder and Elbow Surgeons Score (ASES), and the Constant Score. Repeated measures ANOVA was utilized to evaluate ROM and HRQL. Results: The mean WOSI score improved from 45.67±17.99 pre-operatively to 83.16±18.58 at final follow-up. The mean ASES scores improved from 80.1±13.06 pre-operatively to 92.25±15.08, while the Constant score improved from 77.52±16.11 pre-operatively to 85.18±26.76. At final follow-up, 4 of 43 patients (9.3%) had experienced recurrent instability. For these 4 subjects, the WOSI score was significantly lower at final follow-up than those who did not experience recurrent instability (61.73±5.76 versus 84.38±16.94). The ASES and Constant scores at final follow-up were not significantly different between these two groups. Conclusion: Arthroscopic anterior stabilization using a bioabsorable tack led to a recurrent instability rate similar to previous reports, and resulted in improved HRQL and shoulder ROM. The WOSI score was better able to detect problems in HRQL related to instability than either the ASES or Constant score

Aims: In this prospective study, we examined the value of capsular shrinkage in the arthroscopic stabilization of the posttraumatic antero-inferior instability of the shoulder. Methods: We treated 58 patients (38 men and 20 women) at the age of 29.7 (19–43) with the diagnosis posttraumatic antero-inferior shoulder instability with an arthroscopic stabilization. The patients were divided in two groups: In the first group with 31 patients we performed a capsule-labrum refixation with Fastak-anchors. In the second group (27 patients), we performed additionally a capsular shrinkage of the antero-inferior capsule with the Hol-Yag-laser. The re-examination was done in a postoperative time of 6, 12 and 24 months. Results: 50 patients (35 men and 15 women, 27 patients of the group 1 and 23 patients of the group 2) could be re-examined. Operation-conditioned complications did not occur. 3 postoperativ reluxations were seen in each group. 22 patients of the group 1 and 19 patients of the group 2 indicated to be content with the postoperative result. The Constant Score rose in the group 1 from 46 (37–59) praeoperativ to 88 (67–100) postOP. In the group 2 the Constant Score of 42 (33–61) rose to 86 (64–100) postOP. Conclusions: There was no significant improvement regarding the re-dislocation rate, the subjective patient satisfaction and the obtained Constant Score by additionally performing capsular shrinkage of the antero-inferior joint capsule, as by the exclusive capsule-labrum refixation. The anatomical reconstruction of the capsule-labrum-complex seems to be the crucial component in the arthroscopic stabilisation regarding to the postoperative results

Introduction: Various surgical methods have been described to manage the problem of recurrent anterior dislocation of the shoulder. Older procedures Putti-Platt’s, Magnuson-Stack’s or Bristow;’s and Boytchev’s repair are not used today due to a high percentage of failure of 7%–17% incidence of recurrence associated with limited ROM. However, in the last decade the goal of treatment has changed. It is directed now towards restoration of normal function with full ROM of the affected shoulder, based mainly on arthroscopic stabilization or on “open” Neer’s capsular shift procedures combined with Bankart’s repair. However, during the last few years there are more and more papers dealing with a surprising unexpected high number of patients with shoulder instability following arthroscopic repair. The purpose of this study is to review the long term results of “open” Neer’s capsular shift procedure. Materials & Methods: This is a presentation of 87 (78M; 9F) consecutive patients, 19 to 47 year old (mean 23 Y) with a length of follow-up of 4Y–15Y (mean 6Y). 45 of them with traumatic recurrent anterior dislocation of the shoulder had a capsular shift procedure according to Rockwood’s modification. In 42 other patients that had a multidirectional instability with proved dislocations of the affected shoulder a Protzman’s modified capsular shift procedure was used. Results: 82/87 patients had a stable shoulder without recurrent dislocation. 3 patients had an episode of traumatic shoulder dislocation within 2 months following operation. Two other patients of 42 with multidirectional instability had a recurrence of traumatic dislocation. One patient developed partial brachial plexus injury, most probably due to traction of the affected limb following operation. 78/87 had at follow-up normal shoulder function with full ROM, and the remaining 9 patients had only a slight limitation in shoulder abduction and in external rotation. Conclusions: Based on this study, it is suggested that capsular shift procedure is an excellent method for repair of recurrent anterior shoulder dislocation, preferable to the “older” procedures, and allows restoration of shoulder stability with better functional results. This is suitable mainly for patients with structural hyperlaxity and multidirectional instability, whereas arthroscopic stabilization might be used in patients with true traumatic instability

Introduction: Instability of the anterior horn of the medial meniscus (MM) has been described as dislocating, subluxating or hypermobile, but it is still controversial whether segments of the MM of the knee were surgically treated by arthroscopic stabilization. The average age of the patients was 28.7 (range 12 to 56). There were 9 men and 4 women. All patients complained of medial knee pain and felt tenderness in the medial joint space, most of them on the anterior side. None showed an apparent tear of the meniscus by arthroscopy or on MRI images, but all arthroscopically showed hypermobility (or easy dislocation from the edge of the tibial plateau) of the anterior to middle segment of the MM. No other apparent pathological changes were found. Six knees had marked limitations in the range of knee motion before operation. Arthroscopic stabilization of the hypermobility was performed in order to restrain the movement of the MM by fixing it to the tibial edge, using staples (2 cases), Kirschner wires (2 cases) or suture anchors (9 cases). Using the Japanese Orthopaedic Association meniscus injury score (maximum 100 points), the result was evaluated. The average follow up period was 20.1 months (range 9 to 49 months). Results: The result of arthroscopic fixation was satisfactory (excellent in 8 cases good in 1, fair in 1, and poor in 1). The average meniscus score at follow up was 87.8, while that of before operation was 41.9. It is suggested that instability of the anterior segment of the MM can be effectively treated by arthroscopic fixation of this site. Discussion: Since all of the knees in this study had an isolated lesion of instability in the anterior segment of the MM, the marked improvement in medial knee pain that resulted from fixation of this site does show that this lesion can be symptomatic. After excluding other possible pathological lesions, stabilization of this lesion by arthroscopic fixation is a good choice of treatment

The purpose of this study was to examine clinical outcomes of capsular plication using subjective outcome measures and objective clinical examination with emphasis on range of motion. Data of consecutive patients (twenty-five at six months and twenty at twelve months) who required arthroscopic stabilization over a period of three years were retrospectively reviewed. At six and twelve month post-operatively, the disease specific outcome measure, ASES, and relative Constant, showed significant changes in quality of life. There was no loss of external rotation at 0° and 90° of external rotation at one year post-operatively. The purpose of this study was firstly to assess the effectiveness of capsular plication, in the treatment of instability related pathology, using subjective outcome measures and secondly to look specifically at the effect of this procedure on range of motion. Suture capsular plication has been advocated as a less invasive technique to reduce symptomatic capsular laxity with less morbidity than traditional open techniques. There is, however, little evidence that this procedure has the same clinical effectiveness as open capsular shift procedures. Arthroscopic capsular plication improves quality of life (QOL) in patients suffering from shoulder instability without significantly restricting external rotation. Data of consecutive patients who required arthroscopic stabilization over a period of three years were retrospectively reviewed. Three outcome measures were used; one disease-specific and two shoulder specific measures:. the American Shoulder & Elbow Surgeons standardized shoulder assessment form and,. the Constant-Murley. Analysis involved a paired T test between the means of each outcome measure pre and post-surgery. Twenty-five patients had complete pre-op and six- month post-op data. Twenty subjects had complete pre-op and twelve- month post-op data. At six month post-operatively, the disease specific outcome, relative Constant, and ASES showed significant improvement in QOL scores (P< 0.000, 0.006, and, 0.004 respectively). At twelve- month post surgery, change in all measures remained statistically significant. There was no loss of range of motion in external rotation at 0° or 90° of abduction between initial and follow up assessments in the clinic. Funding: This study was supported by the research funds of the Orthopedic & Arthritic Institute, Sunnybrook and Women’s College Health Sciences Centre

We undertook the current study to analyze the factors involved with failed previous stabilization surgery for patients with anterior or anteroinferior glenohumeral instability. Between 1997 and 2003 we treated seventy-four patients with traumatic unidirectional instability. The average age was thirty-two and the average follow up was fifty-eight months. There were sixteen females and fifty-eight males. All patients underwent a primary diagnostic arthroscopy followed by arthroscopic stabilization in forty-seven and open stabilization in twenty-seven cases. Ten had a recurrence of instability. Of these two had significant trauma. Of the remaining, six were in the arthroscopic group and two in the open procedure group. Analyze the factors involved with failed previous stabilization surgery for patients with anterior or anteroinferior glenohumeral instability. Between 1997 and 2003 we treated seventy-four patients with traumatic unidirectional instability. The average age was thirty-two years (range nineteen to forty-seven). There were sixteen females and fifty-eight males. The average follow up was fifty-eight months (range seven to eighty-three). All patients underwent a primary diagnostic arthroscopy followed by arthroscopic stabilization in forty-seven and open stabilization in twenty-seven cases. The arthroscopic procedure involved two Suretac II labral reattachment and capsular shrinkage using electrocautery. The open procedure involved a Bristow/Latarjet procedure using a delto-pectoral approach and reattachment of coracoid process using a single malleolar screw. Ten patients had a recurrence of instability. Of these two had significant trauma, one each group. Of the remaining eight, six were in the arthroscopic group and two in the open procedure group. In the arthroscopic recurrence group, three had a large Hill Sach’s lesion and one a large Bankart Lesion. In the open procedure group, both had a large Hill Sach’s and Bankart’s lesion. This gave a recurrence rate of 12.7% in the arthroscopic group and 7.4% in the open group. A large Hill-Sach lesion > 2mm is a contra-indication to arthroscopic repair and the optimum stabilisation procedure is an open repair (Bristow/Laterjet). Without a significant Hill-Sach’s lesion an arthroscopic Suretac II labral re-attachment is an effective way of achieving stability. Those who have a large Hill-Sach and significant Bankart’s lesion may need a combination of Bankart’s repair plus an extra-articular procedure like a Bristow/Laterjet procedure

Purpose of the study: This retrospective study was conducted to analyze the mid-term effect of damage to the anteroinferior rim of the glenoid cavity in failed arthroscopic stabilization of the shoulder. Material and methods: From 1999 to 2001, 54 patients underwent surgery performed by the same operator. Full data were available for analysis for 46 patients. Mean age was 28 years and mean follow-up four years. A pre-operative scan was available for all patients to analyze the bone lesions. The same technique was used for all shoulders: three or four suture points using resorbable thread attached to a Panolok anchor with a north-south retension effect. The Duplay score was noted at last follow-up. Experimental work by Gerber, which demonstrated that the anti-dislocation resistance decreased as a function of the ratio (x) between the length of the anteroinferior glenoid defect and its maximal antero-posterior diameter, was used to assess resistance to dislocation. This resistance decreased 30% when x=0.5 and 50% when x=0.75. Results: The Duplay score at 47 months was 83.3. The rate of recurrence was 13% (n=6). Age, sex, and number of episodes of instability had little effect on outcome. The rate of recurrence (38%) in patients with a significant damage (x> 0.5) was much higher than in patients with minimal damage (x< 0.5) (2.2%). The difference was statistically significant (p< 0.01). The Duplay score (63.8 points) in patients with significant damage (x> 0.5) was significantly lower (p=0.01) than in patients (91 points) with minimal damage (x< 0.05). Discussion: The presence of bony lesions of the anterior glenoid rim appears to be one of the most important prognostic factors of recurrence. Considering the high frequency of these lesions in our series (54%), this element deserves careful analysis which would require computed tomographic reconstruction in the sagittal plane to obtain a precise assessment of the loss of articular surface. The statistical analysis demonstrated that patients with important loss of articular surface (x> 0.5) had a significantly higher risk of recurrent instability (p< 0.01). Conclusion: Arthroscopic stabilization of the shoulder joint yields results similar to those obtained with more conventional techniques. Our study confirmed this notion showing a rate of recurrence of 13% which could be reduced to less than 3% with careful preoperative assessment of glenoid articular surface loss on the preoperative scan

Objective. The purpose of this study was to compare outcome of arthroscopic stabilization of the shoulder using knotted and knotless anchors and two rehabilitation regimes. Method. This is a retrospective study of 58 patients who underwent arthroscopic shoulder stabilization over a five year period (2005–2009). There were two groups of patients. In group A stabilization was performed using absorbable anchors with a knotted technique using No.1 PDS suture. This group had an early mobilization regime. In group B a knotless anchor technique was used with PEEK anchors and nonabsorbable sutures. The patients in this group were immobilised in a sling for 6 weeks. There were a total of 58 patients, 37 in group A and 21 in group B. The mean age of patients undergoing the procedure was 35.7. There were a total of 23 males and 14 females in group A and 15 males and 6 females in group B. The number of dislocations prior to surgery ranged from 0 to multiple times a day. Patients had a mean follow up of 5 years (three to seven years - 2005 to 2009) and subjective shoulder function was evaluated using Oxford instability score and self-assessment questionnaire. Results. The Shoulder scores showed improvement in both groups and there were no significant differences in redislocation rates and patient satisfaction scores with 20 patients in group A and 11 patients in group B going back to sporting activities. Conclusion. Since there were no significant differences in shoulder scores in both groups our conclusion was that secure fixation was what mattered irrespective of the type of anchor used or the physiotherapy regimen

Aim: In this work we report mild term clinical results of a consecutive series of 104 arthroscopic stabilizations for traumatic or non traumatic anterior-inferior shoulder instability treated using for the stabilization always poly- L-lactic acid Bioknotless anchors (Mitek, Nor-wood, Mass., USA) and surgical technique described by Thal, and the clinical results of 74 patients reviwed. Methods: From 2000 to 2005, 104 consecutive patients underwent arthroscopic capsuloplasty repair using bio-knotless anchors.14 cases were performed SLAP II by original reconstruction with bioknotless anchors. All the patient underwent preoperative a clinical examination and valued Constant and Rowe score, and subjected a X-Ray study and MRI o TC\ arthroTC scan. All patients were operated by same surgical team. 74 patients (55 male, 19 female) were reviewed with at least 20 months follow-up (20 – 60 months). Average age was 25 (18–45). Results: Recurrence rate for instability was 6,7% (5/74). All recurrence, was associated with a large Hill-Sachs lesion and poor quality of capsular tissue. Overall, the results were good or excellent in 91,5% using the Rowe score. At X-ray study 28 cases have not show Samilson’s arthrosis, in 4 (14,7%) cases we observed geoid on glenoid side. Conclusion: The improvement in the results, to use absorbable anchor, obtained could be related to the development of materials and in particular at use of PLLA (poly-L- lactic polymer) and PGACP (polygluconate co-polimer), at surgical techniques carried out, to the different fixation methods and not least to the different inclusion criteria used for the selection of patients. Arthroscopic capsulolabral stabilization for the treatment of recurrent anterior shoulder instability repair using absorbable Knotless offers reliable results with respect to failure rate, range of motion, and shoulder function also at 4 years follow-up. The percentage of rate for instability is 6,7% and is in accord with the International Literature on non resorbable anchors

The goal for arthroscopic stabilization of anterior glenohumeral instability is to achieve an outcome equivalent to or better than open procedures. A number of arthroscopic procedures have been advocated to reestablish continuity of the inferior glenohumeral ligament complex (IGHLC) with the glenoid. Implantable suture anchors were developed to avoid the problems associated with arthroscopic staple capsulorrhaphy like iatrogenic injury of the glenoid or humeral surface, loosening and migration of the staple. The preferred techniques are easy implantable suture anchors made of titanium (Fastak). Our experience suggests, that if proper selection criteria are employed, normal patients and overhead-athletes may benefit from the advantages of an arthroscopic repair without accepting an increased risk for recurrence. From 4/96 to 10/00 we performed a prospective analysis of 242 shoulders, who underwent arthroscopic shoulder stabilization with FASTak-(n = 159) Panalok-(n = 26) and Sure-tac suture anchors (n = 57) in our clinic. The patients were re-examined with a follow-up of at least 12 months. The best results were in the FASTak-group. After 2 years 4.7% suffered a redislocation. 28.6% (2 patients) needed a revision, but none of the shoulders required a second open stabilization. The reason for redislocation or sub-luxation were traumatic injuries, participating in contact sports or in one case a generalized ligamentous laxity. The Rowe score was 83.1 ± 20.9 points. There was a high satisfaction of the patients with the operative result and 60.9% could go back to their pre-op sports level. At 24-months follow-up this study demonstrates good results of arthroscopic shoulder stabilisation with FASTak suture anchors. In combination with the LACS-Procedure or the Electro thermally assisted capsular shift (ETACS) not only the capsular detachment but also the capsular redundancy may be adressed and a lower failure rate can be expected

Purpose. Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability. Methods. We studied 122 patients, 101 male and 21 female patients with an average age of 28 (17 to 47 years old), undergoing primary arthroscopic stabilization for anterior instability between 2004 and 2008. The pathoanatomy of the anterior capsule-labral complex was documented. Based on our previous MRI arthrography experience we were able to categorize the lesions seen arthroscopically in three subgroups: the Bankart lesion, the Perthes lesion and the ALPSA (anterior periosteal sleeve avulsion). Results. Arthroscopic findings confirmed the presence of the triad of essential lesion. The relative proportions of the subcategories of the essential lesion were as follows: 71 (58%) Bankart lesions, 18 (15%) Perthes lesions and 33 (27%) ALPSA lesions. Each lesion has unique characteristics, which affect treatment and prognosis. We describe the three types of labral injury and the surgical implications. Conclusion. The literature on the essential anterior capsular-labral lesion has historically focused on the Bankart lesion. There are in fact three variants of the essential lesion: the triad of Bankart, ALPSA and Perthes. This study evaluates these lesions and quantifies their relative proportions in a large series. We believe that awareness of this sub classification of the essential lesion is important as it affects the management of this condition

The assessment of the long –term outcome (5 years) of patients treated with arthroscopic stabilization for acute traumatic patellar dislocation. From September 2004 until April 2009 we treated 29 patients (25 male, 4 female) with a median age of 18 years (range 14–23 years), two of them had suffered from traumatic dislocation of the patella of the other knee joint in the past. The median range from injury to our surgical intervention was 20 days (7–29 days). The return in sporting activities, the possible redislocation or joint instability and the subjective assessment of the symptoms of the patients, were evaluated in a 5 years follow-up. After 5 years, 23 patients (20 males, 3 females), were re-evaluated. After the arthroscopic medial retinacular repair all the patients return to sporting activities. All the patients presented chondral lesions at the medial facet of the patella and to the lateral femoral condyle and hemarthrosis too. The functional outcomes were evaluated with Kujala scoring scale, with Visual analog scale and Tenger scale the range of results was good. The acute arthroscopic repair of the medial retinacular ligaments, protects the patient from redislocation or subluxation, allows the evaluation and stabilisation of the chondral lesions, the removal of free chondral bodies, as well as the evaluation of the possible damage to the menisci or ACL, PCL ligaments. All the patients returned to normal sporting activity avoiding further injury, or the development of osteoarthritis of the knee joint

This paper aims to evaluate the Remplissage arthroscopic technique as described by Eugene Wolf used in patients with traumatic shoulder instability that present glenoid bone loss and Hill Sachs defects. In our study 28 patients (5 women and 23 men) with mean age of 31 yrs underwent arthroscopic stabilization of the shoulder by the same surgeon during 2007–2008 period. All patients presented Hill Sachs lesion, 11 of them had medium or large glenoid bone loss, 10 had an “inverted pear” glenoid shape, 4 had been revised for stabilization in the same shoulder and 14 presented joint hypermobility. Mean age for the age of 1st dislocation was 20,1 yrs and our follow up ranged from 5–28 months (Mean=18). The recurrence of instability and the functional outcome were evaluated pre-op and postop with the Rowe Zarins Score. The post op rehabilitation was performed by a specialist. None of the patients presented recurrent instability. The Rowe Zarins Score raised from a mean pre op score of 23,33 (15–60) to a mean post op score of 97,11 (75–100) (p< 0.05). All the patients that were into sports activities before the presentation of shoulder instability began training again and our post op evaluation of the shoulder’s ROM showed a decrease in the external rotation from 0°–15°. The infraspinatus tenodesis and posterior capsulodesis in patients with humeral bone loss seems to offer so far excellent post op results despite the slight decrease in the external rotation of the shoulder

The expansion of arthroscopic treatment to serious and catastrophic injuries to the weightlifters of the Hellenic National Weightlifting Team. The evaluation of the results of this specific arthroscopic treatment. 45 athletes (36 male, 9 female) with shoulder injuries 2000–2009. 15 yrs – 35 yrs, average: 27 yrs. One 3-times Golden Olympic. One Bronze medalist, Two Silver Olympic, Three Olympic winners, Five World championsetc. Clinical examination and musculoskeletal ultrasound. Plain X-rays. E.M.G, M.R.I.-arthrography, 3DC/T when that was required. Strength measurement with Nottingham McMecin Myometer for ipsi-contro lateral shoulder. Full ROM was necessary for the operated shoulder before starting exercise for a competition. All 48 underwent arthroscopic treatment (3 mini-open). Arthroscopic stabilization using absorbable or non anchors. 45 athletes, 48 shoulders operated,(3 bilat-erally).36 RC tears, 6 bony-bankart, 2 posterior and 28 anterior labrum detachment, 3 avulsion osteochondral fractures, 2 AMBRII, 4 deranged LH of biceps, 4 underwent SSN release. All patient returned at same sport level except one with AMBRII and cervical spine pathology. Rehabilitation time for basic weightlifting exercise was 3.5 months and for competition level was 4,5 -6 months. The shoulder demands during the snatch, clean and jerk of the weightlifters provoke often shoulder injuries. The arthroscopic surgery gives thorough and broad knowledge of their shoulder injuries. The minimal detachment, less postoperative joint stiffness and decreased shoulder pain are encouraging factors for the arthroscopic treatment. Additionally, the returning time for training and competition combining with a proper rehabilitation seems to be less than open surgery

Introduction: Since the first repair of coracoclavicular ligament complex in 1886 there have been more than sixty operative procedures described in the literature. Open methods of reduction and stabilization of AC joint are associated with increased morbidity and violation to the surrounding soft tissue and result in less cosmetic scar and possibly a further surgery to remove the hardware. We propose an arthroscopic technique using Tightrope (Arthrex) to reduce and stabilize the joint with low morbidity. Materials and Methods: We reviewed 26 (21 male, 5 female) consecutive patient’s (notes, radiographs and Oxford shoulder score) who underwent arthroscopic stabilization of AC joint. The average age was 33 years (min.22, max.53). The average period from injury to surgery was nine days. The primary indication for surgery was grade IV to VI injuries and grade III injuries in upper extremity athletes and workers with the need for overhead activities. Patient’s satisfaction and functional improvement were observed. Results: Short-term preliminary results are encouraging and show an excellent functional outcome without significant residual pain. We had four radiological recurrences of the deformity, two of which were completely asymptomatic, one associated with painless clicking and one requested revision surgery (same technique) to improve cosmesis. There were no infections or neurovascular injury in this series. Conclusion: This method of surgically stabilizing the AC joint is minimally invasive, done as a day case and yielding satisfactory results. Among the advantages of the technique are that it does not require specific expensive instrumentation and offers the possibility of visualizing the glenohumeral joint for associated lesions. However, there is a learning curve and experience with arthroscopic procedures is essential

We review our results of arthroscopic capsular plication in patients with ligamentous laxity that had developed symptoms of instability after a traumatic event. Between 2004 and 2005, 115 patients with traumatic injury to their shoulder underwent arthroscopic stabilization and repair of their shoulder. Of these, twelve patients had ligamentous laxity and had their capsule plicated as a means to stabilize their shoulder. All had failed three months of biofeedback physiotherapy. The mean age of the patients was 29 years (range 17 to 46). The average time interval between date of injury and surgery was 21 months. They were reviewed retrospectively with a minimum follow up of 2 yeats. The functional outcome was assessed by Constant scoring system and Rowe score. At arthroscopy, capsular plication with a south to north direction would be fashioned with #1 PDS sutures. In multidirectional instability, the inferior and posterior capsule would be plicated as well. If the labrum was torn, this and the capsule would be repaired together. The repair was reinforced with rotator interval closure. Postoperatively the arm was rested in sling for four weeks followed by gradual mobilization. At a minimum follow up of two years, all twelve shoulders became stable. There were 8 excellent, 3 good and one fair result as graded by modified Rowe score. Re-arthroscopy in the patient with fair result showed good capsular repair and presence of scar tissue in the subacromial space. All patients rated their shoulder as normal. Ten patients returned to their preinjury level of competitive sport. Two patients returned to sport but at a lower level voluntarily. Arthroscopic capsular plication appears to be a safe and reliable technique in stabilizing shoulders in patients with ligamentous laxity. This form of repair should be offered to this group of patients if treatment with biofeedback physiotherapy fails

Aims: To discover how the management of traumatic anterior shoulder dislocation in the young patient (17–25) has changed, if at all, over the past six years. Methods: The same postal questionnaire was used in 2003 and 2009, sent out to 164 members of British Elbow and Shoulder Society. Questions were asked about the initial reduction, investigation undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programme instigated in first-time and recurrent traumatic dislocators. Summary of Results: The response rate were 92% (n=151) – 2009, 83% (n=131) – 2003 The most likely management of a young traumatic shoulder dislocation in the UK would be:. Reduction under sedation in A& E by the A& E doctor (80% of respondents). Apart from X-ray, no investigations are performed (80%). Immobilisation for 3 weeks, followed by physiotherapy (82%). 68 % of respondents would consider stabilisation surgery for first time dislocators (especially professional sportsmen) compared to 35% in 2003. Out of them nearly 90% would perform an arthroscopic stabilization vs. 57.5% in 2003. For recurrent dislocators:. 75% would consider stabilisation after a second dislocation. 85% would investigate prior to surgery, choice of investigation being MR arthrogram (52%), compared to 50% in 2003 that would chose to investigate. 77% would choose to perform arthroscopic stabilisation compared to 18% in 2003, the commonest procedure being arthroscopic Bankart repair using biodegradable bone anchors (62% compared to 27% in 2003). Following surgery, immobilisation would be for 3 weeks, full range of motion at 1 to 2 months and return to contact sports at 6 to 12 months. Conclusions: There has been a remarkable change in practice compared to the previous survey. A significant proportion of Orthopaedic Surgeons would consider stabilisation in young first time dislocators instead of conservative management. Arthroscopic stabilisation is now the preferred technique compared to open stabilisation whenever possible. Surgeons are using more investigations prior to listing the patient for surgery namely the MR arthrogram. There is also an increased use of bio-degradable anchors as compared to metallic bone anchors in 2003

Recurrence represents the leading complication of arthroscopic anterior shoulder stabilization. Even with modern suture anchor techniques, a recurrence rate of between 5 to 20% persists; emphasizing that arthroscopic Bankart repair cannot apply to all patients and selection must be done. Numerous prognostic factors have already been reported, but strict observance would eliminate almost all patients from arthroscopic Bankart repair. We hypothesised that clinical and radiological risk factors could be present and identifiable in the normal outpatient visit, and they could be integrated into a severity score. A case-control study was undertaken, comparing patients identified as failures after arthroscopic Bankart repair (i.e, recurrent instability) with those who had a successful result (i.e., no recurrence). Recurrence was defined as any new episode of dislocation or any subjective complains of subluxation. During a four-year period one hundred and thirty-one consecutive patients with recurrent anterior shoulder instability, with or without shoulder hyperlaxity, were operated by the senior shoulder surgeon with an arthroscopic suture anchor technique and followed for a minimum of two years. Patients were excluded if concomitant pathology, including multidirectional instability, were present. Bony lesions were not excluded. A complete pre and postoperative questionnaire, physical exam, and anteroposterior x-ray were recorded. Mean follow-up was 31.2 months (range, twenty-four to fifty-two months). Nineteen patients had a recurrent anterior instability (14.5%). Preoperative evaluation demonstrated that age below twenty years old, involvement in athletic competition, participation in contact or forced-overhead sports, presence of shoulder hyperlaxity, Hill-Sachs lesion visible on AP external X-ray, and loss of inferior glenoid sclerotic contour on AP x-ray were all factors related to increased recurrence. These factors were integrated in an Instability Severity Index Score and tested retrospectively on the same population. Patients with a score of six or less had a recurrence risk of 10% and those over six had a recurrence risk of 70% (p< 0.001). This study proved that a simple scoring system based on factors of a preoperative questionnaire, physical exam, and anteroposterior x-ray can help the surgeon to select patients who would benefit from arthroscopic stabilization with suture anchors and those for whom an open surgery, like the Latarjet procedure, is a better option