The middle third of quadriceps tendon is an autograft of sufficient size and strength and is stronger than the patellar tendon autograft with the same dimensions. We present the results from the use of a quadriceps autograft for the reconstruction of the chronically ACL deficient knee.

Between March 1999 and March 2000 we treated 36 patients with chronic ACL deficiency using a quadriceps tendon autograft, harvested from the middle third of the tendon with and without a patellar bone block.

The tendinous side of the graft was stabilized using the Mark II and Patella Soffix fixation systems (Surgicraft, UK). In the tibia the graft was passed through a tunnel and in the femur it was passed over the top. In those cases where the graft was harvested with a bone block, his was fixed to the tibia using interference screw fixation. The mean postoperative follow up was 21 months. The results have been evaluated using the IKDC, the Lysholm and the Tegner scales. According to the International Knee Documentation Committee rating system most of the patients had normal or nearly normal ratings. Knee laxity was evaluated using the arthrometers KT-2000 and Rolilmeter. There were no significant complications related to the harvesting site and there was no significant differences between the two groups regarding stability and function. MRI evaluation and second look arthroscopies in 7 patients revealed graft survival

The quadriceps tendon-patellar autograft is a reasonable alternative ACL reconstruction in primary and probably revision ACL reconstruction with minimal donor site morbidity and restoration of knee stability.

Purpose of this study is to examine the role of MRI arthrography in chronic cases of shoulder instability. Shoulder arthroscopy was elected as standard record of diagnosis.

Patients & Method: We evaluated 155 shoulder arthroscopies in 153 cases of recurrent shoulder instability from Sept 99 to Feb 03. Each patient suffered at least 2 true dislocations. Pre-op, we performed MRI scan in 82 of them while, 15 other cases were evaluated more invasively with MRI arthrography, with anterior portal infusion technique. Results were analyzed blindly from 2 radiologists with particular experience in MRI musculoskeletal cases and were compared to arthroscopic findings.

Results: Bankart lesion was diagnosed in all cases with MRI arthrography (sensitivity 100%), SLAP lesion had sensitivity 50% and specificity 100% while, rotator cuff pathology was diagnosed in 6 out of 7 cases. There were also 4 false positive cases in rotator cuff pathology. Sensitivity for superior and inferior gleno-humeral ligament was 100% and 94% respectively, without any true negative findings in both of them. Sensitivity and specificity for middle glenohumeral ligament was 89% and 60% respectively. In cases where we recognized loose anterior capsule pathology during arthroscopy, the radiologists were not able to detect these lesions from a functional aspect. Despite the fact, that all Hill Sachs lesions were identified through MRI arthrography it was also possible to be detected functionally.

Conclusions; MRI arthrography is a reliable tool in recurrent shoulder instability while is an invasive method because of the infusion material. Anterior glenohumeral instability is not always a Bankart lesion but gleno-humeral ligaments pathology too that, can easily be detected during arthroscopy which may be the therapeutic solution at the same time.

Aim: To describe the technique and the mid term results of anterior shoulder instability arthroscopic reconstruction.

Patients-methods: Between March and December 2000 29 patients-28 males with ages ranging between 19–29 years (mean age 23 y.) and 1 female 24 years old-underwent arthroroscopic stabilization of anterior shoulder instability. During the procedure the anterior-inferior part of the labrum was reattached to the glenoid using bioabsorbable and metallic suture anchors. In selected patients in which capsule plication after anchors’ insertion was insufficient additional capsular shrikange or/and rotators’ interval closure was also performed.

Results: Postoperatively patient evaluation took place using Rowe-Zarins scale. According to this score 22 patients (75,9%) had excellent or very good outcome. Three (3) patients (10,35%) were lost during follow up while 1 (3,45%) died. From the remaining 25 patients 2 had recurrence of the instability (6.9%) and in 1 patient (3,45%) a stiff shoulder was noticed and arthroscopically resolved. Finally a disengaged metallic suture anchor was noticed incidentally during routine radiographic examination in one patient (3,45%).The anchor was successfully removed under arthroscopic visualization without compromising the final outcome.

Conclusions: Arthroscopic reconstruction of anterior shoulder instability when precisely performed after correct patient selection is an effective technique achieving results comparable to those of traditional open procedures.

Aim: The description of technique and early results of arthroscopic rotator cuff tears (RCT) reconstruction.

Patients-Methods: Âetween 01/2001 and 02/2003 26 patients, ranging in age from 33–82 (mean age 61,5 y.) – 17 males, 9 females – with RCT underwent arthroscopic reconstruction including debridement, sub-acromial decompression and mobilization of the rotator cuff. The RCT was then repaired with the arm in neutral position using “side to side” suturing technique and rotator cuff anchors when needed. Postoperatively, rehabilitation program included initially passive, active kinisiotherapy while exercises under resistance were finally performed..

Results: All patients were evaluated using ASES and UCLA scores pre-and postoperatively. Pain relief postoperatively was noticed in almost all reconstructed patients. In order to indentify functional improvement range of motion and strength were seperately evaluated. Range of motion just as pain remission was notably improved in almost all patients while strength ameliorate most in patients with complete restoration of rotator cuff tear. The interval between reconstruction and full patients’ recovery ranged between 3 months – pat. < 60 years – to 6–8 months – pat. > 60 years.

Conclusions: Arthroscopic RCT reconstruction although a demanding technique achieves satisfactory early results—mainly regarding pain relief and range of motion improvement- comparable to those of open repair reducing also postoperative morbidity.

Purpose of this report is to present a surgeons group experience in shoulder arthroscopy step by step from a diagnostic status to a therapeutic one, in cases of recurrent instability, impingement syndrome and rotator cuff pathology. There is focus on technique tips, learning curve period, complications and solutions.

We evaluated 250 shoulder arthroscopies from May 99 to Apr.03. 155 cases of them were recurrent instability reconstructions in young patients (16–34 years old, ave.24,3) while the rest of them were rotator cuff pathology patients (22–69 years old ave.44,3). Lateral decubitus position was elected as the standard position in all cases. Patients were operated from a group of two surgeons each time. We analyzed parameters as, EUA, learning curve, technique tips concerning labrum mobilization, anchors and shuttle relay insertion and capsule plication. We describe the intra-op complications and the way out of them. There is also a detection where arthroscopic shoulder instability reconstruction was contraindicated and open technique was preferred.

Our experience in arthroscopic shoulder instability reconstruction and rotator cuff pathology showed that, is a minimally invasive technique. The learning curve period is high, better results can be anticipated when there is a surgical group and when there is a carefully elected sample of patients as it was in our cases.

Purpose: To present the technique and the results of simultaneous arthroscopic reconstruction of Bankart and SLAP lesions in patients with anterior shoulder instability.

Method: We performed shoulder arthroscopy in 95 patients aged 16–38 years (mean age:24,8) suffering anterior shoulder instability. Preoperative evaluation included clinical assessment, x-rays, MRI-arthrogram and examination under anaesthesia in comparison to the healthy shoulder. SLAP lesion was fixed using metallic suture anchors (FASTAK 2,4mm x 11,7 mm-Arthrex).The anchor was inserted in a 45° direction relative to the glenoid level. Bankart lesion was reconstructed using 2–3 bioabsorbable suture anchors (Panalok-Mitek J& J).The arthroscope was inserted through standard posterior, anterosuperior and anteroinferior portals while a posterolateral portal (portal of Whilrnington) was created for SLAP lesion repair. Patients’ average follow-up was 22 months (range, 18–30 months) and the results were evaluated using the ASES score.

Results: SLAP lesion was found in 13 patients: 6 pat.-type II (46%), 3 pat.-type I (23%), 2 pat.-type IV (15%), 1pat.-type III (7,6%) and 1 pat with a complex lesion. Of these patients 10 had also co-existed Bankart lesion. In 2 patients Hill-Sachs lesion was found while degenerative rotator cuff changes existed in 3 patients. While performing clinical evaluation anterior instability signs and symptoms were apparent with the patients complaining also for discomfort and crepitus during overhead activities. MRI preoperative sensitivity for SLAP lesion diagnosis was 59% while specificity and Positive predictive value were 90% and 76% respectively. Shoulder function and the overall ASES score improved from 44 pre-op. to 96 post-op.

Conclusion: Combined Bankart and SLAP lesions are uncommon in non-throwing patients with anterior instability. Arthroscopic suture anchors fixation ensures early and reliable rehabilitation. MRI arthrography study by a skeletal radiologist predicts to a high rate diagnosis.