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.

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.

Aim: Traumatic shoulder dislocation in patients older than 50 years is an unusual injury with specific anatomic lesions and different treatment considerations than these encountered in younger patients. We present our experience in treating such kind of injuries.

Patients-methods: Between January December 2002 9 patients-4 males, 5 females – with ages ranging between 50–72 years (mean age 64 y.), have been treated in our department suffering from first traumatic shoulder dislocation. Rehabilitation program and overall recovery progress was observed in an outpatient basis while postoperative outcome was evaluated using ASES and UCLA rating scores.

Results: In 4 patients rotator cuff tear was found and reconstructed by suturing the lesion. One (1) of these patients, who had a coexisted bony Bankart lesion, presented 1 ½ month postoperative with recurrence of dislocation. Bony Bankart lesion prevented reduction in 2 patients and was reconstructed using open stabilization in one and arthroscopic to the other. HAGL lesion was detected in another patient and treated with open reduction and shoulder stabilization. Finally 2 patients with shoulder dislocation and coexisted greater tuberosity fracture were treated with closed reduction.

Conclusions: Ttraumatic shoulder dislocation in patients older than 50 years consists a distinct entity which if inadequately treated leaves the shoulder with severe functional impairment. Recurrent shoulder dislocation is an unusual complication in such patients but on the other hand rotator cuff tears and glenoid bony lesions are frequently encountered necessitating treatment. Postoperative patients should be examined in small intervals with a high degree of suspicion for the above mentioned coexisted lesions.