Purpose: There are few reports in the literature detailing the arthroscopic treatment of multidirectional instability of the shoulder. The purpose of this study was to evaluate the results of arthroscopic methods in the treatment of athletes with symptomatic multidirectional instability of the shoulder.

Method: Forty patients (43 shoulders) with multidi-rectional instability of the shoulder were treated via arthrscopic means and were evaluated at a mean of 33.5 months post-operatively. The mean patient age was 19.1 years (range 14 to 39). There were 24 male patients and 16 female patients. Patients were evaluated with the ASES and WOSI scoring systems. Stability, strength, and range of motion were evaluated with patient-reported scales.

Results: The mean ASES score postoperatively was 91.4 out of 100. The mean WOSI post-operative percentage score was 91.1 out of 100. Ninety-one percent of patients had full or satisfactory range of motion, 98% had normal or slightly decreased strength, and 86% of patients were able to return to their sport with little or no limitation.

Conclusion: Arthroscopic methods can provide an effective treatment for symptomatic multidirectional instability in an athletic population.

Purpose: While several studies have reported improved pain control with use of femoral nerve blocks (FNB) following ACL reconstruction, there are few studies that have evaluated the effect of continuous perineural infusion on quadriceps activation and recovery of range of motion after ACL reconstruction. The purpose of this prospective randomized placebo-controlled clinical trial was to determine if the use of continuous infusion of levobupivacaine for pain control following ACL reconstruction had an adverse effect on postoperative quadriceps activation and recovery of ROM.

Method: Two-hundred-seventy patients underwent ACL reconstruction and were randomly assigned to one of three FNB groups (placebo bolus and infusion, active bolus with placebo infusion, or active bolus and continuous infusion). The patients’ ability to perform a SLR was assessed daily for the first four post-operative days. Range of motion of the knee was measured with a goniometer 1, 4, 8 and 12 weeks after surgery. Range of motion complications requiring arthroscopic debridement, manipulation under anesthesia, or application of a drop-out cast were recorded.

Results: There were no significant differences between groups in their ability to perform a SLR on postoperative day 1 through 4. There were also no differences between active and passive ROM values between groups at each follow-up period. There were 7 (3.2%) early ROM complications, but no detectable differences between groups.

Conclusion: Continuous perineural infusion of levobupivacaine (0.25% at 5mL/hr for 50 hours) following ACL reconstruction does not appear to negatively influence quadriceps activation as evidenced by the inability to perform a SLR or adversely affect recovery of range of motion in the early postoperative period after ACL reconstruction. Continuous perineural infusion can provide effective pain relief without adversely affecting post-operative recovery following ACL reconstruction.