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.

Hip arthroscopy has gradually evolved over the past two decades. Recently hip arthroscopy has an increasing role in diagnosis and treatment for specific intra articular and extra articular hip injuries and especially for soft tissue injuries.

February 2002 – May 2009

18 athletes

Mean age: 32 y.o. (19–39 y.o.)

Undiagnosed hip pain, Osteoarthritis, Labral pathology, Loose bodies, Osteochondral defects, Sepsis, Liga-mentum Teres, Trauma, Synovitis

Symptoms: Deep dull ache pain during hip flexion and external or internal rotation. Decreased R.O.M.

12/18 Cam sign + (positive), 11/18 Pincher sign + (positive), 14/18 Impingement syndrome in adduction and in flexion.

Instrumentation and Equipment: 30°, 70°, 4,5mm arthroscope, High flow rate mechanical pump, 15 gauge 6" cardiac needle, Convex full radius chondroplasty blades, Special electrocautery (Philippon), Distraction apparatus, Mechanical water pump unit, Image intensifier

Surgery: Standard orthopaedic traction table, Supine position, Hip is extended and abducted 25°

Detachment of the labrum, 2/18 erosion of the articular cartilage of the acetabulum and drilling of the bare area, 12/18 Cam sign excision

The athletes with symptoms of an internal hip pain and impingement signs after a clinical exam of their hip will get a benefit from an arthroscopic procedure for treating any existing cetabulo-femoral pathology, especially for the athletes with femoraloacetabular impingement syndrome (FAI).

The early diagnosis of the suprascapular nerve (SSN) entrapment in overhead athletes with simultaneous shoulder injuries and its arthroscopic release plays an important role for their appropriate treatment and recovery. SSN release at suprascapular and spinoglenoid notches, seems very helpful for increasing their performance.

21 Elite overhead athletes were treated from Jan 2005–May 2009. From 16 to 34 years old, mean 26 years, 4 Javelin throwers (Olympic and National level thrower), 4 Weightlifters (International level), 8 Volleyball Players, 3 Kick Boxer, 2 Water Polo Players.

Extreme ROM of arm creates large torques about the shoulder cycle of repetitive microtrauma to the SSN, Direct trauma: fracture, dislocation, blunt trauma traction injury, Sling effect with hyper-abduction injury at the SS Notch, Correlation ROM with SSN entrapment in volley ball players, Eccentric contraction of the ISP (spinoglenoid notch), Internal impingement, Rotator cuff tears, Biceps lesions, Instability, SLAP lesion, Bankart lesion, Mainly infraspinatus muscle atrophy. X-rays, Nerve conduction studies, EMG studies, MRI

All of them had complete pain relief, especially at the posterior shoulder, regained full ROM of the operated shoulder, 19 fully recovered at the pre-injury level, 2 at the postoperative phase, Muscle atrophy improved

Advanced SSN entrapment provoke significant muscle wasting, often irreversible. This underscores the importance of a quick and accurate diagnosis to appropriate intervention. The overhead athletes with increased ROM of their shoulder predispose in SSN entrapment and shoulder injuries and vice-versa. An arthroscopic shoulder procedure for repairing the glenohumeral pathology with a simultaneous arthroscopic SSN release seems to be the appropriate treatment regarding to our resu

Purpose: To present the results of the tibial tuberosity osteotomy as part of the surgical approach for total knee replacement. Material and Methods: Tibial tuberosity osteotomy was performed during TKR for better exposure in 19 knees corresponding to 19m patients (9 male, 10 female), with average age 76 years (68–80). Four of the procedures were revisions. Fifteen were primary TKR, ten of which had been subjected to high tibial osteotomy previously. The rest þve patients had excessive valgus deformity (over 20 degrees), and they were approached through a lateral parapatelar incision. In two cases screws only were used to stabilize the osteotomised tubercle, and wire loops in the rest of them. Patients were instructed for partial weight bearing for six weeks postoperatively. Results: All osteotomies united in less than four months. In three cases (including the two with only screw þxation), proximal migration of the tuberosity was noted, but less than 2cm. No skin problems were encountered. Three patients,(22%), complained for anterior knee pain. Preoperative mean range of movement was 75 degrees, and improved to 90 degrees postoperatively. Average blood loss was 850 cc. Conclusions: The tibial tuberosity osteotomy offers excellent exposure in the revision and difþcult primary TKR, but it lengthens the operative time, and the blood loss is higher.

Purpose: To present the results of the use of shoulder prosthesis in multifragmented displaced humeral head fractures. Material-methods: 19 patients with comminuted and severely displaced fractures of the upper humeral epiphysis were treated with shoulder hemiar-throplasty. Their age varied from40 to 81 years (av:71). Seven patients had severely displaced four-part fracture; eight patients had four- part fracture-dislocation and four patients, three-part fracture dislocation with extended damage to humeral head articular surface. In 16 cases the arthroplasty was performed within 10 days, and in three, 6 weeks or more after the injury. The glenoid was not replaced in any of the cases. Results: The follow-up period was 16–84 months (av: 51). None of the patients had been reoperated, and none of the prosthesis was regarded ÒlooseÒ. The clinical assessment was done using the Constant-Murley scale. The score varied from 50 to 89 points, (av: 79). The average score for ÒpainÒ was 13(max 15) and for ÒmobilityÒ29(max 40). Average abduction reached 100 degrees and forward ßexion 110 degrees. At the last examination, 15 out of the 19 patients had returned to the previous social and occupational activities. Conclusions: The shoulder replacement offers satisfactory results in cases with comminuted and badly displaced fractures, but is a technically demanding procedure, and the time interval between injury and operation, strongly affects the result. Long lasting physiotherapy, patient compliance and cooperation are necessary for a satisfactory outcome.