Aims. There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Methods. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis. Results. A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity. Conclusion. This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group. Cite this article: Bone Jt Open 2022;3(10):815–825

Purpose: The purpose of our work was to report causes and results of treatment of anterior shoulder instability after implantation of a shoulder prosthesis. Material and methods: This retrospective multicentric study included 51 patients with prosthetic anterior instability: 42 patients after first-intention shoulder prosthesis and nine after prosthesis revision. There were 39 women (79%) and 12 men, mean age 67 years, who underwent total shoulder arthroplasty (n=29, 57%) or hemiarthro-plasty (n=22, 43%). Thirty-eight patients (75%) had prosthetic dislocation and 13 (25%) subluxation associated with pain an loss of anterior elevation. The initial prosthesis was implanted for degenerative disease (n=29), rheumatoid arthritis (n=7), or fracture (n=15). Anterior prosthetic instability occurred early in 23 shoulders (first six weeks) and lat in 28 shoulders (7 after trauma, 21 without trauma). Conservative treatment by reduction-immobilisation was performed in 16 cases and prosthetic revision in 35. The patients were reviewed radiographically at mean 41 months follow-up (range 24–62). Results: Subscapular tear or incompetence was the main cause of prosthetic anterior instability, observed in 87% of the cases. Technical errors concerning the prosthesis were also observed: oversized head, malrotation of the prosthesis. Associated complications were frequent: glenoid loosening (24%), polyethylene dissociation from the metal glenoid implant (10%), infection (10%), humeral fracture (4%). The final Constant score was 54 points and 55% of the patients were disappointed or dissatisfied. None of the shoulders were stable after consevative treatment. The prosthetic revision provided disappointing results with 51% recurrent anterior instability. Discussion: Anterior instability of shoulder prostheses is a serious complication which responds poorly to treatment. Loosening of the subscapular suture is the main cause

Purpose of the study: The purpose of this study was to report the clinical and radiographic outcomes a minimum five years after Latarjet-Patte treatment for recurrent traumatic anterior instability of the shoulder in rugby players. It was hypothesised that the Latarjet-Patte procedure fulfils the needs for shoulder stability in rugby players with anterior instability. Material and methods: Thirty-four players (37 shoulders) were included. Mean age was 23.4 years (17–33). A bone lesion of the glenoid was noted in 73% of the shoulders, a humeral defect in 68%. Results: Mean follow-up was 144 months (range 68–237). There was no recurrence (dislocation or subluxation). Apprehension persisted in five patients (14%). Sixty-five percent of the patients resumed playing rugby. Only one patient interrupted his sports activities because of the operated shoulder. The Walch-Duplay and Rowe scores were 86 and 93 points on average. The satisfaction rate was 94%. The block healed in 89% of shoulders (3 fractures, 1 nonunion). Twenty-six shoulders (70%) were free of degenerative disease, 11 shoulders (30%) presented stage 1 lesions. Discussion: In rugby players, anterior instability exhibits characteristic bone lesions of the humerus and glenoid which can be identified as risk factors for recurrent instability. The Latarjet-Patte procedure provides a stable shoulder allowing resumption of rugby player for most patients with no long-term degradation of the shoulder joint. These results are in favour of our strategy to propose the coracoids block systematically for recurrent anterior instability in rugby players

The bare area of the humeral head is limited in front by the cartilage and backwards by the insertion of the Infra Spinatus tendon. There are few references in the current literature. The aim of this work was to precise the anatomic description of the bare area and to compare the size of this area in patients with anterior shoulder instability and patients without anterior shoulder instability. Material and method. We have proceeded first to an anatomic study to precise the limit of the bare area. The second part of this study was a retrospective and prospective comparative arthro CT-scan study in two groups of patients. The first group (group 1) had 48 patients, going to have anterior instability surgery. The second group (group 2) had 38 patients, without shoulder instability. Mean age was respectively 28.2 years (range: 19–48) in group 1; and 39.3 years (16–69) in group 2. The size of the bare area was measured on the axial injected CT cut passing by the larger diameter of the humeral head, The size of the bare area was definite by the angle between the line connecting the centre of the head to the posterior limit of the cartilage and the line connecting the centre of the head to the anterior point of the Infra Spinatus tendon. The reproducibility of the measure has been evaluated by a Bland and Altman test and an intra class correlation test. The measures were realised by two independent surgeons in a blind manner. The results where compared by a Student test with a threshold at 5%. Results. In the anatomic part of this study, the average angle of the bare area was 32.7° equal to 13.7mm wide. Mean intraobserver variability was 4° (range: 0 to 20°) (NS) and mean interobserver variability was 4° also (range: 0 to 20°) (NS). Mean size of the bare area was 49.6° eaqual to 19.8mm wide [range 25° to 70°] in group 1 and 33.2° equal to 13.5mm wide [range 21° to 60°] in group 2 (p< 0,05). Discussion. Our measures were reproducible. This study confirms our hypothesis: the bare area is significantly larger in shoulders suffering of anterior instability, but we cannot yet tell if this result is a consequence or a risk factor of anterior shoulder instability

Purpose of the study: Several series have been reported on arthroscopic treatment of anterior instability. Few authors have focused on patient outcome after recurrent instability following arthroscopic stabilisation. Did these patients undergo revision surgery? What proportion? What were the results of secondary surgical coracoids block?. Material and methods: This was a retrospective analysis of 53 failures after arthroscopic stabilisation collected among a cohort of 182 patients who underwent surgery in our institution between 1988 and 2006. At last follow-up, shoulder function was noted using the Walch-Duplay score. The degree of joint degenerative disease was noted on the radiographs using the Samilson classification. Results: Mean time to recurrence after arthroscopic stabilisation was 21 months (range 3–114). Patients were reviewed at mean 68 months. Twenty-four patients (45%° had not had revision surgery: 17 (32%) had declined a new operation and 7 (13%) had a unique episode of instability. Twenty-nine patients (55%) had revision surgery: 27 underwent an open procedure in our institution for a coracoids block. The revision was performed in another institution for two patients who were excluded from the analysis. Mean time between the two operations was 29 months. At last follow-up, 89% of the reoperated patients were satisfied. The mean Walch-Duplay score was 83.6/100 (activity=18.5; stability=15.9; pain=23.9; mobility=24.2). The Duplay score was 100 for 48% of the reoperated patients; 41% had persistent apprehension. Three patients (11%) developed recurrent dislocation at a mean 23 months (19–29). Among the 53 patients included in the study, 26% had moderate osteoarthritic lesions (Samilson 1 or 2). The reoperated patients were free of such lesions. Hyperlaxity, age, and sport practiced did not have any impact on surgical revision. Discussion: In this overall series of 53 patients, 20 (37%) retained an unstable shoulder. Among them, 17 had declined new surgery. Eleven percent of the reoperated patients developed subsequent recurrence. This rate is higher than after first-intention blocks. Published series of arthroscopic revisions reported a higher recurrence rate (Kim, Arthroscopy 2002: 21 % recurrence; Neri, JSES 2007: 27 % recurrence). Conclusion: The Latarjet block is the treatment of choice after failure of arthroscopic stabilisation, despite a high recurrence rate

We have developed an apparatus to measure the anteroposterior stability of the knee to forces of up to 250 N, applied at 20 degrees of flexion. We measured anterior laxity at 200 N, anterior stiffness at 50 N and total laxity at +/- 200 N. A study of cadaveric knees revealed that the soft tissues surrounding the bones had a significant influence on the force-displacement curve, and emphasised that differences between injured and normal pairs of knees are much more important than the absolute values of the parameters. In 61 normal volunteers we found no significant left to right differences in anterior laxity at 200 N and anterior stiffness at 50 N. In 92 patients with unilateral anterior cruciate deficiency there were significant differences (p less than 0.0005) in anterior laxity, anterior stiffness and total laxity, the injured-normal differences averaging 6.7 mm, 1.3 N/mm, and 8.1 mm respectively.

We studied retrospectively a consecutive series of 547 shoulders in 529 patients undergoing operation for instability. In 41, the cause of instability was considered to be lateral avulsion of the capsule, including the inferior glenohumeral ligament, from the neck of the humerus, the HAGL lesion. In 35, the lesion was found at first exploration, whereas in six it was noted at revision of a previous failed procedure. In both groups, the patients were older on average than those with instability from other causes. Of the primary cases, in 33 (94.3%) the cause of the first dislocation was a violent injury; six (17.4%) had evidence of damage to the rotator cuff and/or the subscapularis. Only four (11.4%) had a Bankart lesion. In patients undergoing a primary operation in whom the cause of the first dislocation was a violent injury, who did not have a Bankart lesion and had no suggestion of multidirectional laxity, the incidence of HAGL was 39%.

Acute Hill-Sachs (HS) reduction represents a potential alternative method to remplissage for the treatment of an engaging HS lesion. The purpose of this study is to biomechanically compare the stabilising effects of a acute HS reduction technique and remplissage in a complex instability model.

This was a comparative cadaveric study of 6 shoulders. For the acute HS lesion, a unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface in a more anatomic fashion. In addition, a 15% glenoid defect was made in all specimens. The HS lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with Quickset (Arthrex) bone cement to prevent plastic deformation. Five scenarios were tested; intact specimen, bipolar lesion, Bankart repair, remplissage with Bankart repair and HS reduction technique with Bankart repair. Translation, kinematics and dislocation events were recorded.

For all 6 specimens no dislocations occurred after either remplissage or the reduction technique. At 90 degrees of abduction and external rotation (ABER), anterior-inferior translation was 11.1 mm (SD 0.9) for the bipolar lesion. This was significantly reduced following both remplissage (5.1±0.7mm; p<0.001) and HS reduction (4.4±0.3mm; p<0.001). For anterior-inferior translation there was no significant difference in translation between the reduction technique and remplissage (p=0.91). At 90 degrees of ABER, the intact specimens average joint stiffness was 7.0±1.0N/mm, which was not significantly different from the remplissage (7.8±0.9 N/mm; p=0.9) and reduction technique (9.1±0.6 N/mm; p=0.50). Compared with an isolated Bankart repair, the average external rotation loss after also performing a remplissage procedure was 4.3±3.5 deg (p=0.65), while average ER loss following HS reduction was 1.1±3.3 deg (p=0.99). There was no significant difference in external rotation between remplissage and the reduction technique (p=0.83).

Similar joint stability was conferred following both procedures, though remplissage had 3.2-degree loss of ER in comparison. While not statistically significant, even slight ER loss may be clinically detrimental in overhead athletes. Overall, the acute reduction technique is a more anatomic alternative to the remplissage procedure with similar ability to prevent dislocation in a biomechanical model, making it a viable treatment option for engaging Hill-Sachs lesions.

Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.

Cite this article: Bone Joint J 2024;106-B(10):1100–1110.

Arthroscopic stabilisation of the shoulder is a technically-demanding and developing technique, and the reported results have yet to match those for open surgery. We present a consecutive initial series of 55 patients with post-traumatic recurrent anteroinferior instability managed since September 1999 using a titanium knotless suture anchor. Patients were reviewed from 12–33 months postoperatively and assessed using the Rowe, Walch-Duplay and Constant scores. Following mobilisation of the capsulolabral complex, labral reconstruction was achieved using a two-portal technique and an average of three anchors placed on the glenoid articular rim. In 13 cases, additional electrothermal shrinkage was required to reduce capsular redundancy in the anterior and inferior recesses following labral repair, although 11 of these were in the first 18 months. Incorporation of a south-to-north capsular shift has reduced the need for supplementary shrinkage. Complications have included one instance of anchor migration requiring open retrieval and two documented episodes of recurrent instability, although these occurred in patients having surgery within the first six months after the introduction of this technique. Based on our initial experience, we believe that arthroscopic labral repair is a viable alternative to open Bankart repair and have now expanded the indications to include patients with primary dislocation, those participating in gymnastic and contact/collision sports, and revision cases with failed open repairs.

Purpose: The purpose of this work was to determine whether the position of the coracoid block used for surgical stabilisation of the shoulder using the Patte procedure has an influence or not on persistent postoperative apprehension.

Material and methods: Forty patients, mean age 26 years (19–37) operated on by the same surgeon (PV) were reviewed retrospectively at mean 40 months (24–60). Instability was expressed by dislocation (70%), subluxation (20%), or both (10%). Hyperlaxity was not found in any of the patients. The same surgical technique was used in all cases: subscapular discision along the axis of the fibres and fixation of the coracoid block using a single cortical lag screw (4.5 mm) with a washer. Radiological assessment at review included a three-quarter AP view in rotation and a glenoid lateral view (Bernageau). The height of the block was measured from the equator of the glenoid and lateral position in relation to the glenohumeral joint line (medial, flush, lateral).

Results: The block was always in an inferior position, flush in 70%, medial in 22% and slightly overhanging in 8%. Twenty percent of the patients experienced persistent apprehension for extreme abduction and external rotation; only one patient with a flush block reported apprehension compared with seven among patients with a medial block. There were two cases of recurrent dislocation and two episodes of subluxation in the patients with a medial block; none required revision. Function was assessed with the DASH: mean score was 6.7 for the entire series, 10 for patients with a medial block and 4.2 for those with flush blocks.

Conclusion: This retrospective analysis emphasises the difficulty and the necessity of rigorous technique to obtain an “ideal” position of the coroacoid block. When the technique is perfectly performed in patients with posttraumatic chronic instability without hyperlaxity, apprehension disappears with little risk of recurrence.

Forty-seven patients with disabling instability due to isolated anterior cruciate deficiency are described. None had responded to conservative measures or to attempted correction of internal derangements. Eighteen patients were treated by extra-articular MacIntosh lateral substitution alone, the other 29 were treated by the same procedure combined with carbon-fibre replacement of the anterior cruciate ligament. No statistically significant difference was found between the two groups at six years. A satisfactory outcome was found in 44% of the extra-articular group and 55% of the carbon-fibre group at last review; however, the latter group had more complications. There was a marked deterioration in the quality of results between three and six years in both groups.

Acromial morphology has been implicated as a risk factor for unidirectional posterior shoulder instability. Studies utilising plain film radiographic landmarks have identified an increased risk of posterior shoulder dislocation in patients with higher acromion positioning. The aims of this study were to develop a reproducible method of measuring this relationship on cross sectional imaging and to evaluate acromial morphology in patients with and without unidirectional posterior shoulder instability. We analysed 24 patients with unidirectional posterior instability. These were sex and age matched with 61 patients with unidirectional anterior instability, as well as a control group of 76 patients with no instability. Sagittal T1 weighted MRI sequences were used to measure posterior acromial height relative to the scapular body axis (SBA) and long head of triceps insertion axis (LTI). Two observers measured each method for inter-observer reliability, and the intraclass correlation coefficient (ICC) calculated. LTI method showed good inter-observer reliability with an ICC of 0.79. The SBA method was not reproducible due suboptimal MRI sequences. Mean posterior acromial height was significantly greater in the posterior instability group (14.2mm) compared to the anterior instability group (7.7mm, p=0.0002) as well when compared with the control group (7.0mm, p<0.0001). A threshold of 7.5mm demonstrated a significant increase in the incidence of posterior shoulder instability (RR = 9.4). We conclude that increased posterior acromial height is significantly associated with posterior shoulder instability. This suggests that the acromion has a role as an osseous restraint to posterior shoulder instability

Aims. Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT. Methods. Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA. Negative values indicate posterior PT. Patients with > 13° of posterior PT from preoperative supine to postoperative standing (ΔPT ≤ -13°) radiographs, which corresponds to approximately a 10° increase in functional anteversion of the acetabular component, were compared with patients with less change (ΔPT > -13°). Logistic regression analysis was used to assess preoperative demographic and spinopelvic parameters predictive of PT changes of ≤ -13°. The area under receiver operating characteristic curve (AUC) determined the diagnostic accuracy of the predictive factors. Results. PT changed from a mean of 3.8° (SD 6.0°)) preoperatively to -3.5° (SD 6.9°) postoperatively, a mean change of -7.4 (SD 4.5°; p < 0.001). A total of 95 patients (10.2%) had ≤ -13° change in PT from preoperative supine to postoperative standing. The strongest predictive preoperative factors of large changes in PT (≤ -13°) from preoperative supine to postoperative standing were a large posterior change in PT from supine to standing, increased supine PT, and decreased standing PT (p < 0.001). Flexed-seated PT (p = 0.006) and female sex (p = 0.045) were weaker significant predictive factors. When including all predictive factors, the accuracy of the AUC prediction was 84.9%, with 83.5% sensitivity and 71.2% specificity. Conclusion. A total of 10% of patients had > 13° of posterior PT postoperatively compared with their supine pelvic position, resulting in an increased functional anteversion of > 10°. The strongest predictive factors of changes in postoperative PT were the preoperative supine-to-standing differences, the anterior supine PT, and the posterior standing PT. Surgeons who introduce the acetabular component with the patient supine using an anterior approach should be aware of the potentially large increase in functional anteversion occurring in these patients. Cite this article: Bone Joint J 2024;106-B(3 Supple A):74–80

Mechanical irritation or impingement of the iliopsoas tendon accounts for 2–6% of persistent postoperative pain cases after total hip arthroplasty (THA). The most common trigger is anterior cup overhang. CT-scan can be used to identify and measure this overhang; however, no threshold exists for symptomatic anterior iliopsoas impingement. We conducted a case–control study in which CT-scan was used to define a threshold that differentiates patients with iliopsoas impingement from asymptomatic patients after THA. We analyzed the CT-scans of 622 patients (758 CT-scans) between 2011 and 2020. Out of this population we identified 136 patients with symptoms suggestive of iliopsoas impingement. Among them, 6 were subsequently excluded: three because the diagnosis was reestablished intra-operatively (one metallosis, two anterior instability related to posterior prosthetic impingement) and three because they had another obvious cause of impingement (one protruding screw, one protruding cement plug, one stem collar), leaving 130 patients in the study (impingement) group. They were matched to a control group of 138 patients who were asymptomatic after THA. The anterior cup overhang (anterior margin of cup not covered by anterior wall) was measured by an observer (without knowledge of the clinical status) on an axial CT slice based on anatomical landmarks (orthogonal to pelvic axis). The impingement group had a median overhang of 8 mm [IQR: 5 to 11] versus 0 mm [IQR: 0 to 4] for the control group (p<.001). Using ROC curves, an overhang threshold of 4 mm was best correlated with a diagnosis of impingement (sensitivity 79%, specificity 85%, PPV = 75%, NPV = 85%). Pain after THA related to iliopsoas impingement can be reasonably linked to acetabular overhang if it exceeds 4 mm on a CT scan. Below this threshold, it seems logical to look for another cause of iliopsoas irritation or another reason for the pain after THA before concluding impingement is present

The Hill-Sachs lesion is a bony defect of the humeral head that occurs in association with anterior instability of the glenohumeral joint. Hill-Sachs lesions are common, with an incidence approaching nearly 100% in the setting of recurrent anterior glenohumeral instability. However, the indications for surgical management are very limited, with less than 10% of anterior instability patients considered for treatment of the Hill-Sachs lesion. Of utmost importance is addressing bone loss on the anterior-inferior glenoid, which is highly successful at preventing recurrence of instability even with humeral bone loss. In the rare situation where the Hill-Sachs lesion may continue to engage the glenoid, surgical management is indicated. Surgical strategies are variable, including debridement, arthroscopic remplissage, allograft transplantation, surface replacement, and arthroplasty. Given that the population with these defects is typically comprised of young and athletic patients, biologic solutions are most likely to be associated with decades of sustainable joint preservation, function, and stability. The first priority is maximizing the treatment of anterior instability on the glenoid side. Then, small lesions of less than 10% are ignored without consequence. Lesions involving 10–20% of the humeral head are treated with arthroscopic remplissage (defect filled with repair of capsule and infraspinatus). Lesions greater than 20% that extend beyond the glenoid tract are managed with fresh osteochondral allografts to biologically restore the humeral head. Lesions great than 40% are most commonly associated with advanced arthritis and deformity of the humeral articular surface and are therefore treated with a humeral head replacement. This treatment algorithm maximises our ability to stabilise and preserve the glenohumeral joint

The Hill-Sachs lesion is a bony defect of the humeral head that occurs in association with anterior instability of the glenohumeral joint. Hill-Sachs lesions are common, with an incidence approaching nearly 100% in the setting of recurrent anterior glenohumeral instability. However, the indications for surgical management are very limited, with less than 10% of anterior instability patients considered for treatment of the Hill-Sachs lesion. Of utmost importance is addressing bone loss on the anterior-inferior glenoid, which is highly successful at preventing recurrence of instability even with humeral bone loss. In the rare situation where the Hill-Sachs lesion may continue to engage the glenoid, surgical management is indicated. Surgical strategies are variable, including debridement, arthroscopic remplissage, allograft transplantation, surface replacement, and arthroplasty. Given that the population with these defects is typically comprised of young and athletic patients, biologic solutions are most likely to be associated with decades of sustainable joint preservation, function, and stability. The first priority is maximising the treatment of anterior instability on the glenoid side. Then, small lesions of less than 10% are ignored without consequence. Lesions involving 10–20% of the humeral head are treated with arthroscopic remplissage (defect filled with repair of capsule and infraspinatus). Lesions greater than 20% that extend beyond the glenoid tract are managed with fresh osteochondral allografts to biologically restore the humeral head. Lesions great than 40% are most commonly associated with advanced arthritis and deformity of the humeral articular surface and are therefore treated with a humeral head replacement. This treatment algorithm maximises our ability to stabilise and preserve the glenohumeral joint

The shoulder is the least constrained of all joints of the body and is more susceptible to injury including dislocation. The rate of recurrent instability following primary stabilization procedure at 10 years of follow-up ranged from 3.4 to 35 %. We describe the outcomes of 74 patients who underwent knotless arthroscopic anterior stabilisation using 1.5 mm Labral Tape with 2.9mm Pushlock anchors for primary anterior instability. We performed a retrospective analysis of patients who underwent surgery for post-traumatic recurrent anterior instability for 2 years by a single surgeon. Patients with glenoid bone loss, >25% Hill Sachs lesion, posterior dislocation, paediatric age group and multidirectional instability were excluded from this study. Over 90% of our case mix underwent the procedure under regional block anaesthesia and was discharged on the same day. The surgical technique and post-operative physiotherapy was as per standard protocol. Outcomes were measured at 6 months and 12 months. Of the 74 patients in our study, we lost 5 patients to follow up. Outcomes were measured using the Oxford Shoulder Score apart from clinical assessment including the range of motion. We noted good to excellent outcomes in 66 cases using the Oxford Instability Scores. All patients achieved almost full range of motion at the end of one year. Our cumulative Oxford Instability Score (OIS) preoperatively was 24.72 and postoperatively was 43.09. The Pearson correlation was .28. The t Critical two-tail was 2.07 observing the difference between the means of the OIS. Complications included recurrent dislocation in 2 patients following re-injury and failure of procedure due to recurrent instability requiring an open bone block procedure in one case. We had no reported failures due to knot slippage or anchor pull-out. We publish the largest case series using this implant with distinct advantages of combining a small bio absorbable implant with flat braided, and high-strength polyethylene tape to diminish the concern for knot migration and abrasive chondral injury with the potential for earlier rehabilitation and a wider footprint of labral compression with comparative outcomes using standard techniques. Our results demonstrate comparable and superior results to conventional suture knot techniques for labral stabilization

Aims. We report the clinical results of glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Patients and Methods. The study reports results in 211 patients (249 shoulders) with atraumatic posteroinferior instability. The patients comprised 63 men and 148 women with a mean age of 20 years. The posteroinferior glenoid surface was elevated by osteotomy at the scapular neck. A body spica was applied to maintain the arm perpendicular to the glenoid for two weeks postoperatively. Clinical results were evaluated using the Rowe score and Japan Shoulder Society Shoulder Instability Score (JSS-SIS); bone union, osteoarthrosis, and articular congruity were examined on plain radiographs. Results. The Rowe score improved from 36 to 88 points, and the JSS-SIS improved from 47 to 81 points. All shoulders exhibited union without progression of osteoarthritis except one shoulder, which showed osteoarthritic change due to a previous surgery before the glenoid osteotomy. All but three shoulders showed improvement in joint congruency. Eight patients developed disordered scapulohumeral rhythm during arm elevation, and 12 patients required additional open stabilization for anterior instability. Conclusion. Good results can be expected from glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Cite this article: Bone Joint J 2018;100-B:331–7

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