One hundred and twenty-four patients who had undergone arthroscopic repair of rotator cuff tear, during the period of 2006–2008, were evaluated. All operations were performed under the same surgeons. The mean follow-up period was 1.1±0.4 years (range, 0.5 to 2 ys). The patients were devided in three groups:

patients underwent complete repair (n=104),

Clinical outcomes preoperatively and postoperatively, were assessed with use of ASES, CONSTANT and UCLA scores. Statistical analysis was performed by using STATA 8.0.

Postoperative functional scores were better than preoperative ones, in all patients (p< 0.05).The patients underwent complete repair achieved preoperatively Constant score: 58.15±3.26, ASES score: 55±3.6, UCLA score: 22.3±1.2 and postoperatively Constant score: 92.65±4.15, ASES score: 92±2.4, UCLA score: 32.1±1.3. The patients underwent incomplete repair achieved preoperatively Constant score: 46.18±3.12, ASES score: 44.2±3.4, UCLA score: 18.1±3.3 and postoperatively Constant score: 76.35±4.22, ASES score: 72±5.4, UCLA score: 24.1±2.3. The patients underwent medialized technique repair achieved preoperatively Constant score: 52.3±1.12, ASES score: 51.9±2.4, UCLA score: 20.4±1.3. and postoperatively Constant score: 86.15±2.22, ASES score: 85.4±4.4, UCLA score: 28.24±2.3. Significant difference was observed between (a) and (b) groups (p< 0.05, CI1: 0.83–0.97, CI2: 0.86–0.95, CI3: 0.81–0.97).

Functionality improvement after arthroscopic repair of rotator cuff tear, with complete, incomplete or medialized repair either, is evidence.

To evaluate the incidence of early complications and operative events during shoulder arthroscopy.

A prospective study of 134 consecutive shoulder arthroscopies, performed using lateral decubitus position, by the same team, with 6 months minimum follow up. During 11 months period we performed 80 shoulder arthroscopies in male and 54 in female patients with mean age 48.6 years (15–82 years). Shoulder pathology that we treated was: 74 rotator cuff repair, 37 shoulder instability, 11 frozen shoulder, 9 calcifying tendonitis, 2 SLAP lesion and 1 debridement. We have well-placed 476 anchors and 63 side to side sutures.

We experience 4 early complications in total (2.98%): 1 anterior interosseous nerve paresis, that fully recovered 6 weeks post op, 1 motor and sensor ulnar nerve paresis that has not fully recovered 4 months post op, 1 sensor ulnar nerve paresis that has not fully recovered 5 months post op and 1 septic shoulder arthritis that was treated with arthroscopic lavage and intravenous antibiotics and has not shown recurrence 11 months post op.

Operative events: 5 (1.05%) anchor slippage, 3 (0.63%) anchor breakage, 5 (0.53%) suture slippage from anchors, 5 (3.73%) instrument breakage, 5 (0.53%) knot loosening or suture breakage.

Shoulder arthroscopy is a quite safe but technically demanding operation. Early complications occur in low rate, but due to technical difficulties operative events occur more frequently, without affecting the final outcome of the operation. Although axillary nerve is believed to be prone to injury during shoulder arthroscopy, in this series other neurological lesion occurred more frequently.

To evaluate humeral and glenoid bone loss in patients surgically treated for shoulder instability as factors of recurrence.

During the period 2000–2008, 114 patients (103 men and 11 women) with mean age of 28 yrs underwent arthroscopic treatment for shoulder instability by the same surgeon. Mean age of the 1st shoulder dislocation was 20,89 yo and the average number of dislocations per patient was 17,14. Glenoid bone loss was found in all patients (16 Large, 59 Medium, 29 Small), as well as Hill Sachs lesions (66 Large, 23 Medium, 8 Small) or both. Thirteen (13) patients had an “inverted pear” glenoid shape. Seventy five (75) were into sports and for 57 (76%) of them this involved Overhead/Contact activities. Also 20 patients presented joint hypermobility. Complete follow up existed for 92 patients and it ranged from 4–108 months (Mean=44). The recurrence of instability and the functional outcome were evaluated post-op using the Rowe Zarins Score.

Recurrence of instability was noted in 5 patients (4,38%). All of them presented Hill Sachs lesions and glenoid bone loss (2 Large, 2 Medium, 1 Small) but without an “inverted pear” glenoid shape or joint hypermobility. All 5 of them were into Overhead/Contact sports activities (2 Professional: Mean=15hr/w and 3 Amateur: Mean=2,5hr/w). The post op Rowe Zarins Score ranged from 80–100 (Mean=95,11).

From the evaluation of our data, it seems that humeral and glenoid bone loss do not significantly contribute to the recurrence of arthroscopically treated shoulder instability.

This paper aims to evaluate the Remplissage arthroscopic technique as described by Eugene Wolf used in patients with traumatic shoulder instability that present glenoid bone loss and Hill Sachs defects.

In our study 28 patients (5 women and 23 men) with mean age of 31 yrs underwent arthroscopic stabilization of the shoulder by the same surgeon during 2007–2008 period. All patients presented Hill Sachs lesion, 11 of them had medium or large glenoid bone loss, 10 had an “inverted pear” glenoid shape, 4 had been revised for stabilization in the same shoulder and 14 presented joint hypermobility. Mean age for the age of 1st dislocation was 20,1 yrs and our follow up ranged from 5–28 months (Mean=18). The recurrence of instability and the functional outcome were evaluated pre-op and postop with the Rowe Zarins Score. The post op rehabilitation was performed by a specialist.

None of the patients presented recurrent instability. The Rowe Zarins Score raised from a mean pre op score of 23,33 (15–60) to a mean post op score of 97,11 (75–100) (p< 0.05). All the patients that were into sports activities before the presentation of shoulder instability began training again and our post op evaluation of the shoulder’s ROM showed a decrease in the external rotation from 0°–15°.

The infraspinatus tenodesis and posterior capsulodesis in patients with humeral bone loss seems to offer so far excellent post op results despite the slight decrease in the external rotation of the shoulder.

To analyze the relationship between functional outcome and tissue quality after arthroscopic rotator cuff repair.

One hundred and forty-five patients who had undergone arthroscopic repair of rotator cuff tear, during the period of 2003–2008, were evaluated. All operations were performed under the same surgeons. The mean follow-up period was 2.4±1.2 years (range, 0.5 to 5 ys). The patients were devided in two groups:

patients with good tissue quality and

As good tissue quality is defined the tendon with enough mass for suturing (thickness> 3mm) and good elasticity (the footprint is covered properly under tendon traction with tissue grasper). The independent variable studied here was the tissue quality of rotator cuff tendon. Clinical outcomes preoperatively and postoperatively, were assessed with use of ASES, CONSTANT and UCLA scores. Statistical analysis was performed by using STATA 8.0.

Good tissue quality was identified in 119 patients (82%) and poor tissue quality in 26 (18%) patients respectively. At the follow up the patients with good tissue quality achieved Constant score: 86.85±12.49, ASES score: 84±3.4, UCLA score: 28.7±1.9 and the patients with poor tissue quality achieved Constant score: 62.35±13.85, ASES score: 61.49±8.9, UCLA score: 21±3.2. Significant difference between the two groups concerning the clinical outcome was observed after adjusted the data for age. Besides high correlation was noticed between old age and increased rate of poor tissue quality (r=0.88).

Better clinical outcomes are expected in patients associated with good tissue quality, adjusted for age. So the tissue quality is positively correlated with the final functional outcome.

The evaluation of the results obtained after a long term follow up (over 60 months) from patients that were treated arthroscopically for shoulder instability.

In our paper we evaluated 116 patients (108 men and 8 women) with mean age of 24 yo, that were treated surgically by the same surgeon from 1999–2004. Seventy seven (77) of them (66,4%) were into sports activities and during pre op clinical examination 15 patients (12,9%) were diagnosed with joint hypermobility syndrome taking into account the Beighton criteria. Arthroscopic findings showed that 80 of them (68,9%) had some kind of bone loss, either glenoid (7 Large, 23 Medium, 6 Small) or Hill Sachs lesion (28 Large, 30 Medium, 20 Small) and in 8 patients an “inverted pear” glenoid shape was found. Our follow up ranged from 60–117 months (Mean=84) and the recurrence of instability and functional outcome were evaluated post-op using the Rowe Zarins Score.

Recurrent instability presented in 7 patients. Five (5) of them was due to high energy accidents, one was due to non-compliance and one was involuntary. Of these patients 5 presented Hill Sachs lesion, 3 showed glenoid bone loss (2 Large, 1 Small) and in none of them an “inverted pear” glenoid shape was found. All recurrent cases were into some kind of Overhead/Contact sports activity (6 Amateur, 1 Professional). The post op Rowe Zarins Score ranged from 80–100 (Mean=95,53).

The arthroscopic treatment of glenohumeral instability is an excellent method that provides similar or better results when compared to the open surgical treatment and with clear advantages over the latter because of lower morbidity, better cosmetic effect and lower total cost.

Aim: We report on the use of external þxation as an alternative þxation of femoral fractures in patients where internal þxation is a borderline indication. Patients and method: From 1991 to 2001, twenty-þve patients with femoral diaphysis fractures were treated by external þxation. Indications included candidates with multiple injuries and unstable general condition, open fractures IIIA, B, C, neglected open fractures with or without infection, comminuted shaft fractures, gunshut injuries and infections after internal þxation. The fractures were stabilized with a unilateral external þxation or with a special anti-varus frame. Results: In twenty patients, external þxation was the deþnitive method of stabilization, while in þve, it was a temporary method. The average time to union was 5 months. Complications included: pin tract infection, restricted knee motion, and loss of reduction. Conclusion: External þxation should not be routinely used for þxation of femoral fractures, but may be considered in multiply injured and critically ill patients. As in any method of þxation, the surgeon must be familiar with the device used, the mechanical and the application properties of such devices, and, most importantly, the postoperative management of the patient.

Aims: a) To review donor site morbidity and record problems coming out during bone harvesting, b) to evaluate bone graft adequacy and effectiveness. Methods: Senior author operated 127 patients using cancellous bone autografts (from May 1988 to September 2001). Bone grafts were obtained from iliac crest (83 patients), proximal tibial metaphysis (39 patients) and other donor sites (5 patients). In all cases intraopera-tive problems and early postoperative problems were recorded. Late postoperative problems were evaluated either subjectively (questionnaire) or clinically for 109 patients. Minimum length of follow up was 12 months. Results: In all the cases, the goals of graft harvesting were accomplished. Generally, grafts were adequate in quantity and quality (apart from 2 cases in which grafts were taken from proximal tibial metaphysis). Blood loss from the proximal tibia was less than iliac bone. Iliac pain was more severe than tibial, resulting to delayed mobilization and pain could persist for a long period of time. Conclusions: Proximal tibial metaphysis, as a donor site, is associated with far less morbidity than iliac and it should be chosen in patients with lower-extremity fractures or nonunions. Harvesting from tibia is adequate and easier comparing to iliac. Tibial bone grafts were as effective as iliac, despite that iliac bone graft is widely used and generally referred as a better quality autologus bone graft.