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Elbow arthroscopy has become an accepted surgical option for treating numerous conditions of the elbow, including septic, degenerative, or traumatic arthritis; capsular release; removal of loose bodies; synovectomy or plica excision; and chondral lesions of the capitellum. Surgeon experience, knowledge of elbow anatomy, patient positioning, and portal selection and placement are important factors for successful arthroscopy and avoiding complications. This article describes the basic surgical setup and technique for elbow arthroscopy., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

We describe here a procedure of endoscopic removal of a gutta-percha point under the maxillary sinus mucosa by using an ultrathin arthroscope. In this study, a 1.2-mm-diameter ultrathin arthroscope was introduced for observation into the maxillary sinus. The surgical technique is suggested to be a reliable and minimally invasive procedure that provides limited incision and bone removal and respects the integrity of the sinus.

Purpose: The ideal operative treatment for cubital tunnel syndrome, the second most common form of peripheral compression neuropathy, remains controversial. We therefore reviewed our series of endoscopically assisted ulnar nerve decompression at the elbow to determine the effectiveness of the procedure, which was intended to minimize perioperative morbidity and scar discomfort., Methods: In 36 patients (ages 22-76 years) with clinical McGowan grade I (4 patients), II (21 patients), and III (11 patients) and electrophysiologic signs of cubital tunnel syndrome (35 primary, 1 recurrent), 20 cm of the ulnar nerve was released through a 3.5-cm-long skin incision above the medial epicondyle. A 4-mm, 30 degrees standard endoscope and custom-made guiding-dissecting tool were utilized during the procedure, and the mean postoperative follow-up examination was 14 months (range 6-19)., Results: No macroscopically visible nerves and vessels were injured during the procedure. The only postoperative complication was hematoma in one patient that resolved after conservative management. One case was converted from endoscopic to open because of a ganglion that surrounded the nerve in the forearm. There was no scar discomfort (ie, painful neuroma, impaired sensibility, or burning sensation) or elbow extension deficit after surgery, and surgical wounds all healed within a week. Outcomes were excellent in 21 of 36 cases and good in 12 of 36 cases. All patients improved electrophysiologically after surgery, were satisfied with the procedure, returned to full activities within 3 weeks, and would have the procedure again., Conclusions: By using a safe and reliable endoscopic technique characterized by a short incision, minimum soft tissue dissection, and early postoperative mobilization, we were able to preserve the benefits of conventional approaches (namely, complete release and good visualization), while avoiding problems such as painful scarring and elbow contracture.

Hip joint problems in the athlete can be disabling, yet remain elusive to investigation. The arthroscope has proved essential in both the detection and treatment of many of these disorders. Less invasive methods with quicker return to safe competition has been a sine qua non of sports medicine. The incentive to return motivated athletes to a sport has proven fertile ground for advancement of arthroscopic techniques. This has been especially exemplified in the rapidly evolving field of hip arthroscopy, and has allowed these methodologies to find application in the management of patients of all levels of activity. As has been stated, the athletic field of competition represents one of the most fertile clinical laboratories in the world.

Purpose: The present in vitro investigation was carried out to assess the efficacy of treatment with 308 nm excimer laser radiation applied to the structures of the temporomandibular joint of a pig. Laser parameters suitable to ensure adequate clinical efficiency with only minor thermal damage to the surrounding tissues were to be determined., Material and Methods: Tissue structures of the temporomandibular joint (cortical and cancellous bone, cartilage, disc and muscle) were extracted from freshly killed pigs and served as specimens. The specimens were embedded in polymethylmethacrylate. The laser light was applied after horizontal sectioning and measurement of thickness. The number of impulses that were necessary to perforate the specimen was counted and the rate of ablation determined. In addition, the irradiated surface was investigated histologically and the degree of tissue alteration was evaluated., Results: The lowest energy threshold for ablation was found at an energy density of 0.8 J/cm2. Depending on the type of tissue, the maximum rate of ablation was evaluated as 1.7-6.3 microm/pulse. The depth of the thermal alteration to the surrounding tissue was about 30-70 microm., Conclusion: The guidable 308 nm excimer laser light offers a combination of precise tissue ablation with only minimal thermal damage to the surrounding tissue.

Objective: Visually guided irrigation (VGIR) is simple joint irrigation with minimally invasive intracapsular inspection through the use of a thin arthroscope. The aims of the present study were to develop VGIR for the superior joint compartment of the temporomandibular joint (TMJ) by using a 1.2-mm-diameter rod-lens arthroscope and to examine the short-term clinical outcomes. The correlation between the clinical outcome of VGIR of the TMJ and intracapsular findings was also evaluated., Study Design: Twenty patients who underwent VGIR for symptomatic internal derangement of the TMJ (n = 20) were enrolled in this study. The clinical outcome of VGIR was evaluated in terms of the improvement in the painless range of mandibular motion (ROM: interincisal distance in millimeters), and functional jaw pain was evaluated by using a visual analog scale (VAS) ranging from 0 to 100. Painless ROM and VAS scores 6 months postoperatively were compared with the preoperative data. A good clinical outcome was defined as an increased ROM (ROM > 38 mm) and a decreased VAS score (VAS score < 20%, and <60% of the preoperative level). With respect to these criteria, all joints were classified into either good clinical outcome (GO) or poor clinical outcome (PO) groups. The difference in the distribution of the arthroscopic findings obtained during VGIR, with respect to severity, was analyzed between the GO and PO groups., Results: None of the 20 patients experienced any serious local or systemic complications, including the breakage of instruments. We were able to perform a reliable intracapsular diagnosis during VGIR. Sixteen of 20 patients (80%) had significant improvements in postoperative painless ROM and the VAS score of functional pain, thereby being classified into the GO group. The distribution of the severity of intracapsular findings did not differ significantly between the GO group and the PO group., Conclusions: VGIR is useful for the treatment and diagnosis of internally deranged TMJs. These data suggest that the clinical outcome of TMJ irrigation is not related to the intracapsular condition of the superior joint compartment.

Objective: The aim of this study was to evaluate the clinical outcome after visually guided irrigation (VGIR) of the temporomandibular joint (TMJ) and its relationship with postoperative arthroscopic changes., Study Design: Of the original 69 patients, thirty patients (30 TMJs) underwent VGIR of the TMJ a second time. After the first VGIR, the clinical outcome was assessed, and 18 patients were assigned to the good outcome group. The remaining 12 patients were assigned to the poor outcome group. The arthroscopic findings related to the articular surface, synovial lining, and fibrous adhesion scores were recorded. Then, the arthroscopic findings in the first and second VGIR were compared., Results: The intra-articular tissue status between the first and second VGIR was unchanged in approximately 40% of all joints. No significant differences with respect to an improvement in tissue status were found when the good outcome and poor outcome groups were compared., Conclusions: In patients with chronic closed lock of the TMJ, a clinical improvement after VGIR does not seem to be accompanied by improved intra-articular tissue status.

Hip arthroscopy is an effective technique. It can be performed successfully either supine or in the lateral position, but there appear to be modest advantages of the supine approach. Arthroscopy offers a less invasive alternative to arthrotomy for traditionally recognized forms of hip pathology, such as loose bodies or impinging osteophytes. Arthroscopy also offers a method of treatment for many conditions (including labral tears, acute articular injuries, and damage to the ligamentum teres) that previously went unrecognized and untreated. In the past, these patients were simply resigned to living within the constraints of their symptoms. Several dictums about hip arthroscopy must be acknowledged. First, the key to a successful outcome lies in proper patient selection. A technically well-executed procedure will fail when performed for the wrong reason, or when the outcome fails to meet the patient's expectations. Second, the patient must be properly positioned for the procedure to go well. Poor positioning will assure a difficult procedure. Third, simply gaining access to the hip joint is not an outstanding technical accomplishment. The paramount issue is accessing the joint in as atraumatic a fashion as possible. Due to its constrained architecture and dense soft tissue envelope, the potential for inadvertent iatrogenic scope trauma is significant and, perhaps unavoidable to some extent. Therefore, every reasonable step should be taken to keep this concern to a minimum. Perform the procedure as carefully as possible and be certain that it is being performed for the right reason. After accessing the joint, the techniques of operative arthroscopy for the hip employ existing strategies established in other joints. Because of the restraints imposed by the hip, however, technical deficiencies may be more apparent.

The lateral approach provides an easy and safe access to the hip joint. The line from skin to the joint itself is a straight, downward drop (Fig. 18). The vital arteries and nerves are a safe distance from the portal sites. The potential problems that can arise from this procedure are from the traction applying a compression force on the branches of the pudendal nerve as they cross the ischium (Fig. 19) and traction force on the sciatic nerve. I have always maintained that traction should be treated like a tourniquet; that is, it should be applied for no more then 2 hours. [figure: see text] Furthermore, the amount of traction should not exceed 75 pounds. I use a tensiometer, but it is not mandatory because the major issue with traction is the duration of application. I have monitored the sciatic nerve using both evoke potentials and, in some cases, motor potentials in over 50 cases in the past year, and the poundage and time limits of the traction (75 pounds and 2 hours) were verified. In addition, if the fracture [figure: see text] table has a vertical post as well as a peroneal post, set the vertical post in the back of the patient, and not in the front. Flexing the hip around that post will greatly increase the traction and at the same time will place an extreme stretch on the sciatic nerve, setting up the chance of a significant sciatic nerve neuropraxia. To protect the pudendal nerve, Lyon et al suggest that the perineal post be at least 9 cm in diameter to distribute the forces in a wide area on the ischium and make sure that the pelvis is well supported so the pressure of the post is not placed directly on the this nerve. The perineal posts on most fracture tables are only 3 cm in diameter. These can be made larger by wrapping them with padding. In some fracture tables, the slats that support the lower leg can be removed, and consequently the support on the pelvis is lost. For hip arthroscopy, the slats do not have to be removed. The lateral approach provides a safe and simple way of performing hip arthroscopy. The instruments can be manipulated easily so that the entire confines of the joint can be visualized with the arthroscope and reached with operative instruments.

Purpose: This preliminary clinical study evaluated the applicability, accuracy, and benefits of computer-assisted arthroscopy of the temporomandibular joint (TMJ) with optoelectronic tracking technology., Materials and Methods: A hybrid of reality and virtual reality is built as a composite-reality environment by extracting 3-dimensional anatomical structures through use of computed tomography, magnetic resonance imaging, radiography, and other types of imaging procedures commonly used in clinical praxis. These various independent sources of imaging data of a particular patient can be combined with and complemented by complex graphic simulations. Intraoperatively they are merged with online position data of surgical instruments inside the patient's TMJ. This hybrid model of detailed anatomical structures, guidelines, and real-time instrument positions allows the surgeon to accurately plan the arthroscopic intervention as well as to navigate effectively intraoperatively., Results: In the first 10 cases of computer-assisted TMJ arthroscopy, composite reality environment technology permitted the online visualization of TMJ structures, puncture sites, instrument positions, and virtual pathways in relation to anatomical landmarks with high spatial accuracy (minimum, 0.0 mm; maximum, 2.5 mm; mean, 1.4 mm; SD, 0.6 mm) and high temporal resolution (100 ms). Past, present, and possible future instrument positions can be displayed. The application of computer-assisted arthroscopy caused little immobility for either surgeon or patient., Conclusion: Even experienced surgeons profit from improved precision in the handling of the arthroscope; thus this technology was found to be particularly useful in degenerative temporomandibular disorders and for triangulation procedures.

Arthroscopic debridement of the articular disk is an accepted method for the treatment of symptomatic central tears of the triangular fibrocartilage complex. Current techniques use punches, knives, and shavers to debride the torn disk back to a stable peripheral rim. The holmium:yttrium-aluminum-garnet laser offers an alternative method for disk debridement with potential advantages of enhanced speed, precision, and hemostasis. We present a retrospective review of 35 patients who underwent arthroscopic laser debridement for a Palmer type IA tear in the triangular fibrocartilage complex. Overall response to treatment was good to excellent in 68% of patients and return to work was seen in 88%. One patient developed a deep wound infection. Clinical results after arthroscopic laser debridement are comparable to those reported by other investigators using conventional techniques.

A unique surgical technique, arthroscopic eminoplasty was undertaken in 16 joints of 11 patients with habitual dislocation of the temporomandibular joint (TMJ). There were 10 joints with subluxation and 6 joints with complete dislocation in 4 male and 7 female patients with a mean age of 33 +/- 20 years. The procedure consisted of conventional diagnostic arthroscopy, followed by shaving of approximately 3 to 5 mm in height of the articular eminence with an electric motorized shaver with bone files, depending on the bone thickness as detected by preoperative imaging. The arthroscopic eminoplasty was accomplished without any peri- or postoperative complication. During the postoperative follow-up period of 19 months on average (6-36 months), all patients were free of dislocation of the TMJ, except for one joint. The patients could open their mouth 42 +/- 6 mm without arthralgia 2 weeks after surgery, and finally 47 +/- 7 mm without any subjective symptom but small joint noises (clicking or crepitus) in 10 joints. On postoperative radiographs only minor changes of the mandibular condyle were apparent in four joints. Arthroscopic eminoplasty might become a significant procedure for habitual dislocation of the TMJ and seems to produce results comparable to open arthrotomy. Further study will be required to assess this method as an acceptable modality in the future.

Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics undoubtedly underestimate the true incidence of complications. Many complications, including neurovascular injuries and articular damage, are preventable and can be minimized through familiarity with anatomy, proper surgical technique and instrumentation, and clinical experience. Nevertheless, despite these efforts, a few complications, including recurrent instability, persist. Despite careful patient selection and attention to labral pathology and capsular laxity, arthroscopic repairs continue to have success rates lower than those achieved through open means. While cautiously proceeding toward a more complete understanding of the instability continuum, surgeons must maintain a high index of suspicion for new techniques that purport to "solve" the problem of arthroscopic shoulder stabilization, lest the history of enthusiastic but ultimately unsubstantiated claims is repeated. Outcomes must withstand the rigors of scientific scrutiny and the test of time. Without this cautious vigilance, the appeal of today's solutions becomes the fodder of tomorrow's articles about the complications of arthroscopic shoulder stabilization.

Meniscal surgery is one of the most common orthopedic procedures performed today. Orthopedic surgeons must be familiar with the indications for meniscal excision versus repair and comfortable with the diverse instrumentation used for both techniques. Numerous pitfalls exist in diagnosis, indication, and technical aspects of surgery but can be minimized or avoided by careful preoperative planning and attention to detail during the surgical procedure.

Meniscal repair is an important technique for the orthopaedic surgeon. As familiarity, equipment, and techniques improve, the interest in expanding the indications for application of meniscal repair also increases toward improving patient outcomes and long-term function. An overview of the indications, techniques, complications, and future direction of meniscal repair is presented in this article.

Arthroscopy of the first carpometacarpal joint has been developed as a reliable surgical procedure offering an opportunity for direct evaluation of the joint's intra-articular status, with minimal morbidity to the joint capsule. The procedure uses a 1.9-mm short barrel arthroscope with standard supportive electronic equipment. After adequate anesthesia is established, approximately 5 lb. of longitudinal traction is applied to the thumb. Arthroscopic portals are located on the radial side of the abductor pollicis longus tendon (1-R portal) and the ulnar side of the extensor pollicis brevis tendon (1-U portal). Care must be exercised in establishing these portals so that injury to the radial artery and branches of the superficial radial nerve can be avoided.

The functional outcome after surgery was determined in 21 patients an average of 29 months (range, 24-52 months) after surgery to evaluate the efficacy of arthroscopic repair of triangular fibrocartilage complex (TFCC) tears and ulnar shortening. All of the patients had reparable lesions of the TFCC treated after a delay of more than 6 months from the time of injury. The patients' average age was 32 years and all patients had wrist pain limiting them from work and/or sports prior to surgery. After surgery, there was a significant relief of pain (p < .01). Grip strength and range of motion averaged 83% +/- 18% and 81% +/- 16%, respectively, of that of the uninjured side. At follow-up evaluation, 14 patients with repairs underwent follow-up studies; the TFCC was noted to be intact in 12 patients.

A technique for arthroscopic inside-out repair of peripheral traumatic (type 1B) tears of the triangular fibrocartilage complex is reported. The technique can be performed using zone-specific cannulas that are commonly used for repairing meniscal tears in the knee. Anatomic dissections were used to show the safe regions around the TFCC where tears are amenable to this type of repair.

An operative technique of carpal tunnel release using intraoperative ultrasonography is described. In this technique, "safe line" is defined in the transverse carpal ligament and the adjacent deep forearm fascia midway between the ulnar margin of the median nerve and the radial margin of the ulnar artery. After ultrasonographic design of a 1.0 to 1.5-cm skin incision along the safe line at the distal carpal tunnel, the distal ligament is released under direct vision. Proximal release is performed along this line under ultrasonographic monitoring using a device that consists of a basket punch and an outer metal tube. In a prospective randomized study, the outcomes were compared for carpal tunnel release using either this technique in 50 hands of 50 patients or conventional open release in 53 hands of 53 patients. Follow-up assessment at 3, 6, 13, 26, 52, and 104 weeks showed no significant difference with respect to numbness and paresthesias, static two-point discrimination, findings on Semmes-Weinstein monofilament testing, findings on manual muscle testing of the abductor pollicis brevis, and electrophysiologic findings. The ultrasonographic-release group had better outcomes regarding pain, tenderness of the scar, and key-pinch strength at 3, 6, and 13 weeks, and grip strength at 3 and 6 weeks after surgery. The scar was more aesthetic in this group. There were no complications with either technique.

Knee arthroscopy has benefited greatly over the past 2 decades from new developments in technology and instrumentation. These advances have transformed arthroscopy from a purely diagnostic procedure to one through which extensive and intricate surgery can be performed. In addition, the new technology and instruments now place the orthopedic surgeon at the threshold of successful arthroscopic surgery in the office. Attention to the basics ancillary to the actual surgery, however, are still of prime importance in ensuring complication-free arthroscopic procedures.

An arthroscopic technique was used to reduce Stener lesions associated with acute ulnar collateral ligament ruptures of the thumb. We operated on eight thumbs, seven dominant and one nondominant. The average follow-up period was 39 months (range, 30-48). At follow-up examination, no patient reported pain or functional limitation or had joint contracture. In most cases, key pinch, tip pinch, grip strength, and range of motion were equal to or greater than in the thumb on the unaffected side. The only complication, a pin track infection, resolved after wire removal and treatment with oral antibiotics. Results indicate that arthroscopic reduction of a Stener lesion allows healing of the ulnar collateral ligament without the need for open repair.

A 63-center prospective study of endoscopic carpal tunnel release using the Agee Carpal Tunnel Release System was conducted in 1049 procedures in 988 patients. Prior experience with endoscopic release varied significantly among surgeon participants. Surgeons evaluated the newly redesigned system for blade visibility, blade height, and mechanical function. Data on patient complications were collected at the time of surgery and 3-4 weeks postoperative. The results indicated minimal complications and no confirmed injuries to vessels or nerves; the symptoms from one possible digital nerve injury eventually resolved completely. Surgeons were able to observe the point of entry of the blade into the transverse carpal ligament in 97.5% of procedures. Introduction of the blade assembly into the carpal tunnel was rated easy or adequate in 90.6% of procedures, and blade height was rated adequate in 97.4% of procedures.

Arthroscopy allows direct visual examination of joint cavity components and is useful for the diagnosis, treatment and evaluation of lesions. We investigated the contribution of arthroscopy to the evaluation of joint cartilage. The severity of cartilage lesions can be assessed using a total 100-mm visual analog scale (0 = no chondropathy; 100 = the worst possible lesions) or a more objective system based on the site, depth, and surface area of the lesions. This latter system was developed by the French Society for Arthroscopy (Société Française d'Arthroscopie) and provides a score and a class (SFA score and SFA grade). We investigated whether this system has the characteristics required of an evaluation tool, i.e., simplicity, reproducibility, clinical relevance, sensitivity to change, and discriminant capacity. Arthroscopy is an invasive procedure. However, we introduced several simplifications, including use of local rather than general anesthesia, performance on an outpatient basis, elimination of the tourniquet (to avoid muscular dysfunction), and use of a small arthroscope. This simplified technique is called chondroscopy. Intra-observer reproducibility is far better than inter-observer reproducibility. We found a good correlation between the two arthroscopy scales (visual analog scale and SFA scale). Chondroscopy and roentgenographic evaluations of cartilage lesions were closely correlated. Changes in the severity of cartilage lesions were correlated with changes in functional impairment. Chondroscopy proved capable of demonstrating statistically significant changes in cartilage lesions due to knee osteoarthritis between two evaluations done only one year apart, even in a small sample of patients (less than 20). A preliminary study of repeated hyaluronic acid injections suggested that chondroscopy may be capable of identifying truly chondromodulating agents.

Arthroscopic surgery of the foot and ankle represents a relatively new and exciting addition to the armamentarium of the orthopedic surgeon. Direct visualization of all intraarticular structures without extensive surgical approach, arthrotomy, or malleolar osteotomy is now possible. Laxity or incompetency of ligamentous structures can be demonstrated by intraoperative stress testing maneuvers.

The arthroscope can play an important diagnostic role in the arthritis patient. The major utility of this procedure is in the patient with unexplained knee pain and swelling or in the patient with an established knee arthritis whose symptoms are disproportionate to radiographic findings or refractory to standard-course medical therapy. Technologic advances have led to the production of smaller instruments, making office-based diagnostic arthroscopy a practical, cost-effective alternative in the evaluation of these patients, and supporting the clinical argument for it as a procedure distinct from conventional arthroscopy. Separate clinical scenarios further subdivide the indications for diagnostic arthroscopy and define potential intra-articular abnormalities that, if found, can justify alterations in or additions to therapeutic plans, including arthroscopically directed tissue resection and modification or application of tissue-modifying agents. The research capabilities of needle arthroscopy are only just beginning to be realized; opportunities now exist for design of prospective clinical trials in which patients are randomized based on intra-articular abnormalities, and for the serial assessment of specific treatment effects on gross, microscopic, and molecular features of target tissue as identified by the arthroscope.

The arthroscope, currently used in OA mostly as a tool to deliver surgical therapy, can play an important diagnostic role in patients with knee pain for whom OA is part of the differential diagnosis. Concepts that may seem foreign to clinicians who take care of patients with knee OA (that is, of arthroscopy as a purely diagnostic tool and of knee OA as a clinical situation for which a differential diagnosis might be rendered) are supported by an appreciation for the heterogeneity of conditions of which OA is a part as well as an awareness of the pathoanatomic complexity of symptomatic knee OA as revealed by recent MRI and arthroscopy studies. Inspection of the perplexing OA knee with one of the newly available needle arthroscopes in an ambulatory office setting may be preferable to referral for conventional operating room--based arthroscopy, as this new technique adequately delineates intra-articular anatomical abnormalities (for which surgical therapy is not always indicated) and provides saline lavage to the joint (considered by many as a major factor in the improvement of symptoms reported by many patients with knee OA after arthroscopy). At present arthroscopy can serve to aid differential diagnostic efforts in five clinical situations involving knee OA: painful swollen knee with normal radiographs and noninflammatory fluid, clinical and radiographic OA with pain out of proportion to radiographic findings and refractory to conventional medical therapy, chronic stable (radiographic) OA with profound worsening of symptoms, OA with predominate "mechanical" symptoms, and OA with unexpected synovial fluid characteristics. Future use of needle arthroscopy in knee OA could serve to define the intraarticular correlates of pain in OA, to identify specific subgroups of knee OA upon which prospective randomized testing of arthroscopic surgical interventions could be conducted, and to quantitatively assess the effects of new treatment modalities on articular cartilage and other intraarticular structures.

Arthroscopic microdiscectomy represents an alternative method of treatment for herniated lumbar disc and its associated radiculopathy. In contrast to nucleotomy procedures that allow for only central evacuation of the nuclear mass, in arthroscopic microdiscectomy, the emphasis is placed on evacuation of the posterior collagenized fragments, which are responsible for mechanical compression of the nerve roots. Over a period of 10 years, 250 patients with unremitting sciatica due to herniated nucleus pulposus have been treated at the Graduate Hospital through a posterolateral approach via a 6.5-mm cannula. Our overall successful results have been 87.5%, and we have not encountered any neurovascular or other serious complications.

We have developed a step cannulation system consisting of a set of six obturators with increasing diameters for effective use of the arthroscope in the diagnosis and surgical treatment of disorders of the temporomandibular joint.

The goal of surgical stabilization of the unstable glenohumeral joint is to produce a stable yet mobile joint that can return to preinjury function. Open surgical procedures (in particular, the Bankart procedure) have evolved to a point where stability and mobility are being attained with a low complication rate, but the rate of return to preinjury function, particularly in overhead athletes, has not been ideal. Arthroscopic stabilization is an attractive alternative to open procedures, particularly in those patients who have a history of traumatic and unidirectional recurrent dislocations with a labral detachment. A variety of techniques for reattaching a detached labro-ligamentous complex have been described. Longer follow-up is needed to assess the efficacy of these procedures fully, particularly in light of the good results now being obtained with the open Bankart procedure. Longer-term studies have shown a higher rate of recurrence of dislocation with the arthroscopic technique than with the open technique. Arthroscopic stabilization offers the potential advantages of shorter hospitalization, less traumatic treatment of the soft tissues, more thorough examination of the glenohumeral joint and subacromial bursa, and greater cosmesis. It could also provide a means by which selective stabilization of those initial anterior dislocations that might be prone to recurrence could be performed. Long-term follow-up and randomized studies comparing open and arthroscopic techniques are needed to further define the best role of arthroscopic shoulder stabilization and to determine which of the several techniques described provides the best results with the fewest complications.

The operative technique and indications for shoulder arthroscopy have been reviewed, with a description of proper technique and instrumentation. Visualization within the joint is usually superior to visualization with arthrotomy. With the refinement of techniques and equipment, it is expected that the frequency of transarthroscopic procedures will increase in the near future.

The advances in the field of arthroscopy have been keyed to the development of instrumentation. The most significant innovation has occurred in conjunction with the visualization system itself--cutting instrumentation for resection of soft tissues in bone and, more recently, in joints other than the knee. A brief history of the development of arthroscopic instrumentation is provided in this article.