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Purpose: To compare the effectiveness of simple arthroscopic debridement versus arthroscopic autologous chondrocyte transplantation (ACT) for the treatment of hip chondral lesions., Methods: We carried out a controlled retrospective study of 30 patients affected by a post-traumatic hip chondropathy of the third or fourth degree, according to the Outerbridge classification, measuring 2 cm² in area or more. Of these patients, 15 underwent arthroscopic ACT, whereas the other 15 underwent arthroscopic debridement. The 2 groups were similar in age, sex, degree, and location of the pathology. All the patients were assessed before and after the procedure with the Harris Hip Score (HHS)., Results: In both groups the mean follow-up was approximately 74 months (range, 72 to 76 months). The mean size of the defect was 2.6 cm². The patients who underwent ACT (group A) improved after the procedure compared with the group that underwent debridement alone (group B). The mean HHS preoperatively was 48.3 (95% confidence interval [CI], 45.4 to 51.2) in group A and 46 (95% CI, 42.7 to 49.3) in group B (P = .428 [no significant difference]). The final HHS was 87.4 (95% CI, 84.3 to 90.5) in group A and 56.3 (95% CI, 54.4 to 58.7) in group B (P < .001 [significant difference])., Conclusions: This study indicates that an ACT procedure can be used in the hip for acetabular chondral defects., Level of Evidence: Level III, retrospective comparative study., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

The success of anatomic repair of Bankart lesion diminishes in the presence of a capsule stretching and/or attenuation is reported in a variable percentage of patients with a chronic gleno-humeral instability. We introduce a new arthroscopic stitch, the MIBA stitch, designed with a twofold aim: to improve tissue grip to reduce the risk of soft tissue tear, particularly cutting through capsular-labral tissue, to and address capsule-labral detachment and capsular attenuation using a double loaded suture anchor. This stitch is a combination of horizontal mattress stitch passing through the capsular-labral complex in a "south-to-north" direction and an overlapping single vertical suture passing through the capsule and labrum in a "east-to-west" direction. The mattress stitch is tied before the vertical stitch in order to reinforce the simple vertical stitch, improving grip and contact force between capsular-labral tissue and glenoid bone.

Purpose: The purpose of this article is to report the characteristic conditions in which a posterior humeral avulsion of the glenohumeral ligament (PHAGL) lesion occurs, defining also the different possibility of association with other intra-articular shoulder pathologies., Methods: We identified in our database 16 consecutive patients with a PHAGL lesion who underwent surgical treatment. Six of these patients had previous failed anterior shoulder stabilization, and 1 patient failed thermal shrinkage for a multidirectional instability and were not included in this study. The 9 remaining patients were enrolled in this study. All 9 patients developed a PHAGL lesion after a sports-related trauma. Clinical symptoms reported by the patients and clinical examination data were variable depending also on associated intra-articular shoulder pathology. The diagnosis of a PHAGL lesion was not made in any of the cases preoperatively. All 9 patients underwent arthroscopic repair of the PHAGL lesion. During the surgical procedure, any additional intra-articular shoulder lesion was treated. Patients were evaluated preoperatively and postoperatively for pain and range of motion using standardized shoulder scales including the Simple Shoulder Test (SST), University of California Los Angeles (UCLA) rating score, and Constant score., Results: Arthroscopic evaluation revealed that PHAGL was seen as an isolated lesion in only 3 patients. At a mean follow-up of 34.2 months, all patients were pain free and reported a complete resumption of sports and daily living activities. Two patients had a limitation of internal rotation to the T11 level. The UCLA score improved from 16.3 to 34.7, the Constant score improved from 52.3 to 80.2, and the SST score improved from 7.9 to 4.2., Conclusions: The PHAGL lesion is challenging to diagnose clinically. It can be the cause of posterior instability or a component of the spectrum of shoulder instability and associated with anterior labral or capsular pathology. Because physical examination can be misleading, a gadolinium-magnetic resonance arthrogram and comprehensive arthroscopic evaluation visualizing from the anterior and posterior portals can confirm the diagnosis. We repaired the PHAGL lesions arthroscopically along with all associated shoulder abnormalities resulting in a good outcome., Level of Evidence: Level IV, therapeutic cases series.

Alcaptonuria is an inherited hereditary metabolic disorder, which is associated with various systemic abnormalities and related to the accumulation of homogentisic acid and a derived melanine-like pigment in the connective tissues; the latter is termed ochronosis. We present the arthroscopic findings in the shoulder of a 58-year-old female with ochronotic arthropathy and discuss the role of arthroscopy in the diagnosis and management of this rare metabolic disorder.