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Purpose: To evaluate the clinical, functional, and radiological midterm outcomes of the all-arthroscopic modified Eden-Hybinette procedure in patients with recurrent anterior shoulder instability., Methods: A retrospective, single-center case series with prospectively collected data was conducted. The inclusion criterion was traumatic recurrent anterior shoulder instability with significant glenoid bone loss; patients with atraumatic or multidirectional instability were excluded. An all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation was carried out. All patients were postoperatively assessed for recurrence and apprehension. Shoulder range of motion values and functional scores, including American Shoulder and Elbow Surgeons Score, Oxford instability, Rowe instability, and Walch-Dupplay, were recorded. Graft positions, healing, and absorption were evaluated with computed tomography. Comparisons of values were performed with paired t tests for normally distributed differences and with nonparametric Wilcoxon's signed rank test otherwise., Results: The final study cohort included 28 patients, mean age 36 ± 10 years, and mean follow-up period 43 ± 6 months (range 36 to 53). Median glenoid bone loss was 12.4% (range 8% to 33%). No recurrence occurred, no subjective shoulder instability was reported, and no major complications were documented through the last follow-up. Postoperative shoulder range of motion had no significant differences compared with the healthy side. All final postoperative functional scores significantly increased to show excellent results compared with preoperative values. All grafts were positioned and healed optimally, and none was completely reabsorbed., Conclusions: The all-arthroscopic modified Eden-Hybinette procedure is safe, leading to excellent clinical and radiological midterm outcomes in patients with recurrent anterior shoulder instability. This technique restores glenoid bone defects and preserves the normal shoulder anatomy., Level of Evidence: IV, therapeutic, retrospective case series., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate whether arthroscopic Latarjet procedure significantly differs from the open procedure as for the clinical, functional and radiographic outcomes., Methods: Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "shoulder" AND "anterior" AND "instability" AND "Latarjet"., Results: From the 259 initial papers, we finally assessed five clinical studies which were eligible to our inclusion-exclusion criteria. The mean modified Coleman score for methodological deficiencies of the studies was 65.4/100, whereas it ranged from 53/100 to 77/100. The arthroscopic technique illustrated comparable results to the open technique regarding the postoperative recurrence rate. No significant difference was found amongst groups in relation to the postoperative osteoarthritis, infection rates, soft tissue healing, postoperative mean American Shoulder and Elbow Surgeons score, mean Walch-Duplay score, fatty infiltration of the subscapularis muscle and posterior protrusion of the screw. The arthroscopic technique yielded significantly superior results as for the non-union rate of the graft, the total graft osteolysis and graft resorption, the mean Western Ontario Shoulder Instability Index score and the early postoperative pain., Conclusions: Both the open and the arthroscopic Latarjet procedures led to satisfactory radiographic and clinical outcomes for the treatment of patients with recurrent anterior shoulder instability and significant glenoid bone loss. However, the overall quality of the studies ranged from low to moderate., Level of Evidence: Comprehensive and systematic review of level II-III therapeutic studies.

Purpose: The evaluation of the long-term outcome of the arthroscopic remplissage performed in addition to the classic Bankart repair for the primary management of recurrent anterior shoulder instability with engaging Hill-Sachs lesion without inverted pear appearance of the glenoid during arthroscopy., Methods: During a 6-year period, from 2007 to 2012, 65 patients whose average age was 30.1 ± 7.6 years were operated on in our department and satisfied the inclusion criteria of this study. They all had a positive apprehension sign preoperatively. Among them, 51 patients (82%) were available for long-term evaluation. The mean follow-up period was 8.1 ± 1.8 years (range 5.6-10.6)., Results: Three patients (5.6%) had suffered a new dislocation. The remaining patients (94.4%) were satisfied with the surgical result and returned to their previous daily activities, whereas 71% continued to participate in sports without restrictions. The ASES score increased from 72.5 (range 18-100) preoperatively to 100 (range 85-100) postoperatively (p < 0.01). The modified Rowe score increased from 40 (range 15-70) to 100 (range 70-100) (p < 0.001), and the Oxford Instability score from 29 (range 9-47) to 48 (range 36-48) (p < 0.001). No significant restriction in the shoulder range of motion was documented., Conclusions: The combination of the arthroscopic remplissage with the classic Bankart repair was proven to be a safe and effective procedure for the treatment of "engaging" Hill-Sachs lesions without inverted pear appearance of the glenoid. This combination has long-term outcomes in terms of the recurrence rate and does not significantly influence the range of motion of the shoulder., Level of Evidence: Therapeutic Study-Case series with no comparison group, Level IV.

Purpose: The purpose of the study was to present midterm results concerning the management of recurrent anterior shoulder instability with the remplissage technique in addition to the classic Bankart repair, in patients with engaging Hill-Sachs lesions., Methods: During a time period of 4 years (January 2007-December 2010), 48 patients with an average age of 28.9 ± 7.8 years were operated on in our department. They all had a positive apprehension sign pre-operatively and satisfied the inclusion criteria of this study. Seventy-nine per cent of these patients were involved in sport activities of different levels. The mean follow-up period was 37.2 ± 9.9 months., Results: Three patients (6.3 %) had suffered a new dislocation: one of them after a low-energy trauma and the two other after a high-energy trauma. The rest of the patients (93.7 %) were satisfied with the surgical result and returned to their previous everyday activities while 70.8 % continued to participate in sporting activities without restrictions. The ASES score increased from 67.7 ± 21.5 points pre-operatively to 90.8 ± 21.7 points post-operatively (p < 0.01), the modified Rowe score from 38 ± 17.3 to 93.8 ± 14.5 (p < 0.001) and the Oxford Instability score from 27.6 ± 11.1 to 45.1 ± 8.3 (p < 0.001). No significant restriction in shoulder range of motion was documented., Conclusions: The outcome of the enhancement of the classic Bankart repair with tenodesis of the infraspinatus and posterior capsular plication is very good as far as the management of recurrent anterior shoulder instability is concerned, without significantly influencing the range of motion of the shoulder., Level of Evidence: Therapeutic study-case series with no comparison group, Level IV.

Purpose: The purpose of the study was to compare the incidence of secondary intra-articular shoulder lesions in patients with acute and chronic anterior shoulder instability. The occurrence of glenoid shape alterations (inverted pear glenoid) in recurrent instability was especially examined., Methods: Data for all arthroscopically ascertained intra-articular shoulder lesions in a series of 127 patients with acute and chronic traumatic anterior instability were recorded., Results: Hemarthrosis was evident in all patients with acute dislocation and in 7 patients with chronic laxity who underwent surgery shortly after a dislocation episode. In both groups the presence of a chondral or osteochondral Hill-Sachs lesion was noted in 112 patients (88.1%), a Bankart lesion was noted in 106 patients (83.46%), an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion was noted in 13 patients (10.23%), a SLAP lesion was noted in 26 patients (20.47%), a humeral avulsion of the glenohumeral ligament (HAGL) lesion was noted in 2 acutely dislocated shoulders (1.57%), and capsular laxity was noted in 33 patients (25.98%). All ALPSA lesions were noted in patients with chronic instability (P = .044), and both HAGL lesions were found in patients with acute dislocations (P = .002). In patients with acute dislocations the incidence of Bankart lesions was 78.2% (18/23), whereas in chronic cases the incidence of Bankart or ALPSA lesions was 97.11% (101/104) (P = .002). In the group with acute dislocations there was a Hill-Sachs lesion in 15 cases (65.21%) and chronic recurrent instability accounted for 97 cases (93.26%) (P = .001). The capsule was considered lax in 2 patients with acute instability and 31 patients with chronic instability (8.69% v 29.8%, P = .037). The overall frequency of SLAP lesions was not statistically significant between acute and chronic cases (P = .868), unlike their distribution. In acute cases there were 3 type I and 2 type II SLAP lesions, whereas in chronic cases there were 4 type I, 13 type II, 3 type III, and 1 type IV SLAP lesions. Loose bodies were found and removed in 17 chronic and 4 acute cases (16.34% v 13.04%, P = .903). A partial-thickness articular rotator cuff tear was found in 14 patients: 12 with chronic dislocations and 2 with acute dislocations (11.53% v 8.69%, P = .694). The cuff tears were partial articular surface tears, involving less than 25% of the cuff thickness, and were treated with debridement, and cuff repair was not necessary in any case. The inverted pear configuration of the glenoid was found in 16 cases with chronic instability (15.38%), whereas no patient with an acutely dislocated shoulder had an inverted pear-shaped glenoid (P = .044)., Conclusions: Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability, probably as a result of the repeated dislocation or subluxation episodes., Level of Evidence: Level IV, prognostic case series.

The Rolimeter device can provide measurements of anterior/posterior tibial displacement using maximal manual force. The Rolimeter reliability is still under research when used as an independent knee tester. The purpose of this study is to determine the inter-rater reliability of the Rolimeter measurements between anterior cruciate ligament (ACL) injured and normal contra lateral knees. Twelve male patients with ACL deficiency participated in this study. Three physical therapists (PT) performed the Rolimeter measurements in supine position with an approximate 25 degrees flexion of the knees. Each therapist performed three trials on each knee and the difference in results in millimeters between injured knee and normal contra lateral knee was determined. Spearman's rho correlations showed weak relationships between the PT 1, 3 and 2, 3 (PT 1 vs. PT 3 r=0.55, PT 2 vs. PT 3 r=0.57) and the high relation between 1, 2 (PT 1 vs. PT 2 r=0.96) of Rolimeter measurements. Intraclass correlation coefficient showed no significant reliability coefficients among the three PT Rolimeter measurements between ACL injured and normal contra lateral knees (R=0.24, p=0.05). These results reflect the variations among the means of the three physical therapists' Rolimeter measurements between ACL injured and normal contra lateral knees.

The knotless anchor is a new type of suture anchor that eliminates the need to perform arthroscopic knots, thus facilitating the performance of arthroscopic shoulder surgery. We report our experience in the use of this type of anchor in arthroscopic Bankart repair and discuss a complication related to using this type of fixation device.