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.

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.

Between 1999 and 2002 14 children with femoral shaft fractures were treated with closed, locked intramedullary nailing. There were 11 male and 3 female patients, aged 11–16 years (mean 14.4 years). All fractures were closed. There were 9 transverse, 1 pathologic, 1 bipolar, 1 malunited and 2 spiral fractures. The fractures occurred following MVA or falls from height. All fractures were reduced and closed locked intramedullary nailing was performed using small diameter titanium nails without reaming. The entrance of point of the nail was created at the tip of the greater trochanter and no traction was used intraoperatively. The mean hospital stay was 2 days and immediate partial weight-bearing was permitted.

All fractures united according to clinical and radiological criteria within 9 weeks. The maximum patient follow-up was 24 months (mean 17 months). Hip and knee mobility was full and no case of femoral head osteonecrosis, infection or malunion was ascertained.

Closed, locked intramedullary nailing in adolescent patients provides immediate fracture immobilization combining safety and limited morbidity. Meticulous adherence to the surgical technique is necessary respecting the developing upper part of the femur.

The middle third of quadriceps tendon is an autograft of sufficient size and strength and is stronger than the patellar tendon autograft with the same dimensions. We present the results from the use of a quadriceps autograft for the reconstruction of the chronically ACL deficient knee.

Between March 1999 and March 2000 we treated 36 patients with chronic ACL deficiency using a quadriceps tendon autograft, harvested from the middle third of the tendon with and without a patellar bone block.

The tendinous side of the graft was stabilized using the Mark II and Patella Soffix fixation systems (Surgicraft, UK). In the tibia the graft was passed through a tunnel and in the femur it was passed over the top. In those cases where the graft was harvested with a bone block, his was fixed to the tibia using interference screw fixation. The mean postoperative follow up was 21 months. The results have been evaluated using the IKDC, the Lysholm and the Tegner scales. According to the International Knee Documentation Committee rating system most of the patients had normal or nearly normal ratings. Knee laxity was evaluated using the arthrometers KT-2000 and Rolilmeter. There were no significant complications related to the harvesting site and there was no significant differences between the two groups regarding stability and function. MRI evaluation and second look arthroscopies in 7 patients revealed graft survival

The quadriceps tendon-patellar autograft is a reasonable alternative ACL reconstruction in primary and probably revision ACL reconstruction with minimal donor site morbidity and restoration of knee stability.

Aims: We present the short term results of a method of reconstruction of the anterior cruciate ligament (ACL) using the Soffix, polyester soft tissue fixation device.

Method: Over a 4-year period, 111 patients underwent reconstruction of the ACL using a 4-strand hamstring graft in combination with a Soffix fixation device. The hamstring tendons were harvested and woven around the Soffix. The tendons are then sutured to the Soffix using polyester baseball type sutures to create a 4-strand graft. Prior to implantation in the knee joint the central part of the Soffix is resected leaving a free tendon window, which eventually becomes intra-articular. Tibial tunnel placement was standardised using the Mayday rhino horn jig. An over the top femoral placement was used together with polysulphon bollard fixation. These patients underwent prospective evaluation in a dedicated research clinic, which included clinical assessment, KT-2000 arthrometric assessment, Lysholm, Tegner and IKDC scoring.

Results: A total of 93 from 111 patients (84%) were available for follow up. The mean follow up time was 22 months (range 12–48). There were 79 males and 14 females with a mean age at operation of 30 years (range 16–48). The pivot shift was abolished in 85% of patients and the mean side to side difference (SSD) was 2.2mm ±1.8. The mean post operative Lysholm score was 93.4 ±8.6, the mean drop in Tegner score was 1.3. 84 patients (90%) scored normal or nearly normal (A or B) using the IKDC system, with no patients scoring D.

Conclusions: We conclude that reconstruction of the ACL using a Soffix-4 strand hamstring graft with an over the top femoral route has good short term subjective and objective outcome measures with a low mean SSD. We recommend this technique in the vast majority of ACL deficient patients.

Aim: This study is to assess whether spinal fusion surgery can be performed safely in patients with Duchenne’s muscular dystrophy (DMD) and a low (less than 30%) predicted forced vital capacity (PFVC).

Patients- Methods: Patients were identified with a diagnosis of scoliosis secondary to DMD who underwent spinal fusion procedures at the Royal National Orthopaedic Hospital, Stanmore between January 1990 and December 1999. Their notes and radiographs were reviewed and a standardised data collection form was completed.

Results: Thirty patients with a mean age of 14 years 8 months at surgery underwent posterior spinal fusions. All were discharged from hospital alive and self-ventilating on average 22 days postoperatively (range 13–62 days). Thirteen patients had a PFVC less than 30%. The mean preoperative curve was 61 degrees (range 30 to 90) and the mean number of levels fused was 15 (i.e. T3 to sacrum). The mean correction was 36 degrees (range 16 to 61). Two patients required temporary tracheotomies, one with a PFVC of 34% and one with a PFVC of 20%. Both were removed successfully after 39 days and 27 days respectively. There was no association between PFVC and operative time, blood loss, length of time on ventilatory support, time intubated, incidence of complications or length of admission.

Conslusion: Historically, only curves of greater than 20–350 have been considered suitable for surgery, as the progression of the curve is associated with a marked decline in respiratory function. Considering the currently used criteria for surgery, the group of 13 with low PFVCs normally would have been denied surgery. We conclude that spinal fusion surgery can be safely performed in DMD patients with a low PFVC.

Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case shoulder surgery.

Patients and Methods. 104 patients undergoing shoulder surgery were audited using a questionnaire immediately postoperatively, and at 6, 12 and 48 hours. Pain scores were recorded using a visual analogue scale. Operative details including operation time, postoperative stay and complications have also been recorded. At 48 hours patients were asked about having their operation as a day case and their pain control was assessed.

Results. 52 males and 52 females mean age 49 years (range 18–85) completed the questionnaire. 90 responded to a 48-hour interview. 75 arthroscopic decompressions, 15 arthroscopically assisted mini open cuff repairs, 9 open glenohumeral stabilisations and 5 open Mumford procedures were performed. Mean operation time was 47 minutes (range 25–90) and 101 patients were discharged after one (86 patients) or two (15 patients) postoperative nights. 97 patients had no pain immediately postoperatively, 76 were pain free at 6 hours and 39 were pain free at 12 hours. Mean pain scores at 6 and 12 hours were 3 and 4. 101 patients said that their pain was well controlled throughout the first 48 hours with simple oral analgesics. 83% of patients expressing an opinion on day case treatment (69 out of 83) could have been managed as day cases provided that they were adequately counseled about the procedure. 6 patients showed signs of Horner’s syndrome that resolved fully by 12 hours. No other complications related to the inter-scalene block occurred.

Conclusion. This study has shown that interscalene anaesthesia is a safe procedure providing sustained and adequate pain relief. In association with oral analgesia and patient counselling it allows a high percentage of patients undergoing shoulder surgery to be discharged home on the day of surgery.

Aim. The purpose of this study was to examine the symmetry of the mechanical and tomographic properties of the rat femur and tibia, frequently used in biomedical research.

Materials-Methods. For this purpose both femora and tibiae of 43 Wistar rats underwent tomographic (pQCT) evaluation while both femora and tibiae of 40 further Wistar rats were subjected to destructive three-point bending testing. The age of the animals ranged between 3 and 12 months and all were males.

Results. While there was significant variation between the structural and the biomechanical properties between different animals the differences between the femora and the tibiae of the same animal were not statistically significantly different in the majority of animals.

Conclusion. We conclude that in healthy, sexually mature Wistar rats, in the first year of their life, there is no significant diversity in terms of tomographic and biomechanical properties of their opposing posterior limb long bones.

Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty.

Patients and Methods: Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction.

Results: The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80% and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 79%, and shoulder function from 34% to 87%.Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%.

Discussion: This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.

Aim: To describe the technique and the mid term results of anterior shoulder instability arthroscopic reconstruction.

Patients-methods: Between March and December 2000 29 patients-28 males with ages ranging between 19–29 years (mean age 23 y.) and 1 female 24 years old-underwent arthroroscopic stabilization of anterior shoulder instability. During the procedure the anterior-inferior part of the labrum was reattached to the glenoid using bioabsorbable and metallic suture anchors. In selected patients in which capsule plication after anchors’ insertion was insufficient additional capsular shrikange or/and rotators’ interval closure was also performed.

Results: Postoperatively patient evaluation took place using Rowe-Zarins scale. According to this score 22 patients (75,9%) had excellent or very good outcome. Three (3) patients (10,35%) were lost during follow up while 1 (3,45%) died. From the remaining 25 patients 2 had recurrence of the instability (6.9%) and in 1 patient (3,45%) a stiff shoulder was noticed and arthroscopically resolved. Finally a disengaged metallic suture anchor was noticed incidentally during routine radiographic examination in one patient (3,45%).The anchor was successfully removed under arthroscopic visualization without compromising the final outcome.

Conclusions: Arthroscopic reconstruction of anterior shoulder instability when precisely performed after correct patient selection is an effective technique achieving results comparable to those of traditional open procedures.

Aim: The purpose of this paper was to describe the biological reaction imposed by a prosthetic ligament.

Materials-Methods: Polyester-carbon synthetic matrices were implanted into 29 rabbits. The implants were transected centrally and reconstructed with resorbable suture material. At regular intervals from 4th day to 29 weeks, tissue samples from the ingrown implants were obtained for histology and mechanical testing. Light microscopy, DNA cytometry, immunohistochemical analysis of the collagen types, transmission and scanning electron microscopy were carried out. Ultimate tensile strength (UTL), elongation to failure (EF) and structural stiffness (SS) were determined at intervals of 8, 16 and 29 weeks.

Results: The ingrowth of tissue into the scaffold provided a significant increase in tensile strength, which improved with time. The UTL significantly increased from 18.86 N ±14.69 at 8 weeks to 51.4 N ±14.64 at 29 weeks. Light microscopy showed no infl ammation or foreign body reaction. At 4th day the first fibroblast cells settled on the matrix. The DNA cytometry showed an increase of the number of the fibroblast cell mitoses up to 16 days. After 2 weeks a mesh of connective tissue was formed around the scaffold, but the number of fibroblast cells remained constant. At 4 weeks the connective tissue started to infiltrate in between the artificial fibres. Type I, III and V collagens were identified. Electron microscopically the collagen weave was irregular with a mean fibril diameter of 28.4 ± 5.2 nm of a monophasic distribution. Collagen type I accumulated progressively and more and more dense collagenous fascicles appeared in the mesh in the proximity of the artificial fibres.

Conclusion: The subcutaneous tissue may act as a bio-reactor and the skin fibroblast seeding of a synthetic matrix appears to be transformed a dense connective tissue during the first 4 weeks, providing tensile strength improvement to the tissue envelope with time.

Aim. We evaluated the effect of the intact periosteum on the biomechanical properties of the rat long bones. Materials-Methods. The biomechanical properties of both femora and tibiae of 30 male, 4-month old Wistar rats have been evaluated in three-point bending testing. In one bone of each pair of femora or tibiae the periosteum was preserved intact, while in the contra-lateral bone the periosteum was stripped off. Ultimate strength,stiffness,energy absorption and deflection were derived automatically from the load-deformation curve recorded for each bone.

Results. As regards the femur, the periosteum-covered bones displayed statistically significant higher values for all parameters measured compared to the periosteum-stripped bones. In the tibia, only energy absorption and deflection were significantly higher in the periosteum-covered bones. The fracture pattern was also different in these two groups. The periosteum-stripped femora and tibiae failed catastrophically, while in the periosteum-covered bones the two bone parts remained in close apposition stabilized by the periosteal membrane.

Conclusion. The periosteum exacerbates the biomechanical capacity of intact rat long bones examined in bending, probably taking advantage of its fibrous composition and elastic properties.

Aim: The aim of our study was to evaluate the results of the Soffix Mark I and Mark II hamstring fixation devices, placed transtibially with an “over the top” femoral route when applied to revision anterior cruciate ligament (ACL) surgery secondary to synthetic ligament failure.

Patients and Methods: 29 ACL revisions performed between 1992 and 2000 were evaluated. Twenty six failed prosthetic ligaments, 2 failed semitendinosus/gracilis (STG) and one BTB autografts were revised using hamstring grafts in 26, quadriceps in 2, and patella bone tendon bone (BTB) in 1 patient. Mark I and II fixation devices were employed. Follow up included clinical examination, KT 2000 arthrometric assessment, Lysholm, Tegner and IKDC scoring. The average follow up time was 50 months ±22.4.

Results: Arthrometric examination showed a mean side to side difference (SSD) of 2.98 mm ±1.5. The mean Lysholm score was 86.5 ±10.5 and 21 patients had a B rating (nearly normal) on IKDC scoring, while 3 score A (normal). The mean Lysholm score was 86.5 ±10.5. The lowest clinical scores were noted in 4 multiply operated knees.

Conclusions: We concluded that a revision technique using the STG Soffix fixation device can restore stability with good functional outcomes following failed primary ACL reconstruction. Multiply re-operated knees had the worst functional results despite restoration of stability.

Aim. The purpose of this paper is to report on the results of ACL hamstring reconstruction using a novel fixation device.

Patients-Methods. We reviewed a total of 132 patients with anterior cruciate ligament reconstruction, operated between 1998 and 2002, with a mean follow up time of 51 ± 9 months. A uniform arthroscopically assisted surgical technique with an instrument guided impingement free tibial tunnel placement and “over the top” femoral routing was employed. An autologous four strand semitendinosus-gracilis tendon graft in combination with a polyester graft suspension tape and cortical fixation device was used. An accelerated rehabilitation was instructed. All patients were examined in a dedicated Research Clinic on a 6 month basis. IKDC, Lysholm and Tegner scoring were employed to validate the end results. Arthrometric evaluation was performed with the KT 2000 device.

Results. The over all analysis showed a mean side to side difference of 2.9 mm ± 1.8 and the International Knee Documentation Committee score rating was 91.6 % normal or nearly normal (121 patients). Complications included one graft rupture, one deep infection and 5 case of loosening.

Conclusion. These findings suggest that the described method of anterior cruciate ligament replacement produces good early functional results and restores knee stability.

Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by evaluating the pre- and postoperative shoulder function using a simple self-assessment questionnaire filled in by the patient.

Patients and Methods. In this study 89 patients were studied who underwent arthroscopic subacromial decompression. Shoulder function was assessed preoperatively and at 3 to 6 months following surgery according to a self-assessment questionnaire, which was developed in our Shoulder Unit. It allows for a maximum score of hundred, with 30 points for pain, 20 for power and 50 points for work, recreation and 8 activities of daily living.

Results. All patients reported improvement in shoulder function with an average total shoulder score increase from 33.4% preoperatively to 87.8% post-surgery. The pain score increased from 21% to 83%, power from 30% to 89% and activities of daily living from 42% to 90%. Detailed analysis of ADL’s showed substantial improvement in all functions.

Conclusion. This study has shown that minimal invasive surgery to the shoulder in the form of arthroscopic procedure, results in satisfactory improvement of all outcome measures in the majority of the patients. Together with low morbidity and early functional recovery, shoulder arthroscopy appears to be the procedure of choice in current surgical practice.

We believe that the self-assessment questionnaire represents a useful outcome measure and reflects the improvement in shoulder function as perceived by the patient.

Purpose: To present the technique and the results of simultaneous arthroscopic reconstruction of Bankart and SLAP lesions in patients with anterior shoulder instability.

Method: We performed shoulder arthroscopy in 95 patients aged 16–38 years (mean age:24,8) suffering anterior shoulder instability. Preoperative evaluation included clinical assessment, x-rays, MRI-arthrogram and examination under anaesthesia in comparison to the healthy shoulder. SLAP lesion was fixed using metallic suture anchors (FASTAK 2,4mm x 11,7 mm-Arthrex).The anchor was inserted in a 45° direction relative to the glenoid level. Bankart lesion was reconstructed using 2–3 bioabsorbable suture anchors (Panalok-Mitek J& J).The arthroscope was inserted through standard posterior, anterosuperior and anteroinferior portals while a posterolateral portal (portal of Whilrnington) was created for SLAP lesion repair. Patients’ average follow-up was 22 months (range, 18–30 months) and the results were evaluated using the ASES score.

Results: SLAP lesion was found in 13 patients: 6 pat.-type II (46%), 3 pat.-type I (23%), 2 pat.-type IV (15%), 1pat.-type III (7,6%) and 1 pat with a complex lesion. Of these patients 10 had also co-existed Bankart lesion. In 2 patients Hill-Sachs lesion was found while degenerative rotator cuff changes existed in 3 patients. While performing clinical evaluation anterior instability signs and symptoms were apparent with the patients complaining also for discomfort and crepitus during overhead activities. MRI preoperative sensitivity for SLAP lesion diagnosis was 59% while specificity and Positive predictive value were 90% and 76% respectively. Shoulder function and the overall ASES score improved from 44 pre-op. to 96 post-op.

Conclusion: Combined Bankart and SLAP lesions are uncommon in non-throwing patients with anterior instability. Arthroscopic suture anchors fixation ensures early and reliable rehabilitation. MRI arthrography study by a skeletal radiologist predicts to a high rate diagnosis.