Mid-term effectiveness of arthroscopic Bankart repair in treatment of recurrent anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation.@*METHODS@#The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded.@*RESULTS@#All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation ( P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients' satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level.@*CONCLUSION@#Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.

Glenoid track «off-track¼ as a risk factor for recurrence of anterior glenohumeral instability in postoperative patients / El encarrilamiento glenoideo off-track como factor de riesgo de recidiva de inestabilidad glenohumeral en pacientes postoperados

Abstract: Introduction: Glenoid track is used to assess the engagement of Hill-Sachs lesions. The objective of this study was to identify if off-track glenoid track was a risk factor for recurrence of anterior glenohumeral instability in postoperative patients with arthroscopic anterior labrum repair. Material and methods: Sixty patients with glenohumeral instability who underwent arthroscopic repair of the anterior labrum were studied. Study group (patients with recurrence of postoperative dislocation) and control (no dislocation). Radiographic measurements were made on magnetic resonance imaging and computed tomography. Measurements of glenoid diameter, glenoid bone loss, as well as the presence and size of Hill-Sachs lesions were obtained. Later they were classified as «on-track¼ or «off-track¼. Results: Seven (11.67%) patients suffered recurrence, of which six (10%) were carriers of an off-track injury and 1 (1.67%) on-Track. 53 (88.33%) patients did not experience recurrence, of which 11 (18.33%) were carriers of an off-track injury and 42 (70%) on track. A 23.47 increased risk of recurrence of instability was interpreted in patients with «off-track¼ lesions compared to patients with «On track¼ lesions. Conclusions: Off-track injuries were a risk factor for recurrence of instability in patients who underwent Bankart-type arthroscopic repair. This allows us to recommend that the presence of lesions be routinely studied and classified as «on-track¼ or «off-track¼ to provide a better therapeutic approach.

Resumen: Introducción: El encarrilamiento glenoideo se emplea para valorar el enganche de lesiones Hill-Sachs. El objetivo de este estudio fue identificar si el encarrilamiento glenoideo off-track fue un factor de riesgo de recidiva de inestabilidad glenohumeral anterior en pacientes postoperados de reparación de labrum anterior por vía artroscópica. Material y métodos: Se estudiaron 60 pacientes sometidos a reparación artroscópica del labrum anterior. Grupo de estudio (pacientes con recidiva de luxación postoperatoria) y control (sin luxación). Las mediciones radiográficas se realizaron en resonancia magnética y en tomografía axial computarizada. Se obtuvieron mediciones del diámetro glenoideo, pérdida ósea glenoidea así como la presencia y tamaño de lesiones de Hill-Sachs. Posteriormente se clasificaron como on-track u off-track. Resultados: Siete (11.67%) pacientes sufrieron recidiva, de los cuales seis (10%) eran portadores de lesión off-track y uno (1.67%) on-track. 53 (88.33%) pacientes sin recidiva, de los cuales 11 (18.33%) eran portadores de lesión off-track y 42 (70%) on-track. Se interpretó un aumento de riesgo de recidiva de inestabilidad de 23.47 en los pacientes portadores de lesión de tipo off-track en comparación con los pacientes portadores de lesiones on-track. Conclusiones: Las lesiones off-track fueron un factor de riesgo de recidiva de inestabilidad en los pacientes a quienes se realizó reparación artroscópica tipo Bankart, lo cual nos permite recomendar que de forma rutinaria se estudie la presencia de lesiones y clasificarlas como on-track u off-track para brindar un mejor abordaje terapéutico.

Manejo con instrumentación 360 o de enfermedad ósea metastásica que condiciona inestabilidad en columna cervical. Reporte de un caso clínico / 360 degrees instrumentation for cervical instability due to metastatic bone disease. Case report

Resumen: Introducción: La columna vertebral es el sitio más frecuente de localización para las metástasis óseas; siendo los tumores de mama, próstata y pulmón los que mayor afectación presentan. La columna torácica es afectada en un 70% de los casos, seguida de la región lumbar y cervical. Material y métodos: se presenta el caso de un paciente con diagnóstico de adenocarcinoma mamario derecho, con enfermedad ósea metastásica en región cervical a nivel de C2, C3, inestabilidad del segmento cervical por fractura por compresión del cuerpo C3 de mayor al 80%, sin invasión a canal medular, inicia con parestesias de extremidades torácicas. Se realiza instrumentación 360º en dos tiempos. Posterior al procedimiento la paciente evolucionó sin dolor cervical y tolerando la vía oral. Discusión: la enfermedad ósea metastásica genera lesiones importantes en la columna vertebral condicionando inestabilidad; la instrumentación mejora el estado funcional y el pronóstico.

Abstract: Introduction: The spine is the most common site for bone metastases; being the breast, prostate and lung cancer which have most affected. The thoracic spine is involved in 70% of cases, followed by the lumbar and cervical region. Material and methods: This is a 59 years old female diagnosed with breast adenocarcinoma and metastatic bone disease in cervical spine C2, C3 level and instability of that segment because of a compression fracture of C3 greater than 80% without invasion of the spinal canal, she begins with paresthesias of upper limbs. A 360º instrumentation was performed in two stages. After the surgical procedure the patient were without neck pain and a good neurological status. Discussion: Metastatic bone disease causes significant damage to the spine sometimes create instability proper instrumentation is needed to improve the functional status and prognosis of these lesions.

Results of Revision Surgery and Causes of Unstable Total Knee Arthroplasty

BACKGROUND: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. METHODS: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. RESULTS: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8degrees/3.2degrees (p = 0.713) and 22.5degrees/5.6degrees (p = 0.032). Mean postoperative alpha, beta, gamma, delta angle were 5.34degrees, 89.65degrees, 2.74degrees, 6.77degrees. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123degrees to 122degrees (p = 0.82). CONCLUSIONS: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.

Avaliação dos fatores predisponentes nas instabilidades femoropatelares / Avaliation of predisposing factors in patellofemoral instabilities

OBJETIVO: Avaliar a prevalência dos fatores predisponentes à instabilidade femoropatelar (displasia de tróclea, patela alta, TAGT, báscula patelar) em um grupo de pacientes acompanhados em nível ambulatorial. MÉTODOS: Avaliou-se 70 pacientes, sendo 52 do sexo feminino (74,28 por cento) e 18 (25,72 por cento) do sexo masculino, num total de 127 joelhos, com uma média de idade de 17,71 anos. A avaliação por imagem foi realizada através de radiografias e tomografia computadorizada. As instabilidades femoropatelares foram classificadas seguindo-se a classificação de Henri Dejour (instabilidade maior, objetiva e potencial). Enquadraram-se as displasias trocleares de acordo com a classificação de David Dejour (tipo A, B, C, D). RESULTADOS: Observou-se displasia troclear em 118 (92,91 por cento) joelhos, sendo 91 (77,11 por cento) joelhos dos tipos A e B. A altura patelar apresentou uma média de 1,23, com 44 (34,64 por cento) consideradas patela alta e 83 (65,36 por cento) normais. A báscula patelar alterada foi encontrada em 92 (72,44 por cento) joelhos e a elevação da TAGT em 63 (49,60 por cento) joelhos. Obteve-se predominância de instabilidades objetivas 89 (70,07 por cento) joelhos, Quanto a associação de fatores predisponentes,, 117 (92,13 por cento) joelhos apresentaram mais quem um fator. CONCLUSÕES: A instabilidade femoropatelar é uma doença multifatorial, os distúrbios trocleares são mais prevalentes e há uma forte associação entre 2 ou mais fatores predisponentes.

OBJECTIVE: To evaluate the prevalence of predisposing factors for femoropatelar instability (dysplasia of the trochlea, high patella, TTTG, and patellar tilt) in a group of patients in outpatient follow-up. METHODS: 70 patients were evaluated; 52 (74.28 percent) female and 18 (25.72 percent) male, with an average age of 17.71 years and a total of 127 knees. The evaluation by imaging was carried out through radiologic examination and computerized tomography. The femoropatelar instabilities were classified according to Henri Dejour's classification (major, objective and potential instability). The trochlear dysplasia was classified according to David Dejour's classification (type A, B, C, D). RESULTS: Trochlear dysplasia was observed in 118 knees (92.91 percent), with 91 knees (77.11 percent) being of type A and B. The average for patellar height was 1.23, with 44 (34.64 percent) considered high patellas and 83 (65.36 percent) within the normal range. Abnormal patellae tilt was found in 92 knees (72.44 percent) and an elevation of TTTG in 63 knees (49.60 percent). The was a prevalence of objective instabilities with 89 knees (70.07 percent). In relation to the association of predisposing factors, 117 knees (92.13 percent) presented more than one factor. CONCLUSIONS: Femoropatelar instability is a multifactorial disease, with trochlear disorders being the most frequent, and there is a strong association between two or more predisposing factors.

Diagnóstico da instabilidade atlanto-axial na Síndrome de Down: revisão de literatura / Atlantoaxial instability diagnosis in Down Syndrome: article review

A Síndrome de Down é a mais comum e a mais bem estudada alteração genética pelo ser humano. É caracterizada por más-formações em diversos órgãos e sistemas, incluindo alterações músculo-esquelético, dentre os quais se destaca a instabilidade atlanto-axial (IAA) devido ao seu potencial de gravidade. Estudos têm sido realizados a fim de padronizar métodos e parâmetros para seu diagnóstico, tendo a radiografia simples em perfil o método mais empregado, porém ainda com grandes divergências sobre os melhores parâmetros adotados como referência de normalidade. Além da radiografia simples, a tomografia computadorizada e a ressonância magnética vêm emergindo como grandes aliadas para tanto diagnóstico como planejamento terapêutico. O presente estudo visa discutir os métodos atuais mais empregados para o diagnóstico da IAA com base em revisão de literatura, focando no diagnóstico radiográfico simples como método de escolha inicial para detecção das IAA.

Down Syndrome is the most common and best studied human genetic alteration. It is characterized by malformations in various organs and systems, including musculoskeletal alterations, prominent among which is the atlantoaxial instability (AAI) owing to its potential gravity. Studies have been carried out to standardize methods and parameters for its diagnosis, a simple profile radiography being the simplest method used. Aside from simple radiography, computerized tomography and magnetic resonance are emerging as great allies for either diagnosis or therapeutic planning. The present study seeks to discuss the methods most in use today for diagnosing AAI based on a review of the literature, settling on simple diagnostic radiography as the method of first choice in detecting AAI.

Mucopolissacaridose tipo VI (síndrome de Maroteaux-Lamy): avaliação da mobilidade articular e das forças de garra e de pinça / Mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome): assessment of joint mobility and grip and pinch strength

OBJETIVO: Descrever o perfil de mobilidade articular e das forças de garra e de pinça de indivíduos com MPS VI, além de sua correlação com a excreção urinária de glicosaminoglicanos, atividade da ARSB e distância percorrida no teste de caminhada de 6 minutos. MÉTODOS: Estudo observacional de 28 pacientes com MPS VI, não submetidos a tratamento específico. Todos os pacientes foram avaliados em relação à amplitude da mobilidade articular, forças de garra e de pinça, excreção urinária de glicosaminoglicanos, atividade da ARSB e teste de caminhada de 6 minutos. RESULTADOS: Demonstrou-se maior comprometimento de flexão de ombro, sem correlação com a idade, e da extensão de joelho e flexão de cotovelo, estas últimas correlacionadas negativamente com a idade. A força de garra mostrou-se comprometida em todos os pacientes, e a força de pinça apresentou correlação positiva com idade. CONCLUSÕES: A restrição da flexão de ombro, sem correlação com a idade, sugere que este achado esteja presente precocemente na MPS VI e se constitua em sinal clínico importante para suspeita diagnóstica desta doença. A amplitude da extensão de joelho e da flexão de cotovelo, por sua vez, por apresentarem correlação negativa com a idade, são possíveis marcadores da evolução da doença. Estudos adicionais são necessários para confirmação dessas hipóteses.

OBJECTIVE: To describe the profile of joint mobility and grip and pinch strength of MPS VI patients and to correlate this with urinary excretion of glycosaminoglycans (GAGs), ARSB activity, and the distance covered in a 6-minute walking test (6MWT). METHODS: This was an observational study of 28 patients with MPS VI, who had not undergone specific treatment. All patients were assessed for amplitude of joint mobility (shoulder, elbow, and knee), grip and pinch strength and urinary GAG excretion and also performed the 6MWT. RESULTS: Shoulder flexion exhibited the greatest limitation, with no correlation with age, followed by knee extension and elbow flexion, both of which were correlated inversely with age. Hand grip strength was compromised in all patients, and pinch strength exhibited a positive correlation with age. CONCLUSIONS: The fact that restricted shoulder flexion was not correlated with age suggests that this finding is present early on in MPS VI and that it constitutes an important clinical sign that should arouse diagnostic suspicion of this disease. The amplitude of knee extension and elbow flexion, in turn, are possible markers of disease progression since they have a negative correlation with age. Further studies are needed to confirm these hypotheses.

Anatomy of the ligamentous and tendinous structures of the posterolateral corner of the knee: a proposal for there perair

Knowledge of the anatomy and biomechanics of the posterolateral corner of the knee is required for the proper evaluation of its posterolateral injuries and provides insight into the treatment of the resulting posterolateral instability. To describe the gross anatomy of the ligamentous and tendinous structures of the posterolateral corner of the knee and to provide a proposal for their repair. Cadaveric study included dissection of ten preserved lower limbs. The three critical stabilizers of the posterolateral corner of the knee are the fibular collateral and poplitofibular ligaments and the tendon of popliteus muscle. They resist varus angulation of the knee and posterior translation and external rotation of the tibia. The Fibular collateral ligament is the stabilizer in full extension and the other two structures are responsible for the posterolateral stability in flexion. The lateral intermuscular septum and the iliotibial tract could provide fibrous band suitable for the reconstruction of the three stabilizer of the posterolateral corner of the knee

Lesión de SLAP: evaluación mediante RM dinámica y artrorm dinámica / Superior labrum anteroposterior (SLAP) lesion: evaluation with dynamic MRI and MR-arthrography

Propósito: presentar nuestra experiencia en pacientes con inestabilidad articular de hombro y RM convencional no concluyente, evaluando los signos de lesión de SLAP en RM dinámica (RMD) y ArtroRM dinámica (ARMD). Material y método: se realizó un estudio prospectivo evaluando mediante RMD y ARMD a 10 pacientes con inestabilidad articular y RM convencional previa no concluyente. Se analizaron los signos positivos para lesiones del complejo bicípito labral (CBL), las lesiones asociadas del manguito rotador y complejo labro ligamentario; y los falsos positivos y negativos. Evaluamos las variantes de la lesión acorde a la clasificación artroscópica de Snyder (tipo I herida labral pura, tipo II avulsión del CBL, tipo III herida en asa de balde que respeta al tendón bicipital y tipo IV herida en asa de balde que se extiende dentro del tendón bicipital), aceptada en forma unánime en la práctica traumatológica nacional e internacional. Resultados: se descubrieron 8 casos con signos positivos para lesiones de tipo SLAP, 6 ARMD y 2 RMD. En 2/10 casos no se observaron lesiones SLAP. La totalidad presentaba alguna otra lesión tendinosa, labral u osteocartilaginosa asociada y diagnosticada previamente en la RM convencional. Conclusión: la RMD y la ARMD han demostrado ser de utilidad en la presentación de la lesión de SLAP y su clasificación, contribuyendo al diagnóstico completo y planeamiento quirúrgico apropiado

Value of arthrosonography in diagnosis of juvenile irritable hip.

This study was designed to evaluate the role of US in the early diagnosis and management of irritable hip in pediatric patients. Full history taking, general examination and thorough local examination of all body joints, especially the hip joints, were performed. Laboratory investigations including hemogram, ESR, CRP, ASO, ANA, RF, tuberculin test, complete urinalysis and stool analysis were done. Radiological examination, especially plain X-ray, AP and frog lateral position was also done. Bilateral hip US, guided US aspiration and analysis of the joint effusion, if needed, were carried out. The results showed that arthrosonography is superior, accurate and early diagnostic tool compared with plain X-ray for the detection of joint effusion as well as it can be used also for guided aspiration for diagnostic, therapeutic and follow up of articular fluid collections. Arthrosonography can detect 1 mm of hip effusion, which is lacking in plain X-ray. Although US can detect gross bony abnormalities in anterior aspect of femoral head and neck, bone disease is better detected by plain X-ray. Therefore, both US and X-ray are complementary in the evaluation of hip diseases in pediatrics

Disfunción patelofemoral: evaluación integral por imágenes / Patellofemoral joint disfunction. Combined diagnostic imaging: evaluation (X-Rays exams, 3D Helical CT and MRI)

Se estudiaron 43 pacientes con diagnóstico presuntivo o de certeza de inestabilidad patelofemoral. A todos los pacientes se les realizó: a) par radiológico; b) adquisiciones tomográficas en extensión y flexión, sin y con contracción, mediante un tomógrafo helicoidal y c) secuencia de RM en plano axial STIR. Los hallazgos fueron clasificados en lesiones musculares, cartilaginosas, óseas y asociadas, comparando estadísticamente los estudios. Los resultados nos permiten aceptar la hipótesis de que el estudio integral proporciona un diagnóstico más completo del origen de la disfunción patelofemoral. En el 65 por ciento de los pacientes el estudio convencional dio un resultado negativo. Sólo en el 35 por ciento de los casos el resultado fue positivo, pero en forma incompleta, mostrando únicamente el 35,3 por ciento de los hallazgos patológicos detectados por el estudio integral

Atlanto - axial rotatory instability

Atlanto-axial rotatory subluxation was diagnosed in 13 patients. Traumatic cases has been recorded in [11] patients [84.16%] in which the rotatory instability was postulated as a result of direct trauma. Seven cases [63.63%] out of 11 cases] were diagnosed early by the aid of radiography and computed axial tomography and they were reduced spontaneously. While the remaining 4 cases [36.37%] were treated by short period of halter traction to achieved reduction and were followed by collar support. Non traumatic subluxation of the altantoaxial joint following peripharyngeal inflammation [Grisel's syndrome], were seen in 2 patients [15.48%] which has been attributed to laxity of the transverse ligament caused by inflammatory hyperemia. These [2 cases, [15.84%]] were diagnosed 10 months later and were submitted to cervical fusion in situ for instability

Lesiones traumáticas del ligamento cruzado posterior / Traumatic injuries of the posterior cruciate ligament

La presencia de lesiones traumáticas del LCP es poco frecuente. El diagnóstico clínico y artroscópico de estas lesiones puede ser difícil, por lo que su detección por RM es de fundamental importancia. Se estudiaron 9 pacientes, 5 de los cuales tenían sospecha clínica de lesión del LCP. Los pacientes fueron evaluados mediante RM, encontrándose 7 casos patológicos. En esos pacientes, los hallazgos obtenidos fueron: tres rupturas parciales, tres rupturas totales y tres fracturas avulsión de la inserción tibial del LCP. Es importante detectar el tipo de lesión que afecta al LCP, ya que su adecuado diagnóstico determinará la conducción terapéutica a instituir, indicando, si fuera necesario, la conducta quirúrgica. La RM es el método más adecuado para la evaluación del LCP, permitiendo diferenciar los distintos tipos de lesión y, en algunos casos, poner en evidencia lesiones no sospechadas

Diagnóstico y tratamiento del síndrome de inestabilidad postraumática del carpo / Diagnosis and treatment of the postraumatic carpal instability syndrome

Se realizó un estudio prospectivo de los pacientes que fueron atendidos en el Servicio de Urgencias del Hospital Docente Clinicoquirúrgico "Vladimir Ilich Lenin" con lesiones traumáticas de la muñeca, entre enero de 1993 y diciembre de 1995. Cuarenta y ocho pacientes presentaron como complicación una inestabilidad del carpo. Ésta fue más frecuente en mujeres y posterior a una fractura de Colles. El 35,41 porciento requirió tratamiento quirúrgico. Se discute el diagnóstico y el tratamiento

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

Anatomical repair of anteroinferior shoulder instability

This work aimed to evaluate the results of identifying the causes and pathological disorders of anteroinferior shoulder instability and accordingly treating the condition. Eighteen patients suffering from persistent disabling shoulder instability were selected after failure of conservative treatment. Patients with anteroinferior instability were examined clinically, radiologically and arthroscopically if available to reach the etiological and pathological underlying factors. Redundancy of the capsule and capacious inferior pouch were detected in all cases of anteroinferior instability. Tear of the labrum and Hill Sachs lesion were found in some patients. Capsular shift procedure and repair of Bankart lesion if present were done. The technique which allows performing the two procedures was described. The results were satisfactory in all patients except two cases. It was concluded that anatomical repair including capsuloplasty and obliteration of the capacious inferior capsular pouch gave good results in treating recurrent anteroinferior shoulder instability