Research progress of the diagnosis and treatment of anterior shoulder instability / 中国修复重建外科杂志

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI / A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

Latarjet procedure on anterior shoulder instability in professional soccer players / Cirurgia de latarjet na instabilidade anterior do ombro em jogadores profissionais de futebol

ABSTRACT Anterior glenohumeral instability is a frequent cause of professional soccer players' removal, reduced performance, and prolonged recovery. Players are subjected to intense physical contact and high performance, thus demanding lower rates of recurrence after surgical correction so they can return to sport quickly. Objective: To assess professional soccer players treated by the Lartajet technique considering the rate and time of return to sports activities, complications or failures. Methods: Analysis held between 2010 and 2018 of professional soccer players diagnosed with anterior shoulder instability operated by the open procedure of Lartajet in our service. Results: The mean return to professional sports was 93.5 days. The mean time of surgery in relation to the first dislocation was 12.4 months. Each athlete had 4.3 shoulder dislocations until the procedure was performed. The rate of recurrence was zero and subluxation was not observed. Conclusion: The Latarjet procedure allowed all professional athletes to return to competitive activities quickly, without dislocations and subluxation, negative seizure and without complications during follow-up. Level of evidence IV, Case series.

RESUMO A instabilidade glenoumeral anterior é uma frequente causa de afastamento dos jogadores de futebol profissional, redução do desempenho e recuperação prolongada. Os jogadores são submetidos ao contato físico intenso e ao alto desempenho, sendo assim necessário atingir menores taxas de recidiva após a correção cirúrgica e retorno ao esporte de forma mais rápida. Objetivo: Avaliar jogadores de futebol profissionais tratados pela técnica de Lartajet com análise da taxa e tempo de retorno às atividades esportivas, complicações ou falhas. Métodos: Análise entre 2010 a 2018 de dez jogadores de futebol que estão atuando em clubes profissionais, diagnosticados por instabilidade anterior do ombro operados pelo procedimento aberto de Lartajet em nosso serviço. Resultados: A média de retorno ao esporte profissional foi de 93,5 dias. A média de tempo da cirurgia em relação ao primeiro episódio de luxação foi de 12,4 meses. Cada atleta teve 4,3 luxações de ombro até o procedimento ser realizado. A taxa de recidivas foi zero e não foi observada subluxação. Conclusão: O procedimento Latarjet propiciou que todos os atletas profissionais de futebol retornassem às atividades competitivas de maneira rápida, sem recidivas das luxações e subluxações e sem complicações durante o acompanhamento realizado. Nível de evidência IV, Séries de casos.

Current concepts of diagnostic techniques and measurement methods for bone defect in patient with anterior shoulder instability / 中国修复重建外科杂志

Objective: To summarize the diagnosis and measurement methods of bone defect in anterior shoulder instability (glenoid bone defect and Hill-Sachs lesion). Methods: The related literature on the diagnosis and measurement of the bone defect in anterior shoulder instability was reviewed and summarized. Results: The commonly used techniques for the diagnosis of anterior glenoid bone defect and Hill-Sachs lesion of humeral head include X-ray, CT, MRI, arthroscopy, arthrography. The methods for measuring the degree of anterior glenoid bone defect include Griffith method, glenoid index method, Pico method, and best-fit circle method. The indexes for measuring the Hill-Sachs lesion include the length, width, depth, and volume. X-ray is mainly used for primary screening. Best-fit circle method on three-dimensional (3D) CT reconstruction is commonly used to measure the glenoid bone defect currently. Glenoid track theory on 3D CT reconstruction is popular in recent years. Reliability of measuring the glenoid bone defect and Hill-Sachs lesion with MRI and arthroscopy is still debatable. Arthrography is more and more used in the diagnosis of shoulder joint instability of bone defect and concomitant soft tissue injury. Conclusion: How to improve the accuracy of evaluating glenoid bone defect and Hill-Sachs lesion before surgery still need further study.

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

PURPOSE: The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods: The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. RESULTS: There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. CONCLUSION: Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.

Establishment of Anterior Instability of Gienohumeral Joint on Rabbits / 中国运动医学杂志

Objective To establish the animal model(rabbit) of shoulder instability for providing the experimental basis of related studies.Methods shoulder joints of 6 skeletally matured New Zealand white rabbits were measured with the anatomical characteristics and joint motion range in order to determine the operative approach,the similarities of skeletal structure,surrounding muscles,joint capsule and ligaments between rabbit and human were compared.Eighteen rabbits,weighing between 2.5 and 3kg were randomized into 2 groups(experimental group 12 and control 6).In experimental group,instability model was established by means of the operation procedure as follows:the glenohumeral joint of right shoulder was exposed by cutting the subscapularis tendon,then the anteroinferior labrum and surrounding capsular ligament were excised.For control group,sham operation was performed by only curing the skin and superficial tissue,the subscapularis tendon and glenoid structures was kept intact.The specimens of 6 rabbits were harvested 6 weeks after operation.The remaining rabbits of both experimental and control groups were killed 12 weeks post the operation for specimens processing.The motion range and instability were measured in all specimens.Results The gross anatomy of shoulder ioint in rabbit is similar to human.In experimental group,the stability is showed less than control,grade 2 anterior instability was found.The motion range was restricted in all directions,such as external and internal rotation,extension and abduction compared to control group.Conclusion Rabbit is suitable to establish animal model for shoulder instability and related iniuries,the animal model which was designed by this study could provide valuable information for the research of anterior shoulder instability.

One Anchor Double Fixation (OADF) Technique for Arthroscopic Bony Bankart Repair

PURPOSE: The aim of this study was to evaluate the usefulness of arthroscopic Bony Bankart repair using a One Anchor Double Fixation Technique. MATERIALS AND METHODS: Seventeen patients with a Bony Bankart lesion were treated using the One Anchor Double Fixation Technique (OADF Technique). There were 13 males and 4 females. The average age was 24 years (range 17-42). The average follow-up period was 22.3 months. One 3.0 mm suture anchor with doubly loaded sutures was inserted into the glenoid rim. One suture strand was passed the around the small bony fragment and tied first. Another suture strand was passed through the capsule and tied over the bony fragment. The result was measured using Rowe's evaluation index & KSS score. The glenoid defect & bony fragment were measured by 3D-CT scan. RESULTS: Rowe's evaluation index on the final follow-up showed an overall improvement from an average of 54 (range, 23-71) to 83.4 (range 71-90). Of the 17 cases, 13 were excellent, 3 were good, and 1 was fair. KSS scores showed improvement from an average of 71 (range 49-82) to 92.5 (range 82-94). There were no cases where pain continued to the final follow-up, and no cases being re-dislocated during the follow-up period. For six cases, we confirmed the bony healing of the bony Bankart lesion by CT. CONCLUSION: Bony Bankart lesion repair using this new method achieves excellent clinical results with low recurrence rates and is considered another choice for bony Bankart lesions.

Integridade do músculo subescapular após a cirurgia aberta para tratamento da luxação recidivante glenoumeral: avaliação clínica e radiológica / Integrity of the subscapularis tendon after open surgery for the treatment of anterior shoulder instability: a clinical and radiological evaluation

OBJETIVO: Avaliar a integridade do músculo subescapular através da força, função e ressonância nuclear magnética após acesso deltopeitoral para tratamento da luxação glenoumeral anterior recidivante. MÉTODOS: Foram avaliados 20 pacientes com luxação recidivante do ombro. Todos os casos possuíam seguimento mínimo de 12 meses, com média de 40 meses. Os pacientes eram todos do sexo masculino, com média de idade de 29 anos (20-42 anos). Os pacientes foram submetidos a exame físico para avaliar mobilidade, força muscular, "Belly" Teste e teste de Gerber. A força isocinética em rotação interna e externa, em velocidades angulares de 60º/s e 180º/s, em ambos os ombros, foi medida utilizando-se um dinamômetro. Em 15 pacientes foi realizada ressonância nuclear magnética (RNM) em ambos os ombros para avaliação da espessura, área e possível hipotrofia do músculo subescapular. RESULTADOS: Houve diferença significativa entre os picos de torque para a velocidade de 60º/s para as rotações interna (p = 0,036) e externa (p = 0,008). Porém, para a velocidade de 180º/s a situação se inverte (rotação interna: p = 0,133; rotação externa: p = 0,393). A espessura e a área do subescapular são significativamente menores que as do lado normal, com déficit de 19 por cento e 23 por cento, respectivamente. De acordo com os escores de Rowe e da UCLA, observamos excelentes e bons resultados na maioria dos pacientes, com média de 88 e 31,6 pontos, respectivamente. CONCLUSÃO: Apesar dos bons resultados funcionais, a cirurgia aberta pode restringir a força, bem como reduzir a espessura e a área da seção transversal do músculo subescapular. Os melhores resultados ocorreram no lado dominante.

OBJECTIVE: To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. METHODS: 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 - 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 60º/s and 180º/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. RESULTS: A significant difference was found between torque peaks at the speed of 60º/s for internal (p=0.036) and external (p=0.008) rotation. However, at 180º/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19 percent and 23 percent, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. CONCLUSION: Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated.

Análise das lesões intra-articulares na instabilidade anterior do ombro / Analysis of intra-articular lesions in anterior shoulder instability

Introdução: Instabilidade anterior do ombro é uma afecção frequente, na qual uma de suas consequências é o surgimento de lesões labrais, ósseas e do manguito rotador. Estas lesões que, muitas vezes, estão associadas, variam no seu tamanho de acordo com a causa e número de episódios de luxações. Objetivo: Descrever as alterações intra-articulares encontradas nos pacientes submetidos ao tratamento artroscópico para instabilidade anterior do ombro e correlacionar os achados com a causa da luxação e o número de episódios até o tratamento. Material e métodos: Entre agosto de 2006 e julho de 2007, 60 cirurgias para instabilidade anterior do ombro foram realizadas no Instituto Nacional de Traumatologia e Ortopedia (INTO). Protocolo pré-operatório específico identificando-se: idade, sexo, mecanismo do primeiro episódio de luxação (traumática ou atraumática) e número de luxações foi preenchido em todos os casos. Ao final do procedimento cirúrgico foi preenchido um protocolo descrevendo a eventual presença das seguintes lesões: Bankart, Hill-Sachs, SLAP, ALPSA, HAGL, ruptura do manguito rotador e lesão óssea da glenoide. As lesões da glenoide foram divididas em três tipos: lesão condral sem defeito ósseo, lesões com perda óssea menor e maior que 27%. Resultados: Dos 60 pacientes, 42 eram do sexo masculino e 18 do feminino. A média de idade foi de 30 anos (16-54), 45 casos traumáticos e 15 atraumáticos e a média de luxações foi de 20 episódios (1-100). A lesão de Bankart esteve presente em 57 pacientes (95%), Hill-Sachs em 53 (88%), a do manguito rotador em três casos (5%), SLAP em 11 (18%) e a lesão ALPSA em três (5%). Conclusão: Todos os casos traumáticos e a maioria dos atraumáticos apresentaram lesão do labrum anterior. Não houve associação entre o número de luxações e lesão óssea na glenoide ou entre o mecanismo do primeiro episódio e presença de lesão óssea.

Latarjet Operation for Anterior Shoulder Instability with Glenoid Bone Defect

PURPOSE: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. MATERIALS AND METHODS: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. RESULTS: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of 8degrees and 16degrees less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. CONCLUSION: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.

Current Concepts in Arthroscopic Treatment of Anterior Shoulder Instability / 영남의대학술지

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.

Analysis of West Point View in Anterior Shoulder Instability / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of the West point view, we investigated the osseous pathology of the glenoid rim associated with shoulder instability and estimate the inter-observer reliability. MATERIALS AND METHODS: The West point views of sixty-seven patients with labral lesion confirmed by operation were mixed with those of thirty-three normal controls. Six observers independently reviewed the mixed radiographs and checked the lesion by identifying the glenoid erosion, bony defect, ectopic ossification and Hill-Sachs lesion. The incidence of osseous lesions suggesting instability was estimated. Sensitivity in the patient group, specificity in the normal control and inter-observer reliability were calculated to evaluate study susceptibility. RESULTS: The sensitivity of 67 patients group was 81.8% on average (73-94%), the specificity of 33 member control group was 85.2% (82-94%). The most frequent finding was glenoid erosion, with an average of 54.7%, which providing a sensitive clue of shoulder instability. Inter-observer reliability analyzed by using Kappa values showed significant agreement. (alpha=0.1 significant level). CONCLUSION: The West point view is considered to be a reliable diagnostic modality for shoulder instability. The additional sophisticated method is indicated only when a discrepancy between physical examination and radiologic findings exists.

Various Pathologic Lesions Associated with Anterior Shoulder Instability: Experience over 10-Years of Arthroscopic Treatment / 대한정형외과학회잡지

PURPOSE: We report upon the frequency and results of treatment for various pathologic lesions such as ALPSA lesions, capsular laxity, mid-capsular tear and HAGHL lesions in cases of anterior shoulder instability. MATERIALS AND METHODS: Two hundred and four consecutive patients with anterior shoulder instability underwent arthroscopic repair and the outcomes were evaluated according to various lesions and treatment modalities in a retrospective study afte a minimum of one year elapsed after surgery. RESULT: All 24 cases of ALPSA lesions were treated using the arthroscopic transglenoid suture technique. Clinical results were excellent in 18 cases. Of 67 cases of capsular laxity, type IV Bankart lesion was combined in 42. 47 cases were treated with the transglenoid technique and 20 with the transglenoid suture technique and capsular shrinkage. The clinical results were excellent in 45 cases. All 11 cases of mid-capsular tear were treated with its combined lesion, and the clinical results proved to be excellent in 8 cases. Of the 4 cases of HAGHL lesions, all cases were treated with the direct suture technique, and 2 had excellent clinical results. CONCLUSION: In the case of anterior shoulder instability, various pathologic lesions as well as Bankart lesion can be found. Therefore, the evaluation of the exact pathologic lesion causing instability and its appropriate treatment are important for satisfactory surgical outcomes. The arthroscopic transglenoid suture technique is one of the most useful methods of reconstruction in various pathologies of shoulder instability.

Arthroscopic Classification of Bankart Lesion and Modification of Arthroscopic Capsular Suture / 대한정형외과학회잡지

Forty-five modified arthroscopic transglenoid suture capsulorrhaphy were performed between January 1989 and May 1995 with minimum follow-up of one year among sixty-four recurrent anterior shoulder instability in Chungnam National University Hostital. The average age at operation were 25 year and average time interval from injury to surgery were 12 month. we classify the Bankart lesion into 4 type according to the extent of capsulolabral complex detatchment, associated glenoid rim fracture, type II SLAP lesion and absence of glenoid labrum. Type Ia have a separation of labrum and inferior glenohumeral ligament from the glenoid rim and scapular neck (classic Bankart lesion) and type IIa have a capsular separation and glenoid rim fracture. Type IIIa have above mentioned type Ia or type IIa with type II SLAP lesion and type IVa have capsular separation without identifiable labral structure. We also subdivided the each type into subgroup b according to coexistence of capsular laxity. We modify the capsular suture technique according to classification. Type Ia, and type IIa were treated with in situ Bankart repair. Type Ib and type IIb were treated with capsular advancement. Type IIIa and 1IIb were treated with Bankart repair and additional fixation of SLAP lesion. Type IVa and IVb were treated with purse string type suture (capsular shift superiorly) with multiple stitches. All patients had various shape of Bankart lesion, so author s proposed classification of the Bankart lesion can be applied to each type. Arthroscopic finding were as follows. Twelve shoulders (27%) have type Ia Bankart lesion and six patient (13%) have type lIa lesion. Type lIIa were observed in eight shoulders (18%) and four patient (9%) were type IVa. The capsular laxity (subgroup b) were found in 15 patient (33%). None of the 45 patients experienced intraoperative complications or infec tion. All patients had full, painless range of motion and had no recurrence except four patient. One is type IIIa Bankart lesion in which associated type II SLAP was not repaired and the other two patients had sport injury and one patient had severe retrauma on 2 years after operation. We conclude that Bankart lesion is the essential lesion of recurrent anterior shoulder instability and were founded in all cases of recurrent anterior shoulder instability, and modified athroscopic transglenoid suture capsulorrhaphy according to arthroscopic classification is safe and effective method with acceptable recurrence rate.