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The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice. [ABSTRACT FROM AUTHOR]

Context: Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. Study Design: Clinical review. Evidence Acquisition: A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. Level of Evidence: Level 5. Results: There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. Conclusion: Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239). [ABSTRACT FROM AUTHOR]

Background: Clinical trials are currently underway to investigate the efficacy of intra-articular administration of mesenchymal stromal cells (MSCs) to mitigate osteoarthritis (OA) progression in the knee. Although multiple MSC sources exist, studies have yet to determine whether differences in therapeutic efficacy exist between them. Purpose: To compare the ability of intra-articularly injected adipose-derived MSCs (AD-MSCs) and amnion-derived MSCs (AM-MSCs) to mitigate the progression of knee OA in a small animal model of spontaneous OA, as well as to compare the therapeutic potential of MSCs in hyaluronic acid (HA) and in HA only with saline (OA) controls. Study Design: Controlled laboratory study. Methods: Injections of AD-MSCs or AM-MSCs suspended in HA or HA only were performed in the rear stifle joints of 3-month-old Dunkin Hartley guinea pigs (DHGPs). Repeat injections occurred at 2 and 4 months after the initial injection in each animal. Contralateral limbs received saline injections and served as untreated controls. Subsequently, joints were analyzed for osteoarthritic changes of the cartilage and subchondral bone via histologic and biochemical analyses. To evaluate MSC retention time in the joint space, DHGPs received a single intra-articular injection of fluorescently labeled AD-MSCs or AM-MSCs, and the fluorescence intensity was longitudinally tracked via an in vivo imaging system. Results: No statistically significant differences in outcomes were found when comparing the ability of AD-MSCs and AM-MSCs to mitigate OA. However, the injection of AD-MSCs, AM-MSCs, and HA-only treatments more effectively mitigated cartilage damage compared with that of saline controls by demonstrating higher amounts of cartilage glycosaminoglycan content and improved histological proteoglycan scoring while reducing the percentage of osteophytes present. Conclusion: Intra-articular injection of AD-MSCs, AM-MSCs, or HA only was able to similarly mitigate the progression of cartilage damage and reduce the percentage of osteophytes compared with that of saline controls in the DHGP. However, this study was unable to establish the superiority of AD-MSCs versus AM-MSCs as a treatment to mitigate spontaneous OA. Clinical Relevance: MSCs demonstrate the ability to mitigate the progression of knee OA and thus may be used in a prophylactic approach to delay the need for end-stage treatment strategies. [ABSTRACT FROM AUTHOR]

Background: In the literature there are divergent results as to the native MPFL length change pattern. The reason for such divergent results may be the heterogeneity of design of studies analyzing MPFL isometry. The hypothesis of this review was that studies assessing MPFL length change pattern are highly heterogenous. The aim was to present a state-of-the-art review of sources of this heterogeneity. Materials and Methods: A total of 816 records were identified through the initial search of MEDLINE and Scopus databases. After eligibility assessment, 10 original articles and five reviews were included. In the included studies, the following 15 potential sources of heterogeneity were assessed: number of patients/cadavers, age, males to females ratio (demographics), identification of measured fibers, measurement method, measurement precision, quadriceps muscle activity, iliotibial band activity, hamstrings activity (study design), patellar height, trochlear or patellar dysplasia, femoral anteversion, mechanical axis of the limb, tibial tubercle–trochlear groove distance, and condylar anteroposterior dimensions (morphology). Each variable was graded in every included article with 1 point if reported precisely and not introducing bias; or with 0 points if reported not precisely, introducing bias, or not reported at all. Results: Within original articles, the highest achieved score was 10 out of 15 possible points with mean score of 6.7, SD = 2.37, and minimum score of just 3 out of 15 points. In the demographics section, mean score was 2.4, SD = 0.8 (80% of maximum possible score of 3); in the study design section it was 3.1, SD = 1.87 (52% of maximum possible score of 6); and in the morphology section it was 1.5, SD = 1.43 (25% of maximum possible score of 6). Conclusions: There is high heterogeneity and incomplete reporting of potential sources of bias in studies assessing native MPFL length change pattern. Future investigators should be aware of the presented factors and their potential impact on MPFL isometry. All methodologic factors should be meticulously reported. Detailed description of demographic data is already a standard; however, authors should more extensively report variables concerning study design and morphology of patients' patellofemoral joint. Furthermore, future studies should try to meticulously simulate the real-life working environment of MPFL and ensure usage of proper measurement methods. [ABSTRACT FROM AUTHOR]

Background: Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare those athletes treated with bracing to those who were not. Hypothesis: The use of functional bracing will improve success rates in a cohort of athletes treated nonoperatively for in-season shoulder instability. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 97 athletes with anterior shoulder instability were followed for a minimum of 1 year. The mean age was 15.8 ± 1.4 years (range, 12.0-18.0 years). All athletes were treated with initial nonoperative management. Twenty athletes (21%) were also treated with bracing while 77 (79%) were not. The athlete completing the current season and 1 subsequent season without surgery or time lost from shoulder injury was defined as a successful outcome. Results: There was no statistical difference in nonoperative success rates between the braced and nonbraced athletes (P = 0.33). Braced athletes (n = 20) returned to play 80% of the time, while nonbraced athletes (n = 77) returned at a rate of 88%. Of the braced athletes, 85% were football players (n = 17). A football-only comparison demonstrated no difference between braced failures (26%) and nonbraced failures (16%) (P = 0.47). Conclusion: This is the first study to evaluate the utility of functional bracing in returning an athlete to sport and completing a full subsequent season without surgery or time loss due to injury of the shoulder. In adolescent athletes with shoulder instability treated nonoperatively, functional bracing did not result in increased success rates when compared with no bracing. Clinical Relevance: The data from this study indicate that functional bracing may not improve success rates for athletes with shoulder instability. [ABSTRACT FROM AUTHOR]

A technique for lateral extra-articular tenodesis using proximal staple fixation is described as an adjunct to anterior cruciate ligament (ACL) reconstruction. Lateral extra-articular tenodesis has been used in an effort to decrease failure rates in ACL-deficient patients with ligamentous laxity, prior failed ACL surgery, or grade 3 pivot-shift findings. Numerous surgeons have described combining ACL reconstruction with extra-articular surgery. The approach described in this article is easy and cost-effective. Moreover, because this technique uses a staple instead of a SwiveLock (Arthrex, Naples, FL) or other suture anchor, it limits the chance of conflicting with the tunnels for the ACL because there is no need to drill or punch additional tunnels. [ABSTRACT FROM AUTHOR]

Background: Young age and contact sports have been postulated as risk factors for anterior shoulder instability. Management after shoulder instability is controversial, with studies suggesting that nonoperative management increases the risk of recurrence. Several studies examined return to play after an in-season instability episode, and few followed these patients to determine if they were able to successfully compete in a subsequent season. No study has evaluated this question in a high school athlete population. Purpose: To compare the likelihood of return to scholastic sport and complete the next full season without an additional time-loss injury among athletes with anterior shoulder instability in terms of treatment, instability type, and sport classification. Study Design: Cohort study; Level of evidence, 2 Methods: Athletes were included in this study as identified by a scholastic athletic trainer as experiencing a traumatic time-loss anterior shoulder instability injury related to school-sponsored participation. The cohort was predominantly male (n = 108, 84%) and consisted mostly of contact athletes (n = 101, 78%). All athletes had dislocation or subluxation diagnosed by a board-certified physician who determined the athlete's course of care (nonoperative vs operative). Successful treatment was defined as completion of care and return to the athlete's index sport, with full participation for the following season. Chi-square and relative risk analyses were completed to compare success of treatment (nonoperative vs operative care) and instability type. Separate logistic regressions were used to compare the effect of sex and sport classification on the athletes' ability to return to sport. Statistical significance was set a priori as α = .05. Results: Scholastic athletes (N = 129) received nonoperative (n = 97) or operative (n = 32) care. Nonoperatively treated (85%) and operatively treated (72%) athletes successfully returned to the same sport without injury for at least 1 full season (P = .11). Players sustaining a dislocation were significantly more likely to fail to return when compared with those sustaining a subluxation (26% vs 89%, P = .013). Sex (P = .85) and sport classification (P = .74) did not influence the athlete's ability to return to sport, regardless of treatment type. Conclusion: A high percentage of athletes with shoulder instability achieved successful return to sport without missing any additional time for shoulder injury. Those with subluxations were at almost 3 times the odds of a successful return compared with those sustaining a dislocation. [ABSTRACT FROM AUTHOR]

Background: This review compares the outcomes and complication rates of three surgical strategies used for the management of symptomatic os acromiale. The purpose of this study was to help guide best practice recommendations. Methods: A systematic review of nine prospective studies, seven retrospective studies, and three case studies published across ten countries between 1993 and 2018 was performed. Adult patients (i.e., ≥ 18 years of age) with a symptomatic os acromiale that failed nonoperative management were included in this review. Surgical techniques utilized within the included studies include excision, acromioplasty, and open reduction and internal fixation (ORIF). The primary outcomes of interest included patient satisfaction. Range of motion and several standardized outcome measurement tools were also included in the final analysis. Results: Patient satisfaction was highest in the excision and ORIF groups, with 92% and 82% of patients reporting good to excellent postoperative results, respectively, compared to 63% in the acromioplasty group. All three patient groups experienced improvements in postoperative outcomes (i.e., active range of motion and patient-reported outcome scores). The excision group experienced a complication rate of 1%, while the acromioplasty group experienced a complication rate of 11% and the ORIF group a rate of 67%. Conclusion: This study reports on the largest sample of patients who underwent surgical treatment for a symptomatic os acromiale. We have demonstrated that excision of the os with meticulous repair of the deltoid resulted in the best clinical outcomes with the least complications. In healthy adult patients with a large os fragment and a normal rotator cuff, surgical fixation may provide increased preservation of deltoid function while offering good to excellent patient satisfaction. However, patients must be informed that a second procedure may be required to remove symptomatic hardware. [ABSTRACT FROM AUTHOR]

Purpose of Review: Platelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies.Recent Findings: The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.Summary: Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies. [ABSTRACT FROM AUTHOR]

Background: Bone loss in shoulder instability is a well-recognized cause of failure after stabilization surgery. Many approaches have been described to address glenoid bone loss, including coracoid transfer. This transfer can be technically difficult and has been associated with high complication rates. An ideal alternative to coracoid transfer would be an autologous source of fresh osteochondral graft with enough surface area to replace significant glenoid bone loss. The distal clavicle potentially provides such a graft source that is readily available and low-cost. Purpose: To evaluate distal clavicular autograft reconstruction for instability-related glenoid bone loss, specifically comparing the width of the clavicular autograft with the width of an ipsilateral coracoid graft as prepared for a Latarjet procedure. Further, we sought to compare the articular cartilage thickness of the distal clavicle graft with that of the native glenoid. Study Design: Controlled laboratory study. Methods: Twenty-seven fresh-frozen cadaver specimens were dissected, and an open distal clavicle excision was performed. The coracoid process in each specimen was prepared as has been described for a classic Latarjet coracoid transfer. In each specimen, the distal clavicle graft was compared with the coracoid graft for size and potential of glenoid articular radius of restoration. The distal clavicle graft was also compared with the native glenoid for cartilage thickness. Results: In all specimens, the distal clavicle grafts provided a greater radius of glenoid restoration than the coracoid grafts (P < .0001). On average, the clavicular graft was able to reconstruct 44% of the glenoid diameter, compared with 33% for the coracoid graft (P < .0001). The articular cartilage of the glenoid was significantly thicker (1.4 mm thicker, P < .0001) than that of the distal clavicular autograft (average ± SD, 3.5 ± 0.6 mm vs 2.1 ± 0.8 mm, respectively). When specimens with osteoarthritis were excluded, this difference decreased to 0.97 mm when compared with the clavicular cartilage (P = .0026). Conclusion: The distal clavicle autograft can restore a significantly greater glenoid bone deficit than the Latarjet procedure and has the additional benefit of restoring articular cartilage to the glenoid. The articular cartilage thickness of the distal clavicle is within 1.4 mm of that of the native glenoid. Clinical Relevance: The distal clavicular autograft may be a suitable option for reconstruction of instability-related glenoid bone loss. This graft provides a structural osteochondral autograft with a broader radius of reconstruction than that of a coracoid graft, is locally available, has minimal donor site morbidity, is anatomic, and provides articular cartilage. [ABSTRACT FROM AUTHOR]

Background and Purpose: The patella plays an important role in knee biomechanics and provides anterior coverage of the knee joint. One to two percent of the population has an anatomical variant of patella called a bipartite patella that usually does not case pain. However, occasionally after injury or overuse during sport it can be a source of anterior knee pain. The purpose of this case report was to present a rare variant of bipartite patella and highlight conservative treatment of this condition. Study Design: Case Report Case Description: A 35-year-old female patient presented with persistent bilateral non-traumatic anterior knee pain of a six-year duration that was enhanced by strenuous kinds of sport activity. Standard radiographs and MRI revealed the presence of bipartite patella with medial pole cartilage edema bilaterally. Conservative care including physical therapy, extracorporeal shock wave therapy (ESWT), and viscosupplementation was utilized. Outcome: After treatment VAS decreased to 0/10 from 5/10 in the left knee and 1/10 from 5/10 in the right knee. The Kujala Scores improved after treatment to 100 and 95 for the left and right knees respectively. The subject returned to full sport activity and work as a fitness instructor without pain and limitations. Discussion: This case describes a rare finding of bilateral medial bipartite patella and the successful use of physical therapy with viscosupplementation in patellar pain caused by bipartite patella. It also supports the use of Extra Corporeal Shock Wave Therapy in bipartite patella pain as a supplement for therapy. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Osteoarthritis is an incurable joint disease manifesting itself with gradually progressing degenerative changes, leading to premature motor disability. These changes mainly occur owing to an imbalance between the processes of degeneration and regeneration of articular cartilage structures. Until now many risk factors favoring the development of degenerative joint disease have been identified. These include age, weight, previously sustained traumas to joints, sports, sex and genetic predisposition. The latest scientific reports confirm that the pathogenesis of changes in osteoarthritic joints is complex and occurs on many levels. Enzymes belonging to the metalloproteinases family are mainly responsible for the degeneration of articular cartilage. Their activity is regulated by numerous pro-inflammatory cytokines, transcription factors and miRNA. A thorough analysis of all processes occurring in the afflicted joints needs to be carried out before effective therapeutic strategies can be developed. [ABSTRACT FROM AUTHOR]

The first national medical database registry was started in Sweden in 1975, and clinical registries have gained enormous popularity. Analysis of a large database of rotator cuff repair surgeries shows that adverse events may occur in almost 1 of 5 cases, showing the use of a register as a highly beneficial source of information. However, retrospective review of prospectively collected registry data has limitations and biases as well as benefits, including inconsistent reporting and recording of data, lack of control of confounding patient variables, and loss to follow-up. [ABSTRACT FROM AUTHOR]

A subscapularis complete tear presents its own challenges in management. The glenohumeral biomechanics and force couple are reliant on a competent and functioning subscapularis muscle. An irreparable subscapularis makes those same challenges even more difficult to address. Traditionally, this problem has been addressed with tendon transfers, including pectoralis major or latissimus dorsi. These techniques can alter the ideal biomechanics of the shoulder and have high rates or failure. Iliotibial autograft or tibialis anterior have also been wrought with high failure rates. Recently, the superior capsular reconstruction has been described for irreparable tears of the supraspinatus and infraspinatus. Theoretically, this procedure can act as a check rein against subluxation, and may serve to reconnect the force couples of the rotator cuff. Anterior escape may represent a similar challenge when the irreparable rotator cuff tendon is the subscapularis. To address this, we describe an open anterior capsule reconstruction technique with an acellular dermal graft. We theorize that this procedure may serve in a similar capacity to its superior capsular counterpart. [ABSTRACT FROM AUTHOR]

Scapular winging can be a significant source of chronic pain, weakness, and disability of the shoulder. Isolated serratus anterior palsy from long thoracic nerve injury, which is the most common cause of this condition, produces prominent winging and medial malpositioning of the inferior angle of the scapula. In the case of persistent symptoms despite conservative care, treatment options primarily include scapulothoracic fusion and pectoralis major transfer. Outcomes of scapulothoracic fusion are notable for a high complication rate and limited functional improvements. We describe our technique of indirect, split pectoralis major transfer to the inferolateral scapula with allograft tissue augmentation for the surgical treatment of chronic medial winging. This procedure provides dynamic stabilization of the scapula with secure and tension-free tendon transfer. Advantages over alternative treatments include a relatively low complication rate, acceptable cosmesis, and better range of motion. The rationale and technical aspects of this procedure are discussed. Additional clinical studies are warranted to compare outcomes for the direct and indirect split transfer methods. [ABSTRACT FROM AUTHOR]

An irreparable subscapularis may have a debilitating influence on glenohumeral joint biomechanics. Traditional treatment approaches are focused on tendon transfers, among which the most popular are pectoralis major and latissimus dorsi transfers. However, these techniques present significant retear rates, possible nerve injuries, and altered biomechanics. Other techniques like tibialis anterior or iliotibial autograft grafting also have many reported failures. We describe an all-arthroscopic anterior capsule reconstruction technique with an acellular dermal graft. [ABSTRACT FROM AUTHOR]

Treatment of symptomatic meniscal tears continues to evolve as we improve our understanding of the biomechanical role of the meniscus and its long-term importance to the health of the knee joint. Suture repair of meniscal tears is challenging, yet the incidence of repairs among our colleagues continues to rise as we aim to preserve meniscal tissue. Many elements of performing a repair are tedious and difficult, including proper meniscal preparation, reduction, mattress suture placement, and fixation. The tear pattern and location present another layer of difficulty. The most widely used all-inside repair devices are harpoon-style devices and present their own challenges in using them without causing harm to the meniscus and surrounding cartilage. In this article, we describe a simple all-inside meniscal repair technique to improve the reproducibility and reliability of meniscal repairs using an accessory midbody meniscal portal and a surgical probe. This ensures proper placement of mattress sutures in a reduced meniscus, with a reduced risk of collateral injury to the meniscus and articular cartilage. Furthermore, this surgical technique is adaptable to any meniscal fixation method to the medial or lateral meniscus. [ABSTRACT FROM AUTHOR]

The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage.To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL.Meta-analysis; Level of evidence, 3.PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms “remplissage” and “shoulder instability” according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up.From 802 articles found during the initial search, 7 studies with a total of 837 patients—558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)—were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, –1.43°; 95% CI, –2.40° to –0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, –1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, –61.60; 95% CI, –148.03 to 24.82; P = .162) scores that were comparable with those of the BR group.Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients’ external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair. [ABSTRACT FROM AUTHOR]