Arthroscopic surgery

Arthroscopic surgery of the shoulder is still very much in its infancy, but appears to be emerging at a virtually uncontrollable rate. When discus­sing such a new technique, two basic ques­tions must be asked. The first is 'what can be achieved?' The second, and far more impor­tant, is 'what should be achieved?' For the wise surgeon will realize that the mere ability to perform an operation should not be an indica­tion for its use. This chapter aims to answer both of these questions in turn, through a review of current techniques.

At present, arthroscopic surgery of the shoul­der can be considered on five planes of increasing complexity, as shown in Table 7.1.

First generation

Diagnostic arthroscopy

Targeted biopsy

Removal of loose bodies

Excision of labral tears

Second generation


Shoulder debridement

Coraco-acromial ligament division

Arthroscopic subacromial decompression (ASD)


Third generation

Anterior rconstruction


   Cannulated screw



Fourth generation

Complex reconstruction

SLAP tears

Inferior capsular shift

Combined intracapsular / extracapsular repair

Fifth generation


Rotator cuff repair

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