Excellent clinical and radiological mid-term outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double pair of button fixation system: "three-year clinical case series with no loss to follow up."

Abstract Purpose To evaluate the clinical, functional, and radiological mid-term outcomes of the all-arthroscopic modified Eden–Hybinette procedure in patients with recurrent anterior shoulder instability. Methods A retrospective single-center case series with prospectively collected data was conducted. Inclusion criterion was traumatic recurrent anterior shoulder instability with significant glenoid bone loss; patients with atraumatic or multidirectional instability were excluded. An all-arthroscopic modified Eden–Hybinette procedure using an iliac crest autograft and double pair of button fixation was carried out. All patients were postoperatively assessed for recurrence and apprehension. Their shoulders’ range of motion values and functional scores, including American Shoulder and Elbow Surgeons Score, Oxford instability, Rowe instability, and Walch-Dupplay were recorded. Graft positions, healing, and absorption were evaluated with computer tomography. Comparisons of values were performed with paired t-tests for normally distributed differences and with nonparametric Wilcoxon’s signed rank test otherwise. Results The final study cohort included 28 patients and mean follow-up period was 43 ± 6 months (range, 36–53 months). The mean patient age was 36 ± 10 years and median glenoid bone loss was 12.4% (range, 8–33%). No recurrence occurred, no subjective shoulder instability was reported, and no major complications were documented until the last follow up. The postoperative shoulders’ range of motion values had no significant differences compared to the healthy sides. All final postoperative functional scores significantly increased to show excellent results, compared to preoperative values. All grafts were positioned and healed optimally and none were completely reabsorbed. Conclusions The all-arthroscopic modified Eden–Hybinette procedure is safe, leading to excellent clinical and radiological mid-term outcomes in patients with recurrent anterior shoulder instability. This technique restores glenoid bone defects and preserves the normal shoulder anatomy.