Purpose: this study was conducted to assess the safety and efficacy of a new surgical technique for anatomical reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments using one singlestrand semitendinosus tendon graft. Methods: eighteen patients affected by chronic type III-V AC joint dislocations were included in the present study between January 2010 and March 2012. All underwent the same surgical operation and rehabilitation protocol. The semitendinosus tendon was harvested from the ipsilateral knee. The CC and AC ligaments were reconstructed using the graft passed beneath the coracoid and through bone tunnels in the clavicle and in the acromion. The graft was secured with non-absorbable sutures. Radiographic recurrence of AC joint dislocation was the primary outcome. Clinical outcome was assessed using the DASH score and normalized Constant score. Wilcoxon's signedrank test was used for comparison between pre-and postoperative results. Significance was set at p≤0.05. Results: the mean follow-up duration was 26.4+2.3 months (range: 24-30 months). On X-ray evaluation, only two patients (11%) showed asymptomatic recurrence of AC joint instability. Comparison between pre-and postoperative DASH and Constant scores showed significant clinical improvement (p<0.001). Conclusion: anatomical reconstruction of CC and AC ligaments using an autologous semitendinosus tendon graft for the treatment of AC joint dislocation provided good and reliable clinical and radiological results with a low failure rate at short-term follow-up. Level of evidence: level IV, therapeutic case series.

Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.

Generalized joint laxity and shoulder instability are common conditions that exhibit a wide spectrum of different clinical forms and may coexist in the same patient. Generalized joint laxity can be congenital or acquired. It is fundamental to distinguish laxity from instability. Laxity is a physiological condition that may predispose to the development of shoulder instability. A high prevalence of generalized joint laxity has been identified in patients with multidirectional instability of the shoulder. Multidirectional instability is defined as symptomatic instability in two or more directions. The diagnosis and treatment of this condition are still challenging because of complexities in its classification and etiology. These complexities are compounded when multidirectional instability and laxity exist in the same patient. With an improved understanding of the clinical symptoms and physical examination findings, a successful strategy for conservative and/or surgical treatments can be developed. Conservative treatment is the first-line option. If it fails, different surgical options are available. Historically, open capsular shift has been considered the gold standard in the surgical management of these patients. Nowadays, advanced arthroscopic techniques offer several advantages over traditional open approaches and have shown similar outcomes. The correct approach to the management of failed stabilization procedures has not been yet defined.

Systematic review of descriptive and qualitative studies, Level IV.