title: All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results.
abstract: OBJECTIVE
  To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique.
  
  
  METHODS
  Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8 months (range, 15 to 60 months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair.
  
  
  RESULTS
  Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P < .0001). The Walch-Duplay score increased from 11.67 to 76.67 points (P < .0001). The Western Ontario Shoulder Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan.
  
  
  CONCLUSIONS
  An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability in this challenging patient population. In our hands, this procedure yields good or excellent results in 67% of patients. Successful outcome is correlated with bony healing of the iliac crest graft to the glenoid.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Asklepios Klinik St. Georg, Chirugisch Traumatologisches Zentrum, Hamburg, Germany.
authors.forename: Antonios
authors.initials: A
authors.lastname: Giannakos
authors.affiliation: Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Vezeridis
authors.affiliation: Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Schwartz
authors.affiliation: Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Jany
authors.affiliation: Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lafosse
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult