We conducted a clinical study identifying the causes of failure and the variables affecting outcome in 28 patients with failed open or arthroscopic anterior shoulder reconstruction for anterior glenohumeral instability. All patients underwent an open revision stabilization procedure. Surgical outcomes at a minimum 24 months' follow-up were available in 25 patients. The most common findings at revision surgery were capsular redundancy and Bankart lesions. Satisfactory results were found in 21 patients (84%) after repeat instability surgery. Factors contributing to negative outcome were glenohumeral arthritis, age greater than 30 years, 2 or more previous instability procedures, a bony Bankart lesion, the diagnosis of multidirectional instability and surgery involving the nondominant arm (P < .05). Revision shoulder stabilization can be successful when the correct diagnosis is made and appropriate surgery performed. However, the outcome is less predictable in patients with multiple previous surgeries.

Surgical treatment of osteochondral defects of the talus encompasses a wide variety of procedures. The results of autologous osteochondral grafting have been successful for large articular cartilage defects of the talus. However, the risk of donor site morbidity from the ipsilateral knee cannot be overlooked. The use of fresh osteochondral allograft for cartilage defects in the talus represents an attractive alternative. We present the technique and early results of replacing large osteochondral lesions of the talus with fresh allograft tissue.

Symptomatic adult acquired flat foot deformity (AFFD) is a commonly-seen problem in orthopedic practices. As the name implies, the structure of the foot was at one time normal; because of conditions, such as posterior tibial tendon dysfunction (PTTD), arthritis, trauma, Charcot (neuroarthropathy) or neuromuscular disorders, a deformity of the foot has occurred [1–4]. Typically, there is flattening of the medial longitudinal arch, abduction of the forefoot, and increased heel valgus that results in a loss of normal interplay between the bones of the foot, which weakens the lower extremity [5]. The spectrum may range from a subtle, easily correctable foot to a rigid, uncorrectable planovalgus deformity. A thorough clinical and radiographic examination will enable the practitioner to recognize the condition early and select appropriate treatment.

Symptomatic adult acquired flat foot deformity is encountered in the orthopedic office on a frequent basis. Although many causes exist, a careful history and a stepwise approach to the physical examination will clue the examiner into making the correct diagnosis and provide appropriate treatment. Radiographs serve as an adjunct and assist in verifying the examination findings. CT, US, and MRI are helpful modalities for surgical planning or when the diagnosis remains questionable.