(iii) Shoulder arthroscopy: the past, present and future directions

Shoulder arthroscopic surgery is almost unrecognizable now from what it was even just 10 years ago. Of course, the basic principles remain largely the same but the theories, techniques, instruments and applications have changed radically. We present a short history of shoulder arthroscopy, detailing some of the key developments and move on to modern day theatre setup with tips on topics such as fluid management, localized haemorrhage control and avoidance of hypoxic ischaemic brain injury in the beach-chair position. Key arthroscopic skills are discussed with an overview of the latest techniques.We then go on to discuss the future of shoulder arthroscopy and the relevance of new technologies that were previously unthinkable, such as stem-cell technology, platelet-rich plasma, arthroscopic arthroplasty and the use of robotics. Shoulder arthroscopy is becoming ever more endoscopic, with procedures such as the arthroscopic Latarjet, all-arthroscopic tendon transfers and brachial plexus releases becoming more commonly performed.The convergence of biological and biomechanical developments in the future will produce radical changes in our approach to shoulder pathology and the techniques that we employ today.