The west point view: An intra-articular 50-yard line view with dynamic arthroscopic load shift

Traumatic anterior shoulder instability may present as a transient instability event (subluxation) or complete glenohumeral disassociation (dislocation). History and physical examination can determine the degree and direction of instability, and associated laxity. Silliman and Hawkins described a load shift test to determine the direction and degree the humeral head translation relative to glenoid in the anterior and posterior directions. The purpose of this article is to describe an intraoperative arthroscopic technique for direct visualization of the load and shift test from an intra-articular 50-yard line view. This technique allows for a direct and intraoperative instability examination and dynamic assessment of the anterior, posterior, and inferior glenohumeral joint laxity before, during, and after stabilization. The arthroscopic West Point Load Shift technique when viewing from a 50-yard line intra-articular view is useful to identify isolated anterior, posterior, or combined anterior-posterior instability and guide anchor placement in arthroscopic stabilization surgery. Utilizing the arthroscopic West Point Load Shift technique from the 50-yard line view before, during, and after arthroscopic anchor placement may help achieve greater restoration of glenohumeral capsuloligamentous balance because of the neutral view afforded.