Purpose: The objective of this study was to analyze the clinical results of arthroscopic release for the treatment of shoulder stiffness and to report the results according to etiology.

Method: Thirty cases were reviewed in 29 patients with a mean age of 48 years [range, 25–75]. The mean time from diagnosis to surgery was 37.5 months [range, 6–120]. The stiffness was considered idiopathic (i.e. frozen shoulder) (10 cases), post-traumatic (eight cases) or post-surgical (12 cases). The release consisted of 14 rotator interval resections, four anterior capsulotomies, 20 anterior and inferior capsulotomies, three tenotomies of the superior portion of the subscapularis, and 11 biceps tenotomies or tenodeses. In 26 cases, associated extra-articular procedures were also performed, including 22 subacromial bursectomies and four acromioplasties. Patients were reviewed at a mean follow-up of 44 months [range, 12–99].

Results: Eighty-nine percent were satisfied or very satisfied. The mean Subjective Shoulder Value was 76%. The mean Constant score increased from 40 ± 13 points preoperatively to 74 ± 16 points postoperatively (p< 0.05).

Conclusion: Arthroscopic shoulder release is effective for pain relief and improved function. The recovery of motion is better in idiopathic stiffness (i.e. frozen shoulder) than in post-traumatic and post-surgical stiffness. Resection of the rotator interval seems effective to restore external rotation and elevation.

Purpose: Classically reported, degenerative femorotibial remodelling after meniscectomy results from different biomechanical mechanisms depending on the compartment considered. Occurring in the medial compartment, the most frequent situation, the lesions result from punctual contact compression of the cartilage. In the lateral compartment the mechanism involves increased relative instability of the structures controlling mobility. Lateral meniscectomy disrupts femorotibial kinetics of the meniscotibial gliding articulation leading to horizontal instability and subsequent generation of osteoarthritic degeneration which explains the development of lateral decompensations without genu valgum. Based on work by Grammont and Rudy, we proposed a method to limit this horizontal instability and transfer part of the stress to the medial compartment by medial translocation of the tibial tubercle.

Material and methods: Eighteen patients, mean age 44 years, underwent treatment for disabling degeneration without major misalignment (mean HKA 181°) a mean ten years after lateral meniscetomy. Degenerative remodelling of the lateral compartment was observed on the AP views in 30% of the knees and on the tangent views in 57% Five patients had early-stage lesions of the medial compartment and femoropatellar degradation was observed in 53%. Involvement of the lateral compartment was confirmed by systematic articular exploration and patellofemoral chondropathy was observed in eight knees. Translocation of the anterior tibial tubercle was associated with section of the lateral patellar wing in all knees associated with tension plasty medially.

Results: In 88% of the knees, the postoperative period was uneventful. Weight-bearing supported with a Zimmer cast was maintained for 21 days. Functional outcome was assessed at mean 28 months. Eleven patients had a new clinical and radiographic work-up (mean 34 months). Pain was improved in 88% of the knees, allowing sustained resumption of occupational activities at three months (four knees completely forgotten). Radiographically, at mean 34 months, the lateral cartilage lesions had stabilised with no impact on the medial compartment.

Discussion: In light of these results, we have decided to continue this therapeutic approach, reserving the technique for cases of symptomatic lateral decompensation in young subjects without major valgus malalignment.

Purpose: Neer modified the Bankart operation, adding a reinforcement crossing the capsule anteriorly on the humeral side. The purpose of this study was to report results after more than two years.

Material and methods: Between 1991 and 1998, 77 patients underwent surgery for traumatic anteroinferior instability. Clinical and radiological outcome was reviewed in 64 of this patients by an observer different from the operator at a mean follow-up of 45 months (24–120 months). Patients with a unique anterior reinforcement were excluded from the analysis. The patients were generally young (mean 27 years) with sports activities (89%). Recurrent dislocation was observed in 39 patients, subdislocation in seven and painful and unstable shoulders in seven. Ten patients had an associated hyperlaxity, defined by elbow-to-body external rotation greater than 85%, according to the SOFCOT criteria. Three patients had had a prior procedure for a coracoid bone block.

Results: According to the Duplay score: outcome was excellent in 27 cases, good in 22, fair in nine and poor in six. Mean delay to return to former occupational activity was four months; it was seven months for sports activity. The deficit in external rotation was 3.4° on the average. Ten patients had persistent apprehension. Recurrence was observed in seven patients (11%) a mean 25 months after the operation (seven days to six years) as dislocation in two and subdislocation in five and due to trauma in five cases. Young age, hyperlaxity, high-risk sports, an important humeral notch, major capsular distension, and a high number of dislocations or subdislocations were the factors associated with recurrence. According to the Samilson criteria, pre-osteoarthritic lesions of the gleno-humeral joint were present in two cases preoperatively (one grade I and one grade II) and in eight cases postoperatively (four grade I, three grade II, and one grade III).

Discussion, conclusion: The Bankart operation as modified by Neer does not produce a stiff joint as is thought by many, probably due to the upper-lower capsular retention rather than lateral-medial retention. Nevertheless, the stability results are less satisfactory than generally reported for coracoid stop procedures.