Total knee arthroplasty has been the main treatment method among advanced osteoarthritis (OA) patients. The main post-operative evaluation considers the level of pain, stability and range of motion (ROM). The knee flexion level is one of the most important categories in the total knee arthroplasty patient's satisfaction in Asian countries due to consistent habits of floor-sitting, squating, kneeling and cross legged sitting. In this study, we discovered that the posterior capsular release enabled the further flexion angles by 14 degrees compared to the average ROM without posterior release group. Our objective was to increase the ROM using the conventional total knee arthroplasty by the posterior capsular release. Posterior capsular release is being used in order to manage the flexion contraction. Although the high flexion method extends the contact area during flexion by extending the posterior condyle by 2mm, the main problem has been the early femoral loosening. We searched for the method to get the deep knee flexion with the conventional knee prosthesis. 122 OA patients with less than preoperative 130 flexion that underwent conventional TKAs using Nexgen from January, 2014 to September, 2016 were reviewed. Posterior femoral osteophytes were removed as much as possible, but 74 cases were performed posterior capsular release, while 48 cases were not performed. After checking postoperative ROM after 6 months of operation, we compared 74 knees with a posterior capsular release and 48 knees without posterior capsular release. As a result, the average ROM in the posterior capsular release group was 132 degrees, but the average ROM without posterior release group is 118 degrees. No postoperative hyperextension was found when the adequate size of polyethylene (PE) thickness was utilized. Hence, the conventional TKA with a posterior capsular release showed satisfactory clinical outcomes in the deep knee flexion of Asians

Aims. Animal models have been developed that allow simulation of post-traumatic joint contracture. One such model involves contracture-forming surgery followed by surgical capsular release. This model allows testing of antifibrotic agents, such as rosiglitazone. Methods. A total of 20 rabbits underwent contracture-forming surgery. Eight weeks later, the animals underwent a surgical capsular release. Ten animals received rosiglitazone (intramuscular initially, then orally). The animals were sacrificed following 16 weeks of free cage mobilisation. The joints were tested biomechanically, and the posterior capsule was assessed histologically and via genetic microarray analysis. Results. There was no significant difference in post-traumatic contracture between the rosiglitazone and control groups (33° (standard deviation (. sd. ) 11) vs 37° (. sd. 14), respectively; p = 0.4). There was no difference in number or percentage of myofibroblasts. Importantly, there were ten genes and 17 pathways that were significantly modulated by rosiglitazone in the posterior capsule. Discussion. Rosiglitazone significantly altered the genetic expression of the posterior capsular tissue in a rabbit model, with ten genes and 17 pathways demonstrating significant modulation. However, there was no significant effect on biomechanical or histological properties. Cite this article: M. P. Abdel. Effectiveness of rosiglitazone in reducing flexion contracture in a rabbit model of arthrofibrosis with surgical capsular release: A biomechanical, histological, and genetic analysis. Bone Joint Res 2016;5:11–17. doi: 10.1302/2046-3758.51.2000593

Introduction: Idiopathic Adhesive capsulitis [IAC] of the shoulder is a self limited condition that can cause significant morbidity. Most patients (90%) respond to conservative management and those who fails (10%) undergo manipulation under anaesthesia (MUA) Patients who are refractory to both treatments, benefits from arthroscopic capsular release. Aim: To assess the efficacy of arthroscopic capsular release in patients with IAC refractory to physiotherapy and MUA. Also to compare the clinical outcome between arthroscopic capsular release and MUA. Materials and methods: We studied 59 patients with IAC, divided into 2 groups. Group A [36patients] had MUA and Group B [23 patients] underwent arthroscopic capsular release. The mean age was (54years). The mean follow up was 21 and 9 months for group A and B respectively. Results: We assessed our results according to three parameters:. Final outcome using the Constant and Murley score. The improvement in the score averaged 42 and 47 points in group A and B respectively. Early Post operative pain using visual analogue score (VAS) average of 6 and 3 in group A and B respectively. Overall patient satisfaction: 81% in group A and 89% in group B. Conclusion:. Patients with IAC who fails to respond physiotherapy and MUA do well after arthroscopic capsular release with little operative morbidity. Complete normal functional outcome of shoulder is not a prerequisite for patient satisfaction

Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great economic burden to health services and absence from work. This prospective cohort study aimed to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and any potential economic benefit to society. Patients were recruited prospectively. Data was gathered by way of questionnaire to ascertain demographics, previous primary care treatment and absence from work. Oxford Shoulder Score (OSS) was also calculated. Arthroscopic capsular release was performed and further data gathered at four week post-operative follow up. Economic impact of delay to treatment and cost of intervention was calculated using government data from the national tariff which costs different forms of treatment. Statistical analysis was then performed on the results. Twenty five patients enrolled. Mean pre-operative OSS: 37.4 (range 27–58, SD 7.4). Mean post-operative OSS: 15.9 (range 12–22, SD 2.3). P<0.01. Mean improvement in OSS: 21.5 (range 12–38, SD 7.1). The cost of non-operative treatment per patient was £3954. The cost of arthroscopic capsular release per patient was £1861, a difference of £2093. There were no complications. Arthroscopic capsular release improved shoulder function on OSS within four weeks. The cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing timings of intervention would further elucidate potential benefits

Introduction: Significant internal rotation limitation is thought to be due to posterior capsular thickening and therefore adding a posterior release to the anterior and inferior releases seems sensible. However, this is technically more difficult. Aims: To assess the overall outcome of arthroscopic capsular release and to establish whether inclusion of a posterior capsular release has an additional beneficial. Methods: 48 patients with primary or secondary frozen shoulder in whom conservative physiotherapy had failed were included. 27 had an anterior and inferior release only, whilst the 21 included a posterior release. All data was collected prospectively. Results: Aetiology of the frozen shoulder was primary (22), diabetic (7), post-traumatic (7) and post-operative (11). There a highly significant improvement in Constant score (P < 0.001) and range of motion (P< 0.001) by 5 months in both groups. The mean satisfaction score (minimum 1 and maximum 10) was 7 post-operatively. There was no significant difference in Constant Score between the two groups (P = 0.56) and no significant difference in the improvement of the range of motion, in particular internal rotation (P=0.35). Conclusion: There was an overall rapid significant improvement following arthroscopic capsular release, but no significant difference in the overall outcome with the addition of a posterior release. Clinical relevance: Adding a posterior release to an arthroscopic capsulectomy does not seem to add any significant benefit to the outcome

Introduction: Upper root injuries (C5–C6±C7) account for 75 % of all obstetric brachial plexus palsies (OBPP). Among them, about thirty percent develop a medial contracture of the shoulder due to an imbalance between strong internal rotators and weak external rotators. This causes glenohumeral deformities. To decrease the internal contracture it had been proposed either to release the subscapularis (Sever procedure) or to perform a capsular release (Fairbank procedure). Arthroscopic capsular release was proposed in young patient to reduce the medial contracture. Material & methods: Six children with an average age of 23 months and 1 case aged 12 years old, had a medial contracture of the shoulder secondary to a C5–C6 ( 3 cases) or C5–C7 (4 cases) obstetrical palsy. An arthroscopic evaluation of the deformities was performed in 3 cases. Next a surgical subscapularis release was applied in association with a latissimus dorsi transfer. An arthroscopic evaluation of the joint associated with an arthroscopic capsular release (release of the coracohumeral ligament) was performed in 4 cases. In addition, the latissimus dorsi was transfered. Pre and Post operative passive external rotation were measured in degrees in R1 position. Pre and post operative medial rotation were evaluated according to the Mallet classification. A comparative evaluation of the glenohumeral deformities were performed between pre-operative MRI and arthroscopic results. Results: An arthroscopic evaluation of the glenohumeral joint was performed in 6 cases. In one case the arthroscopic evaluation could not be performed. In the 6 cases, arthroscopy confirmed the MRI lesion : 3 posterior subluxations, 1 posterior luxation and 2 normal joints. The subscapularis release allowed an increase in the passive lateral rotation of an average of 50°. However, a decrease of 1 point in the medial rotation was noted according to Mallet evaluation. The coracohumeral ligament arthroscopic release allowed an increase in the passive lateral rotation of an average of 60° without decreasing the passive medial rotation. Whatever the method used, a reduction of the subluxation of the glenohumeral joint was obtained. Discussion & Conclusion: Medial contracture of the shoulder may begin in the first two years of life and an early reduction with muscular release and transfers was proposed. However, the precise nature of the progressive limitation of the external passive rotation remains unclear. Is the limitation due to a contracture of the medial rotators or a capsular retraction or a combination of both? Harryman demonstrated the role of the rotator interval capsule and coracohumeral ligament in limiting the external rotation. Our hypothesis was that capsular retraction occurred before the muscular contracture. As a result we decided to perform a capsular release in patients under 24 months. The results on the passive external rotation were similar with both methods. Although, the technique of an arthroscopic release was difficult and demanding, it appears that this technique is beneficial as it allows an evaluation of the joint deformity and treatment of the contracture in the same time. Arthroscopic release is a safe but demanding technique which allows an increase in the external passive rotation in OBPP. It should be noted that this technique requires a significant practice

Purpose of the study. Release of tight lateral structures is an integral part of balancing the valgus knee during knee replacement surgery. The posterolateral capsule is released through an inside-out technique. The common peroneal nerve is in close proximity to the capsule during this step. This study was undertaken to determine the distance of the nerve and the safe level for the posterolateral release. Methods. MR scans of the knee of 100 patients were evaluated. The age range of selected patients was 50 to 70 years. The distance of the nerve was measured to the closest point on the posterolateral capsule. Two separate measurements were taken - one 9mm above the joint line indicating the distal femoral resection level and the other 9mm distal to the joint line indicating the level of tibial resection. A third point was at the joint line level. The position of the nerve was also recorded in relation to the cross section of the femur/tibia on a ‘clock-like’ reference. Results. The mean distance of the nerve from the capsule was 13.4mm at level of distal femoral resection, 12.4mm at the level of the joint line and 10.9mm at the level of tibial resection. The minimum distance was 8.2mm at the proximal level, 6.7mm at the level of joint line and 4.7mm at the distal level. Conclusions. The common peroneal nerve is in close proximity to the resected femur and tibia in knee replacement surgery. The posterolateral capsular release should be done at the level of distal femoral resection using electrocautery to minimise risk of damage to the nerve

Background. Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the two to see which is better. Aim. To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR. Methods. 56 patients with primary frozen shoulder were treated by either MUA or MUA plus ACR. Each patient had their American Shoulder and Elbow Score (ASES), and their Oxford Shoulder Score (OSS) measured pre- and post-operatively. Results. The patients who had MUA plus ACR had a mean ASES of 19.6 pre-operatively, 78.3 at 6 months, and a mean of 80.1 at 12 months. The mean OSS was 32.5 pre-operatively, 53.6 at 6 months and 53.8 at 12 months. The patients who had a MUA had a mean ASES of 28.7 pre-operatively, 57.9 at 6 months and 58 at 12 months. The mean OSS was 33 pre-operatively, 42.5 at 6 months and 48 at 12 months. Conclusions. Both treatments give good results; MUA plus ACR give significantly superior results at 6 to 12 months post-operatively. However, there is no significant difference beyond 12 months

Background – Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the 2 to see which is better. Aim – To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR. Method – 61 patients with primary frozen shoulder were treated by either MUA or MUA plus ACR. Each patient had their American Shoulder and Elbow Score (ASES), and their Oxford Shoulder Score (OSS) measured pre and post-operatively. Results – The patients who had MUA plus ACR had a mean ASES of 24.8 preoperatively, 64 at 4 months, and a mean of 75.4 at 12 months. The mean OSS was 32.5 pre-operatively, 48.5 at 4 months and 53.4 at 12months. The patients who had a MUA had a mean ASES of 28.7 pre-operatively, 60.9 at 4months and 69.6 at 12months. The mean OSS was 33 preoperatively, 46.5 at 4 months and 50.9 at 12 months. Conclusions – Both treatments give good results. MUA plus ACR give superior numerical results at 6 to 12 months post-operatively, however, these figures did not reach statistical significance

We present a single-surgeon series of surgical release of post-traumatic flexion contracture of the elbow performed via a limited lateral approach. We undertook a retrospective review of patients having surgery for established post-traumatic flexion deformity of the elbow. All patients underwent anterior capsulectomy via a limited lateral approach. Patients with an intrinsic contracture also had the intra-articular lesion addressed at the time of surgery. Short-term follow-up was available from clinical review until discharge. Medium-to-longterm follow-up was conducted by telephone interview supplemented by clinical review in selected cases.

Between 1998 and 2004, 23 patients were treated surgically for established flexion contracture of the elbow. There were 15 males and 8 females with a median age of 35yrs (range 16–52yrs). In sixteen patients the contracture was not associated with damage to the joint surface (extrinsic) and in seven it was (intrinsic). The mean pre-operative deformity was 55 degrees (95%CI 49 “ 61) which was corrected at the time of surgery to 18 degrees (95%CI 12 “ 23). The mean residual deformity was 25 degrees (95%CI 20 “ 31). The difference between the pre-operative and discharge deformities was significant (Wilcoxson test p< 0.001). In the extrinsic group the mean deformity at discharge was 21 degrees (95%CI 17 “ 25) compared to 34 degrees (95%CI 19 “ 49) in the intrinsic group “ this difference was significant (Mann-Whitney U test p< 0.01). In those patients with an extrinsic contracture all elbows had a return of functional extension. One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve which resolved after six weeks. Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe, reliable technique with the best results achieved in patients with an isolated extrinsic contracture.

We present a single-surgeon series of surgical release of post-traumatic flexion contracture of the elbow performed via a limited lateral approach.

We undertook a retrospective review of patients having surgery for established post-traumatic flexion deformity of the elbow. All patients underwent anterior capsulectomy via a limited lateral approach. Patients with an intrinsic contracture also had the intra-articular lesion addressed at the time of surgery. Short-term follow-up was available from clinical review until discharge. Medium-to-long term follow-up was conducted by telephone interview supplemented by clinical review in selected cases.

Between 1998 and 2004, 23 patients were treated surgically for established flexion contracture of the elbow. There were 15 males and 8 females with a median age of 35 yrs (range 16–52 yrs). In sixteen patients the contracture was not associated with damage to the joint surface (extrinsic) and in seven it was (intrinsic). The mean pre-operative deformity was 55 degrees (95%CI 49 – 61) which was corrected at the time of surgery to 18 degrees (95%CI 12 – 23). The mean residual deformity was 25 degrees (95%CI 20 – 31). The difference between the pre-operative and discharge deformities was significant (Wilcoxson test p< 0.001). In the extrinsic group the mean deformity at discharge was 21 degrees (95%CI 17 – 25) compared to 34 degrees (95%CI 19 – 49) in the intrinsic group – this difference was significant (Mann-Whitney U test p< 0.01). In those patients with an extrinsic contracture all elbows had a return of functional extension. One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve which resolved after six weeks.

Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe, reliable technique with the best results achieved in patients with an isolated extrinsic contracture.

Aims. Outcomes of current operative treatments for arthrofibrosis after total knee arthroplasty (TKA) are not consistently positive or predictable. Pharmacological in vivo studies have focused mostly on prevention of arthrofibrosis. This study used a rabbit model to evaluate intra-articular (IA) effects of celecoxib in treating contracted knees alone, or in combination with capsular release. Methods. A total of 24 rabbits underwent contracture-forming surgery with knee immobilization followed by remobilization surgery at eight weeks. At remobilization, one cohort underwent capsular release (n = 12), while the other cohort did not (n = 12). Both groups were divided into two subcohorts (n = 6 each) – one receiving IA injections of celecoxib, and the other receiving injections of vehicle solution (injections every day for two weeks after remobilization). Passive extension angle (PEA) was assessed in live rabbits at 10, 16, and 24 weeks, and disarticulated limbs were analyzed for capsular stiffness at 24 weeks. Results. IA celecoxib resulted in greater mean PEA at ten weeks (69.6° (SD 4.6) vs 45.2° (SD 9.6), p = 0.004), 16 weeks (109.8° (SD 24.2) vs 60.9° (SD10.9), p = 0.004), and 24 weeks (101.0° (SD 8.0) vs 66.3° (SD 5.8), p = 0.004). Capsular stiffness was significantly reduced with IA celecoxib (2.72 Newton per cm (N·cm)/° (SD 1.04), p = 0.008), capsular release (2.41 N·cm/° (SD 0.80), p = 0.008), and capsular release combined with IA celecoxib (3.56 N·cm/° (SD 0.99), p = 0.018) relative to IA vehicle (6.09 N·cm/° (SD 1.64)). Conclusion. IA injections of a celecoxib led to significant improvements in passive extension angles, with reduced capsular stiffness, when administered to rabbit knees with established experimental contracture. Celecoxib was superior to surgical release, and the combination of celecoxib and a surgical release did not provide any additional value. Cite this article: Bone Joint Res 2022;11(1):32–39

Aims. A pragmatic multicentre randomized controlled trial, UK FROzen Shoulder Trial (UK FROST), was conducted in the UK NHS comparing the cost-effectiveness of commonly used treatments for adults with primary frozen shoulder in secondary care. Methods. A cost utility analysis from the NHS perspective was performed. Differences between manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR), and early structured physiotherapy plus steroid injection (ESP) in costs (2018 GBP price base) and quality adjusted life years (QALYs) at one year were used to estimate the cost-effectiveness of the treatments using regression methods. Results. ACR was £1,734 more costly than ESP ((95% confidence intervals (CIs) £1,529 to £1,938)) and £1,457 more costly than MUA (95% CI £1,283 to £1,632). MUA was £276 (95% CI £66 to £487) more expensive than ESP. Overall, ACR had worse QALYs compared with MUA (-0.0293; 95% CI -0.0616 to 0.0030) and MUA had better QALYs compared with ESP (0.0396; 95% CI -0.0008 to 0.0800). At a £20,000 per QALY willingness-to-pay threshold, MUA had the highest probability of being cost-effective (0.8632) then ESP (0.1366) and ACR (0.0002). The results were robust to sensitivity analyses. Conclusion. While ESP was less costly, MUA was the most cost-effective option. ACR was not cost-effective. Cite this article: Bone Jt Open 2021;2(8):685–695

Aims. This systematic review places a recently completed multicentre randomized controlled trial (RCT), UK FROST, in the context of existing randomized evidence for the management of primary frozen shoulder. UK FROST compared the effectiveness of pre-specified physiotherapy techniques with a steroid injection (PTSI), manipulation under anaesthesia (MUA) with a steroid injection, and arthroscopic capsular release (ACR). This review updates a 2012 review focusing on the effectiveness of MUA, ACR, hydrodilatation, and PTSI. Methods. MEDLINE, Embase, PEDro, Science Citation Index, Clinicaltrials.gov, CENTRAL, and the World Health Organization (WHO) International Clinical Trials Registry were searched up to December 2018. Reference lists of included studies were screened. No language restrictions applied. Eligible studies were RCTs comparing the effectiveness of MUA, ACR, PTSI, and hydrodilatation against each other, or supportive care or no treatment, for the management of primary frozen shoulder. Results. Nine RCTs were included. The primary outcome of patient-reported shoulder function at long-term follow-up (> 6 months and ≤ 12 months) was reported for five treatment comparisons across four studies. Standardized mean differences (SMD) were: ACR versus MUA: 0.21 (95% confidence interval (CI) 0.00 to 0.42), ACR versus supportive care: -0.13 (95% CI -1.10 to 0.83), and ACR versus PTSI: 0.33 (95% CI 0.07 to 0.59) and 0.25 (95% CI -0.34 to 0.85), all favouring ACR; MUA versus supportive care: 0 (95% CI -0.44 to 0.44) not favouring either; and MUA versus PTSI: 0.12 (95% CI -0.14 to 0.37) favouring MUA. None of these differences met the threshold of clinical significance agreed for the UK FROST and most confidence intervals included zero. Conclusion. The findings from a recent multicentre RCT provided the strongest evidence that, when compared with each other, neither PTSI, MUA, nor ACR are clinically superior. Evidence from smaller RCTs did not change this conclusion. The effectiveness of hydrodilatation based on four RCTs was inconclusive and there remains an evidence gap. Cite this article: Bone Jt Open 2021;2(9):773–784

Background. In total hip arthroplasty (THA), the importance of preserving muscle is widely recognized. It is important to preserve the short external rotator muscles because they contribute to joint stability and prevent postoperative dislocation. However, despite careful capsular release and femoral rasping, damage to the short external rotator muscles may occur. The Optymis Shot Stem preserves more bone and surrounding tissue than does a traditional primary stem. We investigated the usefulness of the stem in terms of the extent of preservation of the tendon attachment on the greater trochanter. Method. In this study, we enrolled 31 consecutive patients (39 hips; 6 males, 25 females) who underwent THA. Simultaneous bilateral THA was performed in 8 patients. The patients’ mean age was 56.1 years. Diagnoses included developmental dysplasia in 35 hips (Crowe group 1: 31 hips, group 2: 4 hips), and sequel of Perthes disease in 4 hips. All THAs were performed via the direct anterior approach without traction tables. The femoral procedure was performed with the hip hyperextended, and posterior capsular release was performed if the femoral procedure became technically difficult. We compared the following among patients: the operative time, intraoperative blood loss, length of hospital stay, rate of posterior capsular release, postoperative radiographic findings, WOMAC score before and after surgery, and any complications. Results. The mean operative time was 42.0 ± 8.9 min, the mean intraoperative blood loss was 308 ± 196 g, and the mean hospital stay was 6.7 ± 1.3 days. Posterior capsular release was performed in 17 hips [44%; 10 hips (32%) in Crowe group 1, 8 hips (88%) for other diagnoses]. The total WOMAC score improved significantly from 42.4 points preoperatively to 11.2 points at 3 months preoperatively. A postoperative stem subsidence ≥3 mm was observed in 1 hip (2.6%), whereas postoperative dislocation, intra- and postoperative periprosthetic fracture, and thigh pain were not observed. Conclusions. The Optymis Short Stem could be placed without performing posterior capsular release in 68% of patients with Crowe group 1 developmental dysplasia. We therefore consider the stem as useful for preserving the tendon attachment on the greater trochanter

Specific brace-fitting complications in idiopathic congenital talipes equinovarus (CTEV) have been rarely described in published series, and usually focus on non-compliance. Our primary aim was to compare the rate of persistent pressure sores in patients fitted with Markell boots and Mitchell boots. Our additional aims were to describe the frequency of other brace fitting complications and identify age trends in these complications. A retrospective analysis of medical files of 247 idiopathic CTEV patients born between 01/01/2010 - 01/01/2021 was performed. Data was collected using a REDCap database. Pressure sores of sufficient severity for clinician to recommend time out of brace occurred in 22.9% of Mitchell boot and 12.6% of Markell boot patients (X. 2. =6.9, p=0.009). The overall rate of bracing complications was 51.4%. 33.2% of parents admitted to bracing non-compliance and 31.2% of patients required re-casting during the bracing period for relapse. For patients with a minimum follow-up of age 6 years, 44.2% required tibialis anterior tendon transfer. Parents admitting to non-compliance were significantly more likely to have a child who required tibialis anterior tendon transfer (X. 2. =5.71, p=0.017). Overall rate of capsular release (posteromedial release or posterior release) was 2.0%. Neither medium nor longterm results of Ponseti treatment in the Australian and New Zealand clubfoot have been published. Globally, few publications describe specific bracing complications in clubfoot, despite this being a notable challenge for clinicians and families. Recurrent pressure sores is a persistent complication with the Mitchell boots for patients in our center. In our population of Australian clubfoot patients, tibialis anterior tendon transfer for relapse is common, consistent with the upper limit of tibialis anterior tendon transfer rates reported globally

Aim: The purpose of this study was to evaluate the results of arthroscopic capsular release in patients with primary adhesive capsulitis of the glenohumeral joint. Methods: Twenty-eight shoulders in 27 patients with adhesive capsulitis of the glenohumeral joint were treated with manipulation and arthroscopic capsular release. Their average age was 54.5 years (range, 39–67). During surgery, synovectomy and a combined anterior, posterior and inferior arthroscopic release using electrocautery or laser was performed. Range of motion and evaluation with the Constant score before and after surgery was performed in all patients. Results: The mean follow-up was 32 months (24–63). The mean Constant score significantly improved from 44.6 (28–52) preoperatively to 86.3 (73–52) postoperatively (p< 0.001, paired t-test). Range of motion for all planes significantly improved. Abduction improved from 72° preoperatively to 165° postoperatively; Internal rotation improved from 13° to 60° and external rotation from 10° to 75°. Subjectively all patients had remarkably less pain, and there were no complications. Conclusions: Our study suggest that arthroscopic treatment of primary adhesive capsulitis with capsular release is an effective and reliable method for restoring a painless motion of the glenohumeral joint

The April 2014 Shoulder & Elbow Roundup. 360 . looks at: arthroscopic capsular release successful after six months; MCIC in cuff surgery; analgesia following arthroscopic cuff repair; platelet-rich fibrin; and cuff tear and suprascapular nerve neuropathy?

Background. Performing total knee replacement needs both bony & soft tissue consideration. Late John Insall advocating spacer blocks with concept of balanced & equal flexion – extension Gap. Although we usually excise both ACL & PCL, still it is possible to retain more soft tissue. Both PCL retaining & sacrificing Require intact collaterals for stability. Superficial MCL & LCL should be preserved, if possible. After PCL removal the following advantages could obtain: More correction of fixed varus or valgus deformity, More surgical exposure. but there are no proved disadvantages like; increasing in stress & loosening of bone-cement-prosthesis interface, specific clinical difference in ROM, forward lean during stepping up, proprioception inferiority. In other hand over tight PCL cause excessive rollback of tibia & knee hinges open, preventing flexion (booking), and Severe posteromedial poly wear in poor balance PCL might be happened. Mid range laxity when Post. Capsule is tight, even with correct tensioning in full extension & 90 degree flexion, may occur (and secondary collateral ligaments imbalance throughout ROM). There is a major effect of capsular contracture in coronal mal alignment with flexion contracture. Full MCL releases not only correct fixed varus but also open the medial space in flexion. MCL & post. Capsule has combined valgus resistant effect in extension. PCL release increase flexion gap more, May be necessary to release something that affect extension gap as compensated balancing (Post.medial capsule). Any flexion contracture need to posterior capsulotomy & post. Condyle osteophyte removal before femoral recut. So it is possible to perform posteromedial capsulotomy prior to superficial MCL release. Method. From May 2009 to June 2013, 219 TKA (165 patient) (bilateral in 54 patients, simultaneous bilateral in 5 patients) with primary DJD and varus deformity of knees were operated by myself with joint replacement. Most patients had some degree of varus correction in flexion, passively. The varus angle was less than 25*, means mild to severe but not decompensate. 46 patients had some degree of patella baja. For soft tissue balancing during Total knee arthroplasty I consider the following steps; Medial capsule & deep MCL release, PCL release, Posteromedial capsulotomy, semimembranous release, Superficial MCL release, Pes anserinous release. Post.medial capsulotomy was done in all cases. The Average Age was 65.47 years, 131 patients (177 knees) were female (79.3%) and five of them had bilateral TKA simultaneously. Lt Knee was operated in 94 cases (42.9% of 219). Spinal anesthesia was applied in 54.3% (119 patients) & epidural anesthesisa in 5 % (13 cases). 14 knees were operated with MIS technique and 205 knees with Standard medial parapatellar incision. Semi membranous release was necessary in 72 knees (33 pure=15%, without S.MCL release). S.MCL release was mandatory in 39 (17.8 %) knees for checking balanced medial and lateral subtle laxity (playing), I have used simple blade with 1 & 2 mm thickness in each ends for younger patients, and the other one with 3&4 mm thickness in elder cases. Results. Average follow up period is 2.07 years. Average Operating time was 1: 38 (h: m). Average Transfusion = 1.29 unit packed cell. Average varus malalignment=14.76*(2–25*) / Av. Valgus angle= 7.11* (5–10 *) / Av. DLFA= 91.15* (85–102*) / Av. PMTA = 82.04* (68.5–90*) / Av. Ext. rotation cut = 5.7* (0–9). Stage l + PCL + Post. Med. Capsular release was performed in all. pure stage l + P.M.capsular release in147 cases(67.2%), plus semimembrnous release in33 cases(15%), S.MCL release in 39cases(17.8%)/ Av. Post op alignment:1.01 * varus(0 −6 *) (worse in medial pivot knee). so S.MCL release was preventedin 82.1% of cases. Av. Polyethylen size: 12.26 (9 in oxynium −19 in plus) / Semi membranous release was necessary in 72(32.8%) cases (preop varus 17.57*). / S.MCL release was mandatory in 39(17.8 %) cases (preop varus 17.6 * & No Flexibility in 30* flexion). pre operation knee society score: stage I = 26.6, stage II = 38.7 increase to stage I = 86.45, stage II = 77.63. Conclusion. In society with more kneeling habitués, during performing total knee arthroplasty with less than 25* degree varus malalignment plus some degree flexibility of the deformity in flexion, it is wise to consider posteromedial capsular release prior to semi membranous & S.MCL release to obtain full correction of alignment. But the most important thing is reaching to more align limb without instability, regardless of various technique

Introduction. The range of motion (ROM) obtained after total knee arthroplasty (TKA) is an important measurement to evaluate the postoperative outcomes impacting other measures such as postoperative function and satisfaction. Flexion contracture is a recognized complication of TKA, which reduces ROM or stability and is a source of morbidity for patients. Objectives. The purpose of this study was to evaluate the influence of intra-operative soft tissue release on correction of flexion contracture in navigated TKA. Methods. This is prospective cohort study, 43 cases of primary navigation assisted TKA were included. The mean age was 68.3 ± 6.8 years. All patients were diagnosed with grade 4 degenerative arthritis in K-L grading system. The average preoperative mechanical axis deviation was 10.3° ± 5.3 and preoperative flexion contracture was 12.8° ± 4.8. All arthroplasties were performed using a medial parapatellar approach with patellar subluxation. First, medial release was performed, and posterior cruciate ligament was sacrificed. After all bone cutting was performed and femoral and tibial trials were inserted, removal of posterior femoral spur and capsular release were performed. The degree of correction of flexion contracture was evaluated and recorded with navigation. Results. After the medial soft tissue release, as a first step, the flexion contracture was recorded as 7.2° ± 4.3 and 4.1° ± 4.0 as varus. The second step, posterior cruciate ligament was sacrificed, the flexion contracture was recorded as 7.2° ± 4.4 and 5.5° ± 3.0 as varus. After posterior clearing procedure and capsular release, the flexion contracture was showed as 3.9° ± 1.2 and 1.4° ± 1.2 as varus. The final angles after cemented real implant were recorded as 3.3° ± 1.4 in flexion contracture, 0.9° ± 1.8 in varus. There were significant differences all steps except between medial release step and posterior cruciate sacrifice step and between posterior clearing step and final angle. Conclusions. The appropriate soft tissue balancing could correct flexion contracture intra-operatively. The medial release could correct the flexion contracture around 5° compared with preoperative flexion contracture, and posterior clearing procedure could improve further extension. However, the sacrifice of posterior cruciate ligament provided little effect on correction of the flexion contracture intra-operatively