Objective: This study compares the results obtained from arthrolysis of the elbow performed arthroscopically with those done open.

Material and Methods: 139 patients from 3 hospitals, who had undergone an arthrolysis of their elbow, were studied retrospectively. 58 had an arthroscopic arthrolysis and 81 were open. The patients included were aged between 18 and 65, had a loss of passive range of motion, due to either osteoarthritis or post trauma. Patients with previous extra articular osteotomy, septic or inflammatory synovitis were excluded. The clinical evaluation comprised measuring their: range of motion, pain, level of activities, presence of effusion or locking. The images obtained were standard radiographs, CT scan and bone scans to allow us to accurately determine the presence of loose bodies, fibrous tissue in the fossae, the presence of osteophytes or arthritis. All data was recorded in preoperative, postoperative and final assessment.

This study also discusses various issues regarding operative techniques (surgical approaches, debridement of joint and capsular releases).

Results: The two groups were similar on all points with the exception of their aetiologies. There was no clinical difference preoperatively. The arthroscopy was performed through 4 portals in 94% of cases; in the open cases the most common approach was lateral (53%). Intra operatively the significant differences were the removal of posterior osteophytes and capsular releases (p< 0.001) were performed more frequently in the open procedure. At the end of the procedure, the flexion and the gain in flexion-extension range was greater in the arthrotomy group; however the arthroscopic group lost less motion from end of procedure to the final result (8 versus 17 degrees). At the last review, the gain in range of motion remained greater in the group with the open arthrotomy. The number of complications in the 2 groups was identical, though the location of any nerve injury was different. The method of rehabilitation was the same; however this was continued for longer in the arthroscopic group. Final radiographic assessment showed that a less extensive debridement of bone was achieved arthroscopically.

Conclusion: A more extensive release and an easier intra operative evaluation resulting in a better improvement in range of motion at the end of procedure are achieved with arthrotomy. The subsequent loss of motion is more significant in this group however the final outcome showed the gain in range of motion remained greater. It was noted however, that even with less improvement in mobility, with either technique, the patients were equally satisfied.

Purpose of the study: For medial osteoarthritis with chronic anterior laxity, we propose an original technique combining subtraction osteotomy and extra-articular ligmentoplasty using the lateral quarter of the patellar tendon.

Material and methods: WE report a retrospective review of 29 patients (11 males/18 females) aged 29–51 years treated from May 1996 to October 2002. Time from rupture of the anterior cruciate ligament (ACL) and the operation was 17.5 years (range 13–22 years). These patients had had 52 prior operations (more than one per knee). All presented functional instability, a positive pivot test, and anterior laxity measured at 8 mm on average (range 5–10 mm) on KT1000. Pain in the medial compartment was observed in all patients with osteoarthritis noted grade II in 7, grade III in 18 and grade IV in 4. Radological varus measured 5–15°. Lateral subtraction osteotomy fixed with a plate was performed in combination with a patellar tendon autograft using the lateral quarter of the patellar tendon. Immediate mobilization with complete weight bearing was the rule.

Results: A mean 5–year follow-up (range 18 months to 9 years). According to the IKDC subjective score, 26 patients were satisfied or very satisfied and 22 of them had resumed their sports activities. Instability persisted in one patient and pain in two. Varus was corrected in three patients but the medial degradation progressed. Anterior laxity measured with KT1000 was 1–6 mm (mean 2 mm). The pivot test was positive in one knee, negative in 18 and revealed slight displacement in 10. Excluding the radiological aspect, the overall IKDC score was 2A, 21B, 6C, 1D.

Conclusion: This combined method is particularly interesting for stabilizing chronic ACL instability causing secondary medial degeneration. It treats two conditions with the same approach with an acceptable rate of satisfaction.

Purpose of the study: This prospective anatomic study was conducted to analyze meniscal healing after arthroscopic repair.

Material and method: Two preliminary studies (a radio-anatomic study and a comparative arthroscan-arthros-copy study) were conducted to define strict radiological criteria (contiguous slices or spiral acquisition)which could be interpreted by all observers. Sixty-five vertical meniscal lesions were included in the study and divided into four groups according to localization (medial or lateral) and knee stability (stable or associated ligamentoplasty). Arthroscopic repair was performed in all cases. Mean length of the lesions was 20.31±6 mm. Minimum follow-up was six months. The work-up included an arthroscan and the IKDC function score.

Results: The work-up could be interpreted for 62 knees. The overall outcome according to Henning was: 42% complete healing, 31% incomplete, 27% failure. Healing outcome was similar for lesion in a red-red zone (73%) or a red-white zone (70%). The healing surface could be assess for 43 knees: 37% complete healing, 21% partial healing of more than half of the initial tear, 12% partial healing of less than half of the tear, and 12% failure. The analytic results of 17 medial repairs on stable knees yielded: 9 complete, 2 partial, 4 failure, with IKDC (79, 68, 73 points) having no significant influence. For the 24 medial repairs on unstable knees outcome was: complete healing in 10, partial in 6 and a good IKDC score (80.85 points). Functional outcome was poor for the eight failures (67 points). Lateral repairs on 11 stable knees yielded: complete healing in 2 (IKDC 76 points), partial in four (IKDC 94 points) and failure in five (IKDC 82 points). For the ten unstable knees, complete healing was achieved in five and partial healing in five with good patient satisfaction (IKDC 80.70 points).

Conclusion: Methodologically, arthroscan provided a good assessment of healing. The notion of the healing surface appears to be more appropriate than thickness, since partial healing can transform an unstable knee into a stable one. Clinically, in one third of the knees, meniscal healing could not be achieved. This failure was more frequent and less well tolerated for the medial lesions. For the lateral lesions, incomplete healing was more frequent, perhaps in relation to meniscal mobility and the associated ligamentoplasty which apparently protected the meniscal repair. In this series, meniscal healing did not have a significant influence on the functional outcome.