The purpose of this study was to determine if arthroscopic release is safe and effective in the management of elbow contracture. Twenty patients (mean age of forty-two), undergoing arthroscopic contracture release were retrospectively reviewed at a minimum follow-up of one year (mean twenty-five months). Most patients had combined extrinsic & intrinsic causes for contractures. Mean flexion improved from 122 to 137°. Mean extension improved from 38° to 18°. The mean arc improvement was 35° (p < 0.001). None of the patients had instability and there were no major neuro-vascular complications. All patients had decreased pain and improved elbow function. To determine if arthroscopic release is safe and effective in the management of elbow contracture. Twenty patients (mean age of forty-two), undergoing arthroscopic contracture release were retrospectively reviewed at a minimum follow-up of one year (mean twenty-five months). Most patients had combined extrinsic & intrinsic causes for contractures. Motion and strength were measured with standard goniometry and the LIDO isokinetic system by independent evaluators. Mean flexion improved from 122 ± 16° to 137 ± 12°. Mean extension improved from 38 ± 18° to 18 ± 14°. The mean arc improvement was 35 ± 21° (p < 0.001). Arthroscopic release did not affect forearm rotation or strength. One patient developed a permanent medial antebrachial cutaneous neuroma. One patient required a repeat surgery to remove a loose body. There were no instability and no major neurovascular complications. All patients had improved elbow function with a mean ASES score of thirty-one out of thirty-six. Most patients were satisfied with their surgery, had minimal pain, considered themselves in good physical health on the SF-36, and had minimal impairment on the DASH. Arthroscopic release is safe and effective in experienced hands. Results are comparable to traditional open techniques. The theoretical advantages of arthroscopy include improved joint visualization, decreased morbidity and earlier rehabilitation. Disadvantages include the potential for serious neurovascular complications, and the inability to deal with ulnar nerve pathology or heterotopic ossification. Indications for conversion to open release include excessive swelling, and failure to maintain adequate view

We describe the surgical technique and results of arthroscopic subtalar release in 17 patients (17 feet) with painful subtalar stiffness following an intra-articular calcaneal fracture of Sanders’ type II or III. The mean duration from injury to arthroscopic release was 11.3 months (6.4 to 36) and the mean follow-up after release was 16.8 months (12 to 25). The patient was positioned laterally and three arthroscopic portals were placed anterolaterally, centrally and posterolaterally. The sinus tarsi and lateral gutter were debrided of fibrous tissue and the posterior talocalcaneal facet was released. In all, six patients were very satisfied, eight were satisfied and three were dissatisfied with their results. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from a mean of 49.4 points (35 to 66) pre-operatively to a mean of 79.6 points (51 to 95). All patients reported improvement in movement of the subtalar joint. No complications occurred following operation, but two patients subsequently required subtalar arthrodesis for continuing pain. In the majority of patients a functional improvement in hindfoot function was obtained following arthroscopic release of the subtalar joint for stiffness and pain secondary to Sanders type II and III fractures of the calcaneum

This study investigated the effects of arthroscopic release for the treatment of stiffness in total knee replacement (TKR) to compare the outcomes against the reported outcomes for more invasive procedures such as open release and revision. We prospectively followed all patients undergoing TKR between 1998 and 2008 at the lead author's institution where stiffness other than that for mechanical or infective reasons was treated arthroscopically. Nineteen knees from the author's series of 572 knee replacements and three knees from other units were treated and outcomes were recorded in terms of pre-operative and post-operative Oxford knee scores and range of motion. At arthroscopy each of the 22 knees displayed extensive scarring (particularly in the suprapatella pouch) that was debrided. The mean follow-up was 40 months (range 5 months to 10.5 years). The Oxford knee score improved from 42.6 (±7.5) prior to TKR to 36.3 (±8.5) after TKR and to 29.3 (±9.0) after arthroscopic arthrolysis. The mean maximum flexion declined from 107° prior to TKR to 64°. Arthroscopic arthrolysis improved mean maximum flexion to 105° on table and 93° at most recent follow-up. We recommend this technique as a reasonable option for the treatment of stiffness after knee replacement as it compares well with more invasive surgical options

Aim: The aim was to prove the efficency of the arthroscopic release of retinaculum as minimally invasive and primary surgical method in treatment of lateral habitual luxation of patella in adolescents. Majority of the patiens were sportswomen and so it was required to have smaller scaring. Materials and Methods: Between july 2003 and july 2007, we did the arthroscopic release of the lateral retinaculum in 24 children, (21, 3) aged between 12 and 18, on 28 knees. All of them were active in different sports, e.g. football, athletics, basketball, kickboxing. The indication was set after the second to twentieth pre-operative luxation depending on when the patient came for treatment to our clinic. Retinaculotomy was always done in fluid milieu, using spinal or endotracheal anesthesia depending on the age of the child. The average postoperative follow-up was 24 months. Results: To compare our patients we made a table, which is filled in with queries preoperatively and postoperatively about the number of luxations and subluxations, pain, mobility, axial images of patella at 60°, patient’s satisfaction and sports activity. In 26 cases we cured the luxations, lowered the painfulness and 17 children returned to their previous sports activities. In 2 cases, after continuation of sports, the luxation occured again, so we had to use additional surgical Methods: Conclusion: With this method we achieved good results with smaller scaring if we did the lateral release earlier comparing to the number of luxations and if there was no hypoplasia of lateral condil of femur

Purpose of the study: The rate of recurrence after conventional manipulation procedures and arthroscopic debridement for idiopathic adhesive capsulitis of the shoulder is rather high. Arthroscopic release using a radiofrequency method might improve results. The purpose of this prospective study was to compare results of two athroscopic methods: manipulation and debridement versus radiofrequency release. Material and methods: Thirty patients underwent arthroscopic treatment for shoulder pain six months after a conventional treatment for idiopathic adhesive capsulitis. In group A (n=15 patients), manipulation under anesthesia was followed by arthroscopic joint debridement. In group B (n=15 patients) arthroscopic section of the contracted structures was followed by radiofrequency section of the rotator interval and the anterior and posterior capsule. The coracohumeral ligament was sectioned in all cases. Subacromial decompression was achieved arthroscopically in four of the cases in group A and in two in group B. Age, gender and preoperative joint motion were similar in the two groups. Results: Follow-up data at six weeks and at 3, 6, and 12 months were assessed in 27 patients (12 group A and 14 group B). Pain, joint stiffness, and function (UCLA and Constant) were assessed. Recurrence required revision in two patients in group A. There was no significant difference for pain (VAS) but there was an improvement in joint motion at three and six months for patients in group B. The outcome was satisfactory in all patients except one. Discussion and conclusion: Radiofrequency release appears to yield better results than manipulation and arthroscopic debridement. The radiofrequency technique enables section of the rotator interval, the coracohumeral ligament and the capsule to prevent early adhesions and allow more rapid recovery of function

Aim: To compare 2 rehabilitation regimes after arthroscopic interval release: immediate mobilization versus immediate mobilization and external rotation night splint for ten days. Methods: 30 patients aged 40–67 years with primary frozen shoulder were included in the study. The surgical procedure consisted of release of the coracohumeral ligament, rotator interval and the posterior capsule with electrocautery, followed by gentle manipulation. Patients were randomised into 2 rehabilitation groups: immediate mobilization (IM) or immediate mobilization with external rotation night splint (ERS) used for 10 days post-operatively. Patients were assessed pre & post operatively and using the visual analogue score for pain, Constant and Oxford scoring systems. Results: There were 15 patients in the IM group and 15 in ERS group. In the IM group the Constant score improved from 35±10 (mean±SD) pre-operatively to 63±14 at 1 month and 75±11 at 6 months, and in the ERS group the Constant score improved from 33±9 pre-operatively to 59±14 at 1 month and 75±7 at 6 months. The Oxford score in the IM group improved from 35±9 pre-operatively to 25±8 at 1 month and 18±9 at 6 months, and in the ERS group from 38±9 pre-operatively to 27±8 at 1 month and 18±8 at 6 months (all changes P< 0.001 cf pre-operative, but NS from 1 to 6 months). Improvements in VAS were significant in both groups (P< 0.02) at 6 months but not at 1 month. There was no significant difference between the two groups in terms of Oxford or Constant scores or VAS at 1 and 6 months. Conclusion: Arthroscopic interval release is successful in restoring range of motion in patients with idiopathic frozen shoulder. Both groups showed significant improvement during the study period with most improvement in terms of range of movement occurring in the first month. There was no significant difference in outcome between the two groups studied

Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic tennis elbow release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release. This was a prospective study of 29 consecutive patients (30 elbows) with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic assessment of the elbow joint was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral, anteromedial and anterolateral portals. Associated intra-articular pathology was noted. The ECRB lesions were classified according to their gross morphology and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and at 3 months using the DASH score. 29 patients with tennis elbow were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 30 elbows undergoing surgery, 22 were noted to have a Nirschl type I lesion (intact capsule), 7 had a type II lesion (linear capsular tear) and 1 had a type 3 lesion (capsular rent). Degenerative articular changes were noted in 18 elbows. Arthroscopic debridement was undertaken if appropriate. Three elbows had eccentric radial heads. Radial plicae which were impinging on the radial head were present in three patients. Mean follow up is 9 months (1–23). 1 patient was lost to follow up. There was a significant improvement in DASH scores (p< 0.05) at 2 weeks post operatively. This improvement became more significant at 3 months post operatively. This is a worst case scenario analysis using a paired t test. 6 patients failed to improve, 1 partially improved and 1 was revised and improved. There were no surgical complications; however, one patient has post operative stiffness which required an arthroscopic release. The early results of this study would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology if required. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation and return to normal activities

Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release. This was a prospective study of 28 consecutive patients with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic joint assessment was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral and medial portals. The ECRB lesions were classified and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and 3 months using the DASH score. Of the 28 elbows 21 were noted to have a Nirschl type I lesion (intact capsule), 6 had a type II lesion (linear capsular tear) and 1 a type III (capsular rent). Degenerative articular changes were noted in 19 elbows. If arthroscopic debridement was required it was undertaken. Three elbows were noted to have eccentric radial heads. Radial plicae which were impinging on the radial head were noted in three patients. 1 patient was lost to follow up. There was a significant improvement in DASH scores (p< 0.002) at 2 weeks post operatively. This improvement was sustained at 3 months. This is a worst case scenario analysis using a paired t test. 1 patient had post operative stiffness and 6 failed to improve of which 2 were revisions. The early results would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation

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

The outcome of arthroscopic medial release of 255 knees in 173 patients for varying grades of osteoarthritis involving the medial compartment is reported. All operations were performed by a single surgeon between January 2001 and May 2003. The Knee Society score for pain and the patient’s subjective satisfaction were used for the outcome evaluation. Overall, satisfactory outcome was reported for 197 knees (77.3%) and the mean Knee Society score for pain improved from 17.6 (95% confidence interval, 16.7 to 18.5), pre-operatively to 39.4 (95% confidence interval, 37.9 to 41.1) (p < 0.001). There were minor manageable complications of persistent effusion in 16 knees and prolonged wound discomfort in 11. In total, 15 of the 21 knees with poor results were converted to total knee replacements and two other patients (three knees) were offered this option after a mean period of 16 months. Based on these observations arthroscopic medial release is an effective treatment for osteoarthritis of the medial compartment of the knee joint and can be expected to reduce the pain in the majority of patients for at least four years post-operatively

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

Aim: Description of and Prospective analysis of long-term outcomes of arthroscopic tennis elbow release. Materials and Methods: 70 patients (72 elbows) with lateral epicondylitis, recalcitrant to a minimum of 6 months of supervised conservative management, underwent arthroscopic lateral epicondylar release. Each patient was clinically evaluated pre operatively and post-operatively and a quantitative assessment of the grip strength was collected on both sides with a dynamometer, in full elbow extension and in 90 degrees flexion. Functional assessment with the Mayo Elbow Performance Score and dynamometer grip strengths were collected for the first two years post-operation. Results: Postoperative follow-up averaged 36 months (range 24–45months). The average MEPS increased from 57/100 to 89/100. 66 patients were graded as excellent outcomes, and 4 patients were noted to have fair outcomes. The latter 4 patients were assessed to have type 2 failure, with two subsequently requiring PIN releases, one requiring an osteochondroma excision from the distal laeral humerus, and one patient lost to follow-up. Dynamometr strength returned to above pre-operative level at an average of 3 months and were and average of 35% greater than the pre-operative level at final review. Complications consisted of synovial fistulae (n=8) all of which spontaneously resolved within one month, 2 portal superficial infections, 1 mild anterior capsular contracture, and no neurovascular injuries. Concurrent intra-articular pathology that was noted included radio-capitellar chondrosis (n=22), lateral trochlear chondrosis (n=20), anterolateral synovial plicae (n=17), synovitis (n=13), radial head instability (n=3), and synovial osteochondromatosis (n=1). Conclusion: Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis

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

The application of arthroscopic procedure for osteoarthritic knee is limited to rather initial stages of the disease. Here we report the results of new arthroscopic procedure, which was named arthroscopic posteromedial release, applied to relatively severe cases of medial type osteoarthrits (OA). Forty-eight knees of 46 patients of OA knees with flexion contracture were treated with arthroscopic posteromedial release. Thirty-two were female and 14 were male. All the patients had been treated conservatively beforehand. The mean age of the patients was 71.6 (range, 47 to 84 years), the average range of motion was 13 to 129 degrees. Only one case was classified stage II in Kellgren Lowrence x-ray classification, 13 and 34 cases were stage III and IV respectively. The average femoro-tibial angle was 183.4+-4.4 degrees. In surgery, we release the joint capsule along with the medial tibial condyle, arthroscopic debridement including medial meniscentomy was performed at the same time. If some cases, medial collateral ligament was cut transversely to obtain enough joint space. We use hyaluronan intra-articularly once a week for 5 weeks postoperatively. Patients were examined at 3,6,12,18 and 24 months after surgery and evaluated subjectively and objectively with the rating system of Japanese Orthopaedic Association knee score (JOA score). Clinical results were also classified excelletn, good, fair and poor by our criteria. Eighty-three per cent (40 knees) of patients were satisfied at their last follow up. Sixty-seven percent (32 knees) of the patients were excellent or good. Six knees were converted to TKA because of their persistent knee pain. Twenty-eight knees complained of night pain pre-operatively, but only four of them complained of it postoperatively. Considering that most of the patients in this series were grade IV in x-rays and their joint surface of medial compartment showed large eburnation both femur and tibia, TKA is most preferable treatment conventionally. But our results showed this arthroscopic technique was one of the applicable choices for severe OA knees

Our aim was to compare the outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. We prospectively compared the outcome in 21 patients with and 21 patients without diabetes, two years post-operatively. The modified Constant score was used as the outcome measure. The mean age of the patients was 54.5 years (48 to 65; male:female ratio: 18:24), the mean pre-operative duration of symptoms was 8.3 months (6 to 13) and the mean pre-operative modified Constant scores were 36.6 (standard deviation (sd) 4.6) and 38.4 (sd 5.7) in the diabetic and non-diabetic groups, respectively. The mean modified Constant scores at six weeks, six months and two years post-operatively in the diabetics were 55. 6 (sd 4.7), 67. 4 (sd 5.6) and 84. 4 (sd 6.8), respectively; and in the non-diabetics 66.8 (sd 4.5), 79.6 (sd 3.8) and 88.6 (sd 4.2), respectively. A total of 15 (71%) of diabetic patients recovered a full range of movement as opposed to 19 (90%) in the non-diabetics. There was significant improvement (p < 0.01) in the modified Constant scores following arthroscopic release for frozen shoulder in both groups. The results in diabetics were significantly worse than those in non-diabetics six months post-operatively (p < 0.01) with a tendency towards persistent limitation of movement two years after operation. These results may be used when counselling diabetic patients for the outcome after arthroscopic treatment of frozen shoulder.

Cite this article: Bone Joint J 2014;96-B:1355–8.

The isolated arthroscopic lateral release has been already presented in the literature as an effective alternative for surgical treatment of different degrees of patellofemoral instability. This paper is to evaluate the long term results of this procedure in patients with recurrent dislocation of the patella (RDP). Material of this study is a group of patients who underwent isolated arthroscopic lateral release for RDP with a minimum 10 years follow-up. All the patients included presented 1) clear clinical history of RDP 2) positive apprehension test 3) patella able to be dislocated under anesthesia. Were excluded from this study patients who presented 1) generalised ligamentous laxity 2) habitual dislocations of the patella 3) avulsion fracture of the patella 4) marked malalignment 5) age over 40 years. 42 patients met these criteria and 27 (28 knees) were available for follow-up. There were 13 females and 14 males with an average age of 20, 1 years and an average follow-up of 13, 4 years. All the patients were evaluated for patellar stability and functional outcomes with both Miller and Bartlett and Crosby and Insall scores. According to the evaluation scores above mentioned 16 knees (57%) were rated as excellent /good results. The isolated lateral release can be considered as the first approach for the treatment of RDP. The outcomes are adversely affected by long term-follow-up, however, it does not compromise any further treatment

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

The February 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty

Purpose of study. Internal rotation (IR) contracture of the shoulder is a frequent complication of obstetric brachial plexus injury, even in the face of full neurological recovery. Surgical procedures to treat this complication include tendon transfers, capsular release and osteotomies. We compared the outcomes in patients who had arthroscopic release only and those who also underwent a tendon transfer. Methods. We retrospectively reviewed the clinical records of all patients with OBPI presenting to our unit in the years 2002–2012 who underwent surgical procedures for the treatment of an IR contracture of the shoulder. Increase in range of external rotation (ER) in adduction and abduction intra-operatively was recorded. At follow-up, active ER, the Mallet score, presence of an ER contracture and the “drop-arm” sign was recorded. Results. 25 procedures were performed in 22 patients. Mean intra-operative gain in ER was greatest in those patients who had simultaneous arthroscopic release and a tendon transfer (83.3° and 60.5° in adduction and abduction respectively). This group had the greatest average range of active ER at follow up (47.5°), the lowest incidence of a “drop-arm” sign (14%), but also the highest incidence of ER contracture (75%). Patients who underwent arthroscopic anterior shoulder release only, had the highest average Mallet score at final follow up (17.1 compared to 16.3 in the scope and tendon transfer group), 45% incidence of a “drop-arm” sign and also the lowest incidence of ER contracture (32%). General satisfaction was greatest in the scope plus tendon transfer group. Conclusion. Patients who had arthroscopic release and tendon transfer had better ER range and power but more severe ER contractures than patients who underwent arthroscopic release only. Patient satisfaction and Mallet scores were comparable between the two groups and therefore bring into question the need for early tendon transfer in these patients. NO DISCLOSURES