Purpose: This retrospective analysis was designed to determine the contribution of arthroscopy in the management of moderately stiff elbows arising from degenerative disease or trauma.

Material and methods: Between 1992 and 2001, we performed 31 arthroscopic examinations of the elbow in patients with moderately stiff elbows. Mean preoperative motion was 94.8°. Men age at surgery was 41.6 years; there were nine women and 22 men. The dominant side was involved in 70% of the cases. Twentyfive patients were available for clinical review at a mean 32 months follow-up (range 5 months to 9 years). The causal event was trauma in 13 cases. The stiff elbow was a consequence of degenerative disease in 13 cases with no notion of trauma. Three elbows had been exposed to repeated microtrauma. For the majority of the cases, the intervention consisted in an anterior time via two portals then a posterior time. In five cases, anterior capsulotomy was performed. The other interventions were limited to joint cleaning. For two elbows, we used the Kashiwagi Outerbridge technique. Neurolysis of the ulnar nerve was performed at the elbow level during the same operative time.

Results: Elbow motion in flexion was significantly improved after arthroscopy (P=0.01) and the flexion of the stiff elbow was reduced significantly (P=0.0001). At last follow-up none of the patients felt arthroscopy had worsened the elbow condition. The gain in joint motion was 25°. This gain was significantly greater when we performed anterior capsulotomy at the end of the procedure (P< 0.001). In three cases, there was a postoperative loss of motion. We did not have any intra or postoperative complications. Eighty percent of the patients felt arthroscopy had improved their elbow.

Discussion: Arthroscopy of the stiff elbow arising from variable causes remains a difficult intervention which in our series provided gain in motion comparable to that reported in other series in the literature. This could be an interesting less invasive alternative to open surgery in the case of moderately stiff elbow.

Purpose: This study was conducted to analyse the importance of the Malgaigne notch and its position on standard x-rays taken in internal rotation or on arthroscan in patients treated for anterior instability of the shoulder. Our purpose was to search for criteria perdictive of outcome of arthroscopic stabilisation of the shoulder joint using the Bankart method.

Material and methods: Fifty-four patients were reviewed to determine the postoperative Duplay score. Mean follow-up was 68 months (32–100). Mean age at surgery was 29 years. We divided the patients into three populations as a function of preoperative symptoms: population A two dislocations or more, population B one dislocation then episodes of subluxation, population C no dislocation but pain. We divided this population according to the Duplay score. Group 1 patients had a fair or poor outcome, Group 2 patients had a good or excellent outcome. We reviewed 54 radiograms using patterns of increasing size (mm by mm) to assess the radius of the humeral head and the depth of the notch. We evaluate the reproducibility of this method by comparing the readings of ten senior orthopaedic surgeons. There were no false positives or false negatives. Variance of the measures taken by the ten surgeons was 0.67 at 1.31 mm, a small variance. We compared the ratio between the radius of the humeral head and the depth of the notch in the different groups.

Results: The Malgaigne notch was significantly deeper in population A (19%) than in population B (14%) or population C (14.3%). This suggests that the size of the notch has an effect on symptomatology of shoulder instability. The notch was also significantly deeper in group 1 patients (fair or poor outcome) (21%) than in group 2 (good or excellent outcome) (16%) (p=0.05).

Discussion: Beyond a threshold set at 15%, there were 54% fair or poor results. The position of the notch in height was significantly different in population A compared with populations B and C (p=0.01). It appears to be higher in case of true recurrent dislocation. We did not demonstrate any statistical link between the position of the notch on the CT scan and surgical outcome. This study demonstrates the importance of information on the internal rotation images in choosing the proper type of surgery for shoulder instability.