Knowledge of diet and blood pressure among African Americans: use of focus groups for questionnaire development

The long-term results were reviewed for seventy-two patients (seventy-five knees) who had had a bone-patellar ligament-bone intra-articular reconstruction of the anterior cruciate ligament between August 1984 and May 1992. The mean age of the patients at the time of the operation was forty-five years (range, forty to sixty years). Three patients had a bilateral procedure. The primary mechanisms of injury were accidents that occurred during skiing (thirty-two knees), tennis (fourteen knees), and soccer (five knees). We analyzed the responses to subjective questionnaires, the functional results, and the objective clinical data. The clinical examination included assessment of the range of motion, performance of Lachman and pivot-shift tests, and measurements with use of a KT-1000 arthrometer. All knees were evaluated with use of three common rating scales: that of Lysholm and Gillquist; that of The Hospital for Special Surgery, as modified by Insall et al.; and the International Knee Ligament Standard Evaluation Form. At the latest follow-up evaluation, at a mean of fifty-five months (range, twenty-six to 117 months), three patients reported pain or swelling. No patient reported giving-way or symptoms related to the patellofemoral joint. The mean range of extension was -12 to 6 degrees, compared with -8 to 42 degrees preoperatively, and the mean range of flexion was 112 to 150 degrees, compared with 52 to 154 degrees preoperatively. Flexion was limited to 112 degrees in one patient, but this was 5 degrees greater than that of the uninvolved knee. Sixty knees (80 per cent) had a negative pivot-shift test, and ten knees (13 per cent) had a grade of 1+. On testing with the KT-1000 device at maximum manual pressure, the mean difference between the injured and uninjured knees was found to have improved by 5.1 millimeters, from 6.4 millimeters preoperatively to 1.4 millimeters postoperatively (p < 0.01). The grade on the International Knee Ligament Standard Evaluation Form improved markedly; seventy-two knees (96 per cent) had a grade of C or D preoperatively, whereas seventy knees (93 per cent) had a grade of A or B postoperatively. The Hospital for Special Surgery score improved from a mean of 69 points preoperatively to a mean of 92 points postoperatively (p < 0.01). The mean score according to the scale of Lysholm and Gillquist increased from a mean of 63 points preoperatively to a mean of 94 points postoperatively (p < 0.01). All patients indicated that they were pleased with the result of the procedure. Bicycling was resumed at a mean of four months; jogging, at a mean of nine months; skiing, at a mean of ten months; and tennis, at a mean of twelve months.     

Results of knee replacement with the Walldius and geometric prostheses. A comparative study

Sixty-two knees that were replaced with Walldius prostheses and twenty-five knees with geometric replacements were studied prospectively. The follow-up ranged from twenty-four to 162 months (average, seventy-four months) for the knees with the Walldius prostheses and from twenty-four to seventy-five months (average, forty-seven months) for those with the geometric prostheses. Using a 100-point clinical rating scale, the knees of patients who underwent Walldius replacement improved from their preoperative status by an average of 33 points (from 44 to 77 points) and those with geometric prostheses, an average of 24 points (from 54 to 78 points). Twelve patients with twenty Walldius prostheses were followed for more than 100 months (average, 127 months). The greater average improvement (36 points) in this group was due primarily to the absence of any major complications. Six patients underwent replacement of one knee with a Walldius prosthesis and one knee with a geometric implant. Although the ratings for the two knees were similar in each patient, four patients preferred the Walldius implant; one, the geometric replacement; and one had no preference. Significant technical errors or complications (defined as those affecting the end result) occurred in 8 per cent of the knees with Walldius implants and in 12 per cent of the knees in the geometric group. There were two late infections in each group. One Walldius prosthesis was removed and the knee was fused. The other three prostheses (one Walldius and two geometric) associated with infection were salvaged.     

Total ankle arthroplasty: a unique design. Two to twelve-year follow-up

We evaluated the intermediate-term results of a novel total ankle arthroplasty that includes insertion of the components without cement and arthrodesis of the tibiofibular syndesmosis as part of the operative procedure. One hundred consecutive Agility ankle replacements were performed in ninety-five patients between 1984 and 1993. At the time of follow-up, eighty-three patients (eighty-six ankles) were alive and twelve patients (fourteen ankles) had died. Five (6 per cent) of the eighty-six ankles in the living patients had been revised. Including the components that had been revised for loosening, twenty-one (twelve tibial and nine talar) components had migrated. Delayed union of the syndesmosis (twenty-eight ankles) and non-union of the syndesmosis (nine ankles) were associated with the development of lysis around the tibial component. Non-union of the syndesmosis was also associated with migration of the tibial component and circumferential radiolucency around that component. In addition to the patients who died, one patient had a resection of the implant with subsequent arthrodesis. The remaining eighty-two patients (eighty-five ankles) were the basis for the clinical evaluation in the study. The average age at the time of the procedure was sixty-three years (range, twenty-seven to eighty-one years). At the time of the most recent follow-up (range, 2.8 to 12.3 years; average, 4.8 years), forty-seven (55 per cent) of the remaining eighty-five ankles were not painful and twenty-four (28 per cent) were only mildly painful. The range of motion of the fifty-six ankles that were examined at the time of follow-up averaged 36 degrees (range, 10 to 64 degrees), and the results for seventy-nine (93 per cent) of the eighty-five ankles were satisfactory to the patients.     

Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force

Forty-eight knees were evaluated after proximal tibial osteotomy, performed for varus deformity to determine the desired amount of correction of the deformity, the effect of osteotomy on knee motion during gait and one medial-plateau force during standing, and the relationships between these factors and the result. Correction of the tibiofemoral angle to 5 degrees of genu valgum or more produced the best and most lasting results. Stance-phase flexion-extension increased the rotation decreased in knees with good results while the other gait parameters were not significantly changed. Medial-plateau force was decreased by successful tibial osteotomy. The knees with the best and most lasting results had 7 degrees of stance-phase flexion-extension or more during walking and either a valgus tibiofemoral angle of 5 degrees or more or a medial-plateau force of 50 per cent of body weight or less.     

Complications and long-term results of ankle arthrodeses following trauma

A review of sixty patients who had undergone ankle fusion for post-traumatic arthritis revealed that thirty-five (58 per cent) had the procedure performed within the first year after injury. A total of forty-eight complications occurred in twenty-nine (48 per cent) of the patients. Frequent complication were infection (23 per cent), non-union (23 per cent), inadequate surgical alignment or early loss of position (15 per cent), malunion (12 per cent), and delayed union (7 per cent). The lateral transfibular approach had the highest incidence of complications, and a two-incision approach using the Charnley compression apparatus was the procedure with the fewest complications. Forty-one patients were followed for an average of 7.5 years after operation. Of these, thirty-four (83 per cent) were satisfied with the procedure. Examination of thirty of the forty-one patients at an average of 7.3 years after surgery revealed virtually no subtalar motion but motion of 13 degrees at Chopart's joint. With shoes, patients had a near-normal gait. The roentgenograms revealed a minimum amount of degenerative arthritis at Chopart's joint, which may worsen with time. Varus or valgus angulation of the hind part of the foot was associated with a greater degree of symptoms in the subtalar area as well as the middle of the foot. The neutral position in varus-valgus angulation as well as dorsiflexion-plantar flexion was the optimum position for both men and women. The results of the procedure did not deteriorate with time.     

Mechanical distraction for treatment of severe knee flexion contractures

Ten patients (14 knees) with severe knee flexion contractures were treated by gradual mechanical distraction using either the Ilizarov or Orthofix external fixator. Range of motion improved from an average flexion contracture of 60 degrees before surgery to 16 degrees at the follow-up evaluation. Range of motion results were graded good or excellent in five knees, fair in two knees, and poor in three knees. Average total arc of motion remained essentially unchanged when comparing the preoperative (59 degrees) with the follow-up results (63 degrees). However, the functional position of this arc improved significantly. Problems encountered included a "rebound" phenomena after frame removal, with loss of the temporarily increased total arc of motion. The role of hamstring tenotomy and radical posterior knee release remains unclear.     

Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis

We determined the long-term results of total hip replacement in a series of young patients who had ankylosing spondylitis. Between 1966 and 1978, forty-three Charnley low-friction arthroplasties were performed in twenty-four patients who had an average age of 28.8 years (range, nineteen to thirty-nine years) at the time of the operation. There were seventeen men and seven women. The average duration of follow-up for the series was 22.7 years (range, one month [a perioperative death] to 30.3 years). Four patients (seven hips) had died an average of 12.6 years (range, one month to 18.7 years) after the operation. The twenty surviving patients had clinical and radiographic follow-up until the time of writing or until both of the original components had been revised. All patients had substantial relief of pain and improvement of function and the range of motion of the joint. Twenty-one patients (88 per cent; thirty-nine hips) were completely free of pain (6 points, according to the scale of Merle d'Aubigne and Postel), and the remainder had only slight discomfort (5 points). Ten acetabular components and one femoral component were revised because of aseptic loosening, and one patient had a revision of both components because of late deep infection. Three additional femoral components were revised during a revision operation for a loose acetabular component. Although the femoral components were not loose, they had been in place for more than ten years and it was thought likely that the bearing surface was damaged. The average time to revision was 13.3 years (range, 4.0 to 20.3 years). At an average of 22.7 years, thirty-eight (88 per cent) of the original femoral components and thirty-two (74 per cent) of the original acetabular components remained in situ. The average annual rate of acetabular wear was 0.12 millimeter for the entire series. Only six hips (14 per cent) had minor heterotopic ossification, and none of the hips had clinically important ossification (class III or IV according to the system of Brooker et al.). To our knowledge, the present report describes the largest series of total hip arthroplasties, with the longest duration of follow-up, in young patients who had ankylosing spondylitis. Survivorship analysis with use of the Kaplan-Meier method revealed that the probability of survival of the femoral component (with 95 per cent confidence intervals) was 91 per cent (83 to 99 per cent) at twenty years and 83 per cent (72 to 94 per cent) at thirty years. The probability of survival of the acetabular components was 73 per cent (61 to 84 per cent) at twenty years and 70 per cent (57 to 83 per cent) at thirty years. The probability that both components would survive was 91 per cent (82 to 100 per cent) at ten years, 73 per cent (61 to 84 per cent) at twenty years, and 70 per cent (57 to 83 per cent) at thirty years. The Charnley low-friction arthroplasty provided consistently good long-term results, with a low rate of complications and revisions, in this group of young patients.     

Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes

In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.25 per cent the lateral meniscus was torn; in 21.25 per cent the ACL tear was associated with a medial meniscus tear, and in the remaining 7 per cent both menisci were torn. The most frequently associated meniscal injury was the bucket handle tear of the medial meniscus (9 per cent), followed by the posterior horn tear of the lateral meniscus, which showed the same frequency as the ragged (or degenerated) tear of the lateral meniscus (6 per cent). The horizontal tear of the posterior part of the lateral meniscus showed a prevalence of 4.3 per cent. This picture is probably dependent on a secondary referral nature of the centre surveyed, in which the average time between injury and arthroscopy was 23.3 months.     

Demographic biases of scoring instruments for the results of total knee arthroplasty

Four knee-scoring systems were used to evaluate 200 adult subjects who had no history of injury, abnormality, or treatment of the knees, hips, lower extremities, or spine. All subjects were in the age-range (fifty to 100 years; average, 65.5 years) typical of candidates for total knee replacement. In addition to a physical examination, complete demographic data were collected for each subject. The knee scores were normalized by dividing the observed score by the maximum possible score. The average normalized total knee score was 91 per cent (range, 22 to 100 per cent) according to the knee score of The Hospital for Special Surgery, 95 per cent (range, 10 to 100 per cent) according to the system of Hungerford and Kenna, 89 per cent (range, -7.75 to 100 per cent) according to a modification of the scoring system of The Knee Society, and 95 per cent (range, 26.5 to 100 per cent) according to the system of Hofmann et al. Demographic variables that had a significant negative correlation with the knee scores included advanced age (particularly of eighty-five years or more), a family income below the poverty level, and two major medical conditions or more. Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant.     

Experience with knee synovectomy in Norwich, 1964-1973

Thirty-six patients (43 knees) who underwent anterior synovectomy for rheumatoid disease between 1964 and 1973 have been personaly reviewed. The notes and X-rays of a further seven patients (10 knees) have been examined. Twenty-five per cent of the knees were failures at the time of review, but only two were failures from the outset. The indications for the operation and also the contraindications are described and evaluated. It is concluded that: 1. In the rheumatoid knee, anterior synovectomy is a pain relieving operation. 2. The indications are wider than classically stated, and can include knees with full thickness cartilage destruction, and flexion deformities up to 20 degrees. 3. The majority of knees fail because of secondary degenerative change, and this is manifested by pain rather than stiffness. 4. Postoperative manipulation does not prejudice the final result. 5. Associated popliteal cysts (five in this series) can be cured by anterior synovectomy.     

Guepar hinge prosthesis: complications and results with two years' follow-up

Experience with the GUEPAR prosthesis in 292 cases of which 103 have been followed for more than 2 years, suggests that: implanting a hinge prosthesis is major surgery on elderly patients in whom severe complications have occurred and for this reason, the operations should be reserved for extremely damaged and unstable knees; the most important local complications have been deep sepsis for which we have noted a rate of 6.6 per cent; in the treatment of sepsis, everything must be done to preserve the prosthesis because arthrodesis is difficult to obtain; pain relief has been significant as a result of the operation. The prosthetic design allows flexion of more than 90 degrees in 85 per cent of the cases and 120 degrees in 26 per cent; after two years, the results seem relatively stable. We have not observed aseptic loosening after this period but a longer observation period is necessary to be reassured on this point; patellar pain remains a major concern because this arthroplasty has not solved the problem, and other solutions will have to be found.     

Prolonged fasting in pediatric outpatients does not cause hypoglycemia

The long-term results after the manipulation and strapping in flexion of selected extension supracondylar fractures of the humerus were evaluated in 43 children. Reduced fractures that were stable when immobilized in approximately 110 degrees of flexion, without producing circulatory obstruction, were treated in this manner. After a minimum review of 4 years, 95 per cent of the children had an excellent or good range of elbow motion and 88 per cent had excellent or good elbow alignment. No child had Volkmann's ischaemic contracture. Five children had cubitus varus which was due to malunion in three, but was unrelated to the treatment of the supracondylar fracture in two children. If these two latter children were excluded then excellent or good alignment was observed in all children who had a Baumann (humerocapitellar) angle of 80 degrees or less at the time of reduction and 84 degrees or less 10 days after the fracture. We concluded that manipulation and strapping in flexion was suitable for approximately 60 per cent of children with isolated displaced supracondylar fractures of the humerus.     

Complications following total knee replacement

Forty-two months follow-up examinations on 30 total knee arthroplasties revealed the following significant complications: phlebothrombosis, 13 knees (46%); pulmonary embolism 3 patients (11%); asymptomatic loosening, 8 knees (11.4%); symptomatic loosening, 3 knees (4.8%); superficial infections, 4 knees (5.4%); deep infections, 4 knees (5.4%); peroneal palsy, 3 patients (4.3%). Early detection of thrombophlebitis by 125I fibrinogen scan and possible aspirin prophylaxis were evaluated. In view of the limited number of encouraging results, e.g. excellent 58.6 per cent; good 28.5 per cent; fair 5.4 per cent and poor 7.1 per cent, caution is advocated until extensive time elapses for more clinical experience with total knee arthroplasty.     

Thermal injury functionally alters bone marrow-derived macrophages: a study of monocyte-hepatocyte interactions

PURPOSE OF THE STUDY: The purpose of this study was to evaluate the results of the anterior cruciate ligament (A.C.L.) reconstruction according to two scoring systems (Arpege and IKDC), to analyse the influence of different factors on the results, to study the effect of a lateral extra-articular tenodesis, the morbidity of patellar tendon graft harvesting, and the advantage of arthroscopically assisted reconstruction. MATERIAL: Seventy nine patients, 17 to 39 years old (average 27 years), underwent an anterior cruciate ligament reconstruction for chronic instability, using a free bone-patellar tendon-bone graft. In 43 cases, a lateral extra-articular plasty was added (Lemaire's procedure). The reconstruction was arthroscopically assisted in 17 cases. Interval between initial injury and surgery was 24 months (2 months to 9 years and 7 months). The average follow-up was 2.5 years (range 1 to 18). METHOD: All patients were reviewed for evaluation with two scoring systems (Arpege and IKDC). Roentgenograms of both knees, including antero-posterior weight-bearing and lateral view, patellar view, dynamic radiographs, allowed evaluation of post-operative arthrosis and residual anterior laxity in extension. Fischer's test and chi square test were used for statistical evaluation. RESULTS: Using the Arpege CLAS system, functional results were excellent or good in 75.9 per cent of cases (excellent in 44.3 per cent, good in 31.6 per cent), fair in 15.2 per cent, poor in 8.9 per cent; according to the IKDC system, 65.8 per cent were excellent or good. 84.8 per cent of the patients were satisfied in Arpege system and 91.2 per cent in IKDC system. The pivot-shift test was negative in 86 per cent, equivocal in 7.6 per cent and positive in 6.4 per cent. The radiological Lachman's test (difference between control and affected knee) was 0-2 mm in 53.2 per cent, 3-5 mm in 39.2 per cent, 6-10 mm in 7.6 per cent, never greater than 10 mm. Antero-posterior weight-bearing radiographs were normal in 83.5 per cent, showed joint remodeling in 10.1 per cent pre-arthrosis in 6.3 per cent but no arthrosis. Functional results were not correlated with age at time of surgery, interval between initial injury and surgery, nor clinical Lachman's test. Competitive sportsmen had a better result (p = 0.001). Residual laxity in extension was correlated with lesions of medial meniscus (p = 0.035). Degenerative changes in femoro-tibial joint were correlated with residual laxity in extension (p = 0.019). There was no significative difference between A.C.L. reconstruction isolated or associated with lateral extra-articular tenodesis. Time to return to work was shorter for patients with arthroscopically assisted procedure (p = 0.067). DISCUSSION AND CONCLUSION: Functional results after A.C.L. reconstruction using a free bone-patellar tendon-bone graft are satisfactory and confirm the reliability of this procedure. Arpege CLAS and IKDC systems give comparable functional results, but IKDC evaluate anatomical results, residual laxity and degenerative changes of the joint, that constitute essential long-term pronostic factors. Morbidity of patellar tendon harvesting appears to be of short duration and largely reversible. Added lateral extra-articular tenodesis doesn't improve the results. Arthroscopically assisted procedure seems to allow a faster rehabilitation.     

Duo-condylar knee arthroplasty: hospital for special surgery design

This is a report of 94 knees in 88 patients with the duo-condylar type of knee arthroplasty. The follow-up period of time was between 2 to 4 years with an average of 3 years. The rheumatoid to osteoarthritic patient ratio was 3 to 1. The overall results were excellent in 37.5 per cent, good in 37.5 per cent, fair in 16 per cent, and poor in 9 per cent. The main causes of failure and poor results were: (1) under or over correction of deformity leading to subluxation and/or instability of the knee; (2) loosening of the tibial component, and (3) symptoms arising from the patellofemoral joint. The revision rate is 5.5 per cent. The progressive radiolucency at the cement bone bond is 26 per cent of which 16 per cent is up to 1 mm and 10 per cent is between 1.5 to 3 mm. To further improve the results of arthroplasty, one should take into consideration (1) replacement of the patellofemoral joint, (2) insertion of the prosthesis in the proper anatomical location under correct tension of the ligaments and capsule with the help of proper instrumentation and (3) improvement in fixation of the tibial component.     

Extensor mechanism reconstruction with an allograft after total knee arthroplasty

The authors report on a series of 15 knees in which an extensor mechanism allograft was used to treat a rupture of the patellar tendon associated with a total knee arthroplasty. Nine of the knees have greater than two-year follow-up evaluation (average, 4.1 years; range, 2.3-7 years). Postoperatively, the average flexion was 106 degrees. All but three patients achieved full passive extension. Six of the nine knees had no extensor lag. The average post-operative clinical score for the follow-up group was 78 points. Graft complications include one early graft rupture, one early quadriceps junction failure, and one patellar component loosening. One graft fractured after revision of a metal-backed patella.     

The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old

Thirty-three patients who had been managed for an isolated, closed fracture of the femoral shaft when they were less than seventeen years old were examined at an average of thirty-three months (range, eighteen to fifty-six months) after the injury. Thirteen patients (39 per cent) had a persistent deficit in the strength of the quadriceps of the fractured limb, as identified on testing with a Cybex-II isokinetic dynamometer. Six patients (18 per cent) had a deficit according to the one-leg-hop for distance test, fourteen (42 per cent) had an average loss of ten millimeters in the circumference of the thigh, and sixteen (48 per cent) had an average loss of 10 degrees of flexion of the knee. The etiological factors that were thought to possibly be responsible for the weakness of the quadriceps were evaluated. The amount of maximum displacement of the fracture, as seen on the initial radiographs, was the only factor that was significant for the prediction of weakness of the quadriceps (p = 0.006) at both test speeds of the Cybex dynamometer and in all statistical analyses. Despite the persistent weakness of the quadriceps, none of the patients had a clinical problem at the latest follow-up examination. A subclinical deficit in the strength of the quadriceps may be related to damage sustained by the muscle at the time of the fracture. On the basis of the results of this study, we do not recommend a change from the traditional methods of treatment, which involve early application of a spica cast or use of traction followed by application of a spica cast.     

Avoiding common mistakes in APA style: the briefest of guidelines

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7 degrees (range, 4-14 degrees), the average hallux valgus angle was 11 degrees (range, 4 degrees of varus to 30 degrees of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0-5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small (r < or = 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.     

Increasing lordosis of the occipitocervical junction after arthrodesis in young children: the occipitocervical crankshaft phenomenon

Five children were treated before age 6 years with occipitocervical fusion for occipitocervical instability. Long-term (average, 11.8 years; range, 8.4-14.5 years) follow-up revealed increasing lordosis across the fused segment in four of the patients, a finding we here refer to as the occipitocervical crankshaft phenomenon. On average, occipitocervical lordosis increased 1.06 degrees per level fused per year until skeletal maturity. Although such a progression might be expected, to our knowledge this is the first report of its occurrence. Compensatory subaxial motion was able to overcome this increase in all of the patients. We recommend occipitocervical fusion in a neutral or slightly flexed position in the very young child to account for this predictable increase in lordosis.     

Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Fran?aise d'Arthroscopie

Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons. MATERIALS AND METHODS: 26 shoulders (25 patients) were reviewed with a follow up of 21 months using the Constant's scoring system. Patients had an average duration of symptoms for 13 months (1 to 27). Pre op passive motion was: abduction: 74 degrees, external rotation: 6 degrees, forward flexion: 84 degrees. The average motion core was 12.9/40. We distinguished three groups: primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease ; acquired "surgical" stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, purely anterior or anterior and inferior, followed by gentle manipulation. If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were performed:acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion debridement (1 case). Only 2 out 13 primary shoulders required an additional procedure. RESULTS: 1-There were no intra-operative complications (vascular or neural). 2-Range of Motion: the average gain under anesthesia was: abduction: 72 degrees, external rotation: 34 degrees, forward flexion: 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aetiology. Gain was more important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3-Subjective results were better in the primary group. 4-Objective results demonstrated an absolute Constant's score of 70.3, that is to say 83.4 per cent of the contralateral supposed healthy shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair or poor results. The relative Constant's score was 91 per cent in the primary group and only 76 per cent in the acquired group. The difference was due to the pain and strength which were greatly improved in the primary group. DISCUSSION: Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).