Arthroscopic Capsular Release Research Articles

拘縮を合併したけん板断裂症例の術後回復経過

The purpose of this study was to examine the process of early postoperative recovery in patients with rotator cuff tears, comparing the contracted with the non-contracted. Eighty patients with cuff tears underwent surgical intervention (ASD, ARCR, mini-open, and open procedures) in our hospital, from August 2002 to January 2004. Of these, 31 patients (< middle-sized cuff tears) were included in this study: 18 with contracture and 13 without contracture. Prior to operation, manipulation was performed in all patients. The presence of contracture was defined if an apparent improvement in range of motion (ROM) was achieved after manipulation. No additional procedure (arthroscopic capsular release etc.) was needed. ROM, muscle strength (MICROFET®, HOGGAN, USA), visual analogue scale (VAS), and JOA score were measured preoperatively and at 1, 2, 3, and 6 months after operation. There was no significant difference between the two groups in patient profile, VAS, JOA score, muscle strength preoperatively and postoperatively. In postoperative course, significant differences were noted in external and internal rotation at 1 month, and elevation at 2 and 3 months. At postoperative 6 months, however, ROM in two groups improved almost equally with no significant difference. We believe that preoperative manipulation is an effective procedure for contracted patients with cuff tears less than middle-size.

Arthroscopic Capsular Release for a Throwing Shoulder with Refractory Posterior Capsular Tightness

Arthroscopic Capsular Release for a Throwing Shoulder with Refractory Posterior Capsular Tightness

Clinical Evaluation of Arthroscopic Capsular Release for Shoulder Stiffness

Clinical Evaluation of Arthroscopic Capsular Release for Shoulder Stiffness

만성 외상성 견관절 전방 불안정성의 치료에서 병행한 관절낭 열 수축술

Purpose: In the traumatic anterior shoulder instability, the laxity of joint capsule and ligament is frequently demonstrated. Although a arthroscopic procedure to address anterior instability with joint capsular redundancy have generally provided good results, its recurrence rate is higher than open procedure. By reducing the capsular redundancy, thermal shrinkage is likely to improve the outcome of arthroscopic anterior stabilization. The objective of this study was to evaluate additional thermal capsular shrinkage as a treatment of joint capsular redundancy in anterior shoulder instability. Materials and Methods: From March 1999 to June 2000, 25 shoulders of 23 patients of recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with shrinkage procedure. The mean follow up was 29 months and average age at the time of operation was 26 years. Of these patients, 20 were male and 3 were female who had been experienced the average 8 times of dislocation before operation. Thermal shrinkage alone without Bankart repair was performed in two cases who did not have Bankart lesion. The clinical result was evaluated in according to Modified Rowe Score. Results: The Modified Rowe Score was improved from preoperative 35 points to postoperative 88 points. None of cases showed recurrence of dislocation. But, in two cases, temporary sensory hypesthesia of the axillary nerve was developed and in two cases of postoperative stiffness, arthroscopic capsular release and brisement were performed. Conclusion: Additional capsular shrinkage in arthroscopic technique to address recurrent anterior shoulder instability could treat effectively the capsular redundancy.

Alternatives to Total Shoulder Arthroplasty in the Young Patient

Early arthritis of the glenohumeral joint represents a diagnostic and therapeutic challenge. Equally challenging is the presence of arthritis at any stage in the young or active patient since joint replacement may not be desirable, while nonoperative treatment may not provide sufficient pain relief. The common theme of all glenohumeral arthritides is one of progressive, irreversible osteoarticular destruction. Articular damage is usually accompanied by secondary involvement of the synovium, capsule, glenohumeral ligaments, and rotator cuff. Surgical intervention is predicated on the specific condition, stage of the disease, and condition of the periarticular tissues. The authors will discuss surgical alternatives including arthroscopic debridement, glenoidplasty, capsular release, synovectomy, corrective osteotomy, core decompression, and soft tissue interposition arthroplasty.

Complete division of the posterior interosseous nerve after elbow arthroscopy: A case report

With increasing use of the arthroscope for treating elbow conditions, some new complications are coming to light. One of them is injury to neurovascular structures lying in close proximity to various portals of introduction of the scope. The reported incidence of neurologic injuries after elbow arthroscopy is 0% to 14%. 4 Kelly E.W. Morrey B.F. O'Driscoll S.W. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001; 83: 25-34 PubMed Google Scholar Injury to the posterior interosseous nerve during an arthroscopic procedure of the elbow is a rare complication with very few reported cases. 3 Jones G.S. Savoie III, F.H. Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow. Arthroscopy. 1993; 9: 277-283 Abstract Full Text PDF PubMed Scopus (153) Google Scholar , 4 Kelly E.W. Morrey B.F. O'Driscoll S.W. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001; 83: 25-34 PubMed Google Scholar , 8 Papilion J.D. Neff R.S. Shall L.M. Compression neuropathy of the radial nerve as a complication of elbow arthroscopy a case report and review of the literature. Arthroscopy. 1988; 4: 284-286 Abstract Full Text PDF PubMed Scopus (81) Google Scholar , 10 Thomas M.A. Fast A. Shapiro D. Radial nerve damage as a complication of elbow arthroscopy. Clin Orthop. 1987; 215: 130-131 PubMed Google Scholar Most injuries described thus far have been either incomplete or temporary. 4 Kelly E.W. Morrey B.F. O'Driscoll S.W. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001; 83: 25-34 PubMed Google Scholar , 8 Papilion J.D. Neff R.S. Shall L.M. Compression neuropathy of the radial nerve as a complication of elbow arthroscopy a case report and review of the literature. Arthroscopy. 1988; 4: 284-286 Abstract Full Text PDF PubMed Scopus (81) Google Scholar , 10 Thomas M.A. Fast A. Shapiro D. Radial nerve damage as a complication of elbow arthroscopy. Clin Orthop. 1987; 215: 130-131 PubMed Google Scholar We report a case of complete division of the posterior interosseous nerve after elbow arthroscopy that was successfully treated by nerve grafting. The relevant literature on the subject is reviewed, possible causes for injury are listed, and preventive methods are discussed.

회전근 개 간격의 가교 반흔 유착에 의한 외상성 견관절 강직증의 관절경적 치료 - 증례 보고 -

In adhesive capsulitis of the shoulder of no response to nonoperative treatment, an arthroscopic capsular release and manipulation improves range of motion and pain relief. We performed an arthroscopic examination in the stiff shoulder, of which she had no response to nonoperative treatment, after the conservative treatment of a clavicular shaft fracture by motorcycle-driver traffic accident. We found the intra-articular `rotator interval bridging scar adhesion` between subscapularis tendon and antero-superior glenoid fossa under the rotator interval which was no adhesion and contracture itself. We performed the scar adhesion removal and synovectomy, maintaining the rotator interval. We recommended nonsteroidal anti-inflammatory drug for postoperative pain relief and continuous active and passive range of motion (ROM) exercise to gain motions. Preoperatively, active and passive range of motion were 70° for forward elevation, 60° for abduction and especially 0° for external rotation. After postoperative 2 months, active ROM were 150° for forward elevation, 130° for abduction and 80° for external rotation. After postoperative 6 months, passive and active ROM were full. UCLA score improved from preoperative 9 points to postoperative 29 points.

Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery.

The aim of this study was to investigate the clinical results and efficacy of arthroscopic anterolateral capsular release achieved through the use of a holmium:YAG laser or electrocautery for the management of patients with internal derangements of the temporomandibular joint (TMJ). We studied internal derangement (106 joints) and osteoarthritis (46 joints) of the TMJ in 129 patients. Preoperatively, the mean mouth-opening degree was 31 mm and 129 TMJs exhibited moderate to severe arthralgia. All patients underwent arthroscopic anterolateral capsular release achieved with a holmium:YAG laser (84 TMJs) or through electrocautery (68 TMJs). At the end of each patient's respective follow-up period, which ranged from 2 to 72 months (mean, 19 months), the mean mouth-opening degree was 43 mm (P<.0001). Also during that time, 105 joints were discovered to exhibit no arthralgia and 36 had mild arthralgia. The total success rates with 2 sets of criteria were 92.8% and 95.6%. Arthroscopic anterolateral capsular release is a minimally invasive and effective surgical method for the treatment of patients with TMJ intracapsular disorders.

Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery

Objective The aim of this study was to investigate the clinical results and efficacy of arthroscopic anterolateral capsular release achieved through the use of a holmium:YAG laser or electrocautery for the management of patients with internal derangements of the temporomandibular joint (TMJ). Study design We studied internal derangement (106 joints) and osteoarthritis (46 joints) of the TMJ in 129 patients. Preoperatively, the mean mouth-opening degree was 31 mm and 129 TMJs exhibited moderate to severe arthralgia. All patients underwent arthroscopic anterolateral capsular release achieved with a holmium:YAG laser (84 TMJs) or through electrocautery (68 TMJs). Results At the end of each patient's respective follow-up period, which ranged from 2 to 72 months (mean, 19 months), the mean mouth-opening degree was 43 mm ( P<.0001). Also during that time, 105 joints were discovered to exhibit no arthralgia and 36 had mild arthralgia. The total success rates with 2 sets of criteria were 92.8% and 95.6%. Conclusions Arthroscopic anterolateral capsular release is a minimally invasive and effective surgical method for the treatment of patients with TMJ intracapsular disorders.

Arthroscopic debridement and capsular release for glenohumeral osteoarthritis (SS-21)

Purpose: The purpose of this study was to determine the efficacy of arthroscopic debridement and capsular release in the treatment of glenohumeral osteoarthritis. Methods: Patients that had been diagnosed with glenohumeral osteoarthritis and had a subsequent arthroscopic debridement and capsular release were assessed using American Shoulder and Elbow Surgeons (AS&E), Constant, Rowe, UCLA, and Walch- Duplay. Preoperative radiographs and arthroscopic findings were assessed and patients were classified into one of four osteoarthritis groups. Each osteoarthritic group was compared statistically, as well as the patient’s pre- and postoperative range of motion. Statistical analysis of our data was done using a Student t test. Results: The average follow-up for the eight patients (9 shoulders) was 13.7 ± 4.9 months. This study demonstrated that arthroscopic debridement and capsular release provided relief of pain for 9.3 ± 4.6 months. The average range of forward elevation preoperative was 131.9 ± 47.6 ° and improved to 153.3 ± 34.6° postoperatively. The average external rotation prior to surgery was 42.8 ± 23.3° and increased to 59.4 ± 23.0° after surgery. Internal rotation improved after surgical intervention from 17.2 ± 5.7° to 48.3 ± 22.2°. Four patients were classified as having moderate osteoarthritis and four patients (5 shoulders) were determined to have severe osteoarthritic changes. A statistical analysis using a Student t test demonstrated that the AS&E score, the Walch-Duplay score, and the UCLA score were significantly better in those patients with moderate glenohumeral osteoarthritis compared to those patients with severe osteoarthritis. Conclusions: Arthroscopic debridement and capsular release provided relief of pain for an average of over nine months even in cases of severe osteoarthritis. Patients with moderate osteoarthritis had a good functional outcome after surgery and their results were superior to those with severe degenerative changes. Based upon these results, arthroscopic debridement and capsular release appears to be beneficial in the treatment of mild and moderate glenohumeral osteoarthritis.

Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery*1

Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery*1

Commentary to ?Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery?

Commentary to ?Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery?

Clinical Results of Arthroscopic Capsular Release for the Treatment of Refractory Shoulder Stiffness

Clinical Results of Arthroscopic Capsular Release for the Treatment of Refractory Shoulder Stiffness

The rheumatoid elbow

The orthopaedic management of the rheumatoid elbow continues to be a challenging and difficult problem. Although the medical management of rheumatoid arthritis continues to improve, the surgical alternatives of synovectomy, capsular release, radial head excision, and total elbow arthroplasty each have their own very important place in the successful comprehensive management of the rheumatoid elbow. As arthroscopic management of orthopaedic conditions in general continues to evolve and improve, so do the results of arthroscopic management of the recalcitrant symptomatic rheumatoid elbow. Total elbow arthroplasty continues to represent an exceptionally successful alternative for the treatment of the severely affected rheumatoid elbow. Linked, semiconstrained and unlinked resurfacing elbow arthroplasties are available, and each has their proponents. Based on the current orthopaedic literature available, the linked, semiconstrained implants overall have a slightly less complication rate, higher patient satisfaction, and greater survivorship than the resurfacing designs. However, a well‐performed prospective, randomized, blinded trial comparing these two types of implants has not yet been performed. The orthopaedic surgical management of the painful rheumatoid elbow continues to evolve. Arthroscopic synovectomy and capsular release without a requisite radial head excision has great clinical advantages and may likely soon represent the procedure of choice over the more traditional open approach. Total elbow arthroplasty using a linked, semiconstrained implant currently represents the most effective arthroplasty alternative considering complication rate, clinical success rate, and implant survivorship. Continued basic science and clinical research efforts are ongoing in the areas of total elbow arthroplasty design.

Paper #48 Temperature along the axillary nerve during arthroscopic capsular release of the shoulder

Adhesive capsulitis of the shoulder has traditionally been treated with therapy, injections and sometimes manipulation under anesthesia. Recently, the technique of an arthroscopic capsular release has become popular as a way of treating adhesive capsulitis. There appears to be minimal morbidity associated with the procedure. However, there is some concern of injuring the axillary nerve while performing the release, particularly in the axillary pouch. The objective of this study is to investigate the temperature of the axillary nerve during an arthroscopic capsular release in a cadaver model.

Artroscopisch losmaken van het kapsel ter behandeling van hardnekkige schouderstijfheid na een operatie of fractuur

Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness [Journal of Bone and Joint Surgery 2001;83-A(11):1682-7]

Arthroscopic capsular release for stiff shoulders

Purpose: The etiology, pathogenesis, time course, and response to treatment of stiff shoulder pathology is still under investigation and debate. This prospective study evaluated arthroscopic capsular release to treat stiff shoulder pathology that was resistant to conservative management. The etiology of the shoulder stiffness was categorized and analyzed for effect on outcomes. Type of Study: Operative technique and prospective evaluation. Methods: In 68 stiff shoulders (41 in women, 27 in men) that underwent arthroscopic capsular release, 5 distinct etiologies were identified: postsurgical in 20, idiopathic in 17, post-traumatic in 15, diabetic in 8, and impingement syndrome (prior primary impingement developing stiffness) in 8. Average age was 50 years (range, 29 to 72), and follow-up averaged 3 years (range, 2 to 8). Prior to this procedure, duration of symptoms averaged 7.3 months (range, 3 to 48), and formal physical therapy averaged 3.7 months (range, 1 to 12). Preoperative average American Shoulder and Elbow Surgeons Score (ASES) was 35.5 (range, 10 to 77), median Simple Shoulder Test (SST) was 3 (0 to 10), and median Visual Analog Score (VAS) for pain was 6 (0 to 10). Average active forward elevation (FE) was 92°, external rotation (ER) at side was 12°, and median internal rotation (IR) was to the buttock. All patients underwent arthroscopic capsular release with a standard aftercare protocol. Results: The study population showed significant improvement ( P < .0001) for all outcome scores and active motion parameters. Average and median outcome parameters for the population, with improvement in parenthesis were: ASES 93 (+57.5), SST 10 (+7), VAS 0 (−6), FE 165° (+73°), ER at side 56° (+44°), and IR to T −12 (+7 spinal segments). The time in formal physical therapy averaged 2.3 months (2 to 20 weeks) and time to attain final, pain-free range of motion averaged 2.8 months (1 to 6). Outcomes for, and between, each etiology were analyzed. There was no difference in time to final motion between the etiologic groups. Conclusions: Stiff shoulder pathology can result from a variety of differing etiologic factors. Arthroscopic capsular release was equally effective across the 5 identified etiologic groups, and provided significant pain relief, restoration of motion, and function within an average of 3 months.

Combined Arthroscopic Capsular Release, Acromioclavicular Joint Excision, and Acromioplasty for End-Stage Glenohumeral Joint Arthritis

Combined Arthroscopic Capsular Release, Acromioclavicular Joint Excision, and Acromioplasty for End-Stage Glenohumeral Joint Arthritis

The role of arthroscopy for the problem shoulder arthroplasty

Between 1995 and 2000, 29 patients who had excessive pain or limitation of motion after a shoulder arthroplasty underwent arthroscopy. Preoperative diagnoses of impingement syndrome in 10 patients (treated by arthroscopic subacromial decompression), large rotator cuff tear in 1, loose bodies in 1, unstable cuff arthropathy in 1, and septic arthritis in another were confirmed at arthroscopy. Of the 15 patients without a preoperative diagnosis, 7 had postarthroplasty capsular fibrosis, with 6 undergoing arthroscopic capsular release. A malpositioned glenoid component was found in 1 patient. Loose or worn components were found in 4 of the shoulders, impingement with a small partial-thickness cuff tear was identified in 1, a florid synovitis was present in another, and in 1 no abnormality could be found. The procedures were often hindered by limited access and reflection from the prosthesis. Arthroscopy after shoulder arthroplasty is useful for the diagnosis and treatment of pain and loss of motion in selected patients but can be technically challenging. (J Shoulder Elbow Surg 2002;11:230-4)

Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?

The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2+/-4.2/14.2+/-2.6 mm; in abduction and neutral rotation, 24.0+/-4.9/15.0+/-5.0 mm; in abduction and internal rotation, 21.1+/-6.6/14.6+/-3.7 mm; and in abduction and external rotation, 24.9+/-3.8/16.4+/-4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.