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Abstract: The arthroscopic capsular release appears as an indication of interest in the therapeutic arsenal for treating such difficult pathology as adhesive capsulitis. Today, the surgical technique of arthroscopic capsular release is well codified, even if some points are still debated. It has to be followed by specific, early postoperative physiotherapy to recover range of motion. The results of arthroscopic capsular release are reliable in improving patients, in terms of pain and function with a satisfactory recovery of range of motion, but often incomplete. Diabetes, whether insulin-dependent or not, is a pejorative factor influencing the result. The question that remains widely debated is what is the right moment to propose this surgery during the evolution of adhesive capsulitis. There is no formal answer yet. Depending on the patient''s motivation to recover as soon as possible a satisfactory range of motion (e.g., professional reasons), the indication may be proposed when there is either no response to medical treatment or worsening symptoms despite a well-conducted treatment within a reasonable period of time. This does not take in account duration of the disease since its occurence. It seems logical to propose a surgical indication more rapidly to patients with risk factors such as diabetes. On the other hand, it is not logical to limit this indication to refractory patients with severe stiffness resistant to medical treatment after several years of evolution. The result would be limited and disappointing. A compromise is necessary. [Copyright &y& Elsevier]

Résumé: Objectif: Revue de la littérature concernant la capsulite rétractile de hanche à partir de trois cas cliniques. Méthode: À partir de trois cas cliniques, décrire la démarche diagnostique et la prise en charge thérapeutique. Discussion: La capsulite de hanche, pathologie rare mais probablement sous-estimée touche préférentiellement les femmes d’âge moyen. L’examen clinique objective une limitation douloureuse de la mobilité articulaire de la hanche. Le diagnostic est confirmé par la réalisation d’une arthrographie qui démontre une capacité articulaire inférieure à 12ml. L’arthrose et le syndrome douloureux régional complexe de type 1 sont les deux principaux diagnostics différentiels. Le traitement médical ou chirurgical est proposé en fonction de l’étiologie. La rééducation est fondamentale pour limiter les déficiences et incapacités fonctionnelles résiduelles. Conclusion: Peu décrite dans la littérature, la capsulite rétractile de hanche n’est cependant pas une rareté clinique. Fréquemment idiopathique, elle peut aussi être associée à une pathologie articulaire. Le traitement de base consiste en l’association d’injection intra-articulaire de corticoïde dépôt et d’une prise en charge en rééducation. Arthroscopie et mobilisation sous anesthésie sont utiles pour les cas récalcitrants. [Copyright &y& Elsevier]

Arthroscopy is an accepted technique for evaluation of intra-articular pathology and treatment of a variety of disorders even in the wrist joint. Dedicated miniaturized instrumentation is needed along with a specific traction system. The external distraction alone (dry technique) allows for complete joint exploration and several type of arthroscopic surgery, avoiding annoying leaking in the subcutaneous tissues, though further distension of the articular pouches can be achieved by saline infusion (fluid distension or wet technique). Knowledge of surface anatomic landmarks and careful surgical technique are required for proper portal placement and in order to avoid injury to the numerous noble structures crossing nearby. Description of radio- and medio-carpal portals is provided along with the different bony, condral, synovial and ligamentous structures that can be visualised or treated through each portal. Surgeon can choose the most suitable portal for scope or instruments, according to specific needs for diagnostic or therapeutic purposes.

Arthroscopy has been established as a valuable technique in diagnosis and treatment of the injured and deseased shoulder. Arthroscopy is not a new diagnostic tool but offers new approaches to the surgical treatment of shoulder pathology. Shoulder arthroscopy is usally performed under general anesthesia or/with scalene block. The patient is positioned in opposite lateral decubitus position or in beach chair position. Diagnostic arthroscopic is initiated with insertion of the arthroscope from the posterior portal into the gleno humeral joint. Inspection should be organized systematic visualization of the entire joint (articular surfaces of the glenoid and humeral head, glenoid labrum, long head of the biceps tendon, sub scapularis tendon, axillary pouch, capsular ligaments, synovial membrane). Then endoscopic visualization of the subacromail space is a valuable and essential adjunct to the gleno humeral arthroscopy (impingement syndrome, rotator cuff tears, calcific tendinitis, acromiocalvicular joint disorders).

Purpose of the Study: Arthroscopic treatment of tibial plateau fractures may reduce morbidity compared to open articular surgery. But bony fixation is necessarily percutaneous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscopic treatment of tibial plateau fractures, with special reference to radiographical results., Material and Methods: Twenty-six patients (mean age 42 years, range 18 to 70 years, 17 men, 9 women) were arthroscopically treated for a fresh tibial plateau fracture. According to Schatzker classification, there was 2 type I, 17 type II, 6 type III and 1 type IV. No type V or VI were treated in this series. The fixation device was: percutaneous cannulated screw in 23 cases, Kirchner wire in 2 cases, and bone cement filing of the fracture site in 1 case. We did not use cancellous bone graft but we used a hydroxyapatite plug in one case. There were 8 meniscal injuries: 2 underwent arthroscopic suture, 1 had partial meniscectomy and 5 were left in place. Twenty-six cases were suitable for immediate post op follow up. 19 were reviewed at long term. A clinical (Knee Society scoring system) and radiographical examination were done with an average follow-up of 32.7 months., Results: There were no complications except one immediate postoperative septic osteoarthritis (case with hydroxyapatite plug) and one bony depression of the lateral tibial plateau at the fourth month. Passive motion of the knee started at 1.8 days postop with no pain. Mean flexion at 3 months was 130 degrees. At revision, the average score was: 94.1 for the knee, 94.7 for the function. In two cases we found early signs of osteoarthrosis. There were no secondary bony depression or significant valgus deformity on X-rays., Conclusion: Arthroscopic management of tibial plateau fractures allows a complete articular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the only possibility under arthroscopic control, did not modify the anatomical results.

Arthroscopy allows direct visual examination of joint cavity components and is useful for the diagnosis, treatment and evaluation of lesions. We investigated the contribution of arthroscopy to the evaluation of joint cartilage. The severity of cartilage lesions can be assessed using a total 100-mm visual analog scale (0 = no chondropathy; 100 = the worst possible lesions) or a more objective system based on the site, depth, and surface area of the lesions. This latter system was developed by the French Society for Arthroscopy (Société Française d'Arthroscopie) and provides a score and a class (SFA score and SFA grade). We investigated whether this system has the characteristics required of an evaluation tool, i.e., simplicity, reproducibility, clinical relevance, sensitivity to change, and discriminant capacity. Arthroscopy is an invasive procedure. However, we introduced several simplifications, including use of local rather than general anesthesia, performance on an outpatient basis, elimination of the tourniquet (to avoid muscular dysfunction), and use of a small arthroscope. This simplified technique is called chondroscopy. Intra-observer reproducibility is far better than inter-observer reproducibility. We found a good correlation between the two arthroscopy scales (visual analog scale and SFA scale). Chondroscopy and roentgenographic evaluations of cartilage lesions were closely correlated. Changes in the severity of cartilage lesions were correlated with changes in functional impairment. Chondroscopy proved capable of demonstrating statistically significant changes in cartilage lesions due to knee osteoarthritis between two evaluations done only one year apart, even in a small sample of patients (less than 20). A preliminary study of repeated hyaluronic acid injections suggested that chondroscopy may be capable of identifying truly chondromodulating agents.

Introduction: The development of the indications in the arthroscopic surgery of the ankle and the narrowness of this joint impose perfectly adapted portals. Several posterior portals which allow to access to the postero medial corner of the joint have been already described, but are not satisfying. We describe, here, a new postero-medial portal which allows a safe and easy access to the posterior part of the joint., Methods: The arthroscopy is performed with a standard arthroscope (30 degrees, 4.5 mm in diameter) and a lateral ankle distractor. The landmark for this portal is the posterior crest of the medial malleolus. Above the posterior tip of the medial malleolus, this crest is directed up and back, then its direction becomes strictly vertical. The new portal is situated there, 5 millimeters behind the crest (generally 2 centimeters above the posterior tip of the medial malleolus). A needle visualized by the anterior portal is helpful to show the right direction for the portal. After skin incision, a forceps is used to widen the portal. Then the instruments or the arthroscope can be introduced. Posterior tibial artery and nerve are protected by the tendons of tibialis posterior and flexor digitorum longus., Material: We have used this portal (instrumentation and arthroscope) in four patients (3 osteochondritis dissecans of the medial part of the talus, 1 loose body) without problem., Results: This portal is safe; it does not intersect the direction of posterior tibial artery and nerve as in the postero-medial portal described by Parisien and avoids in most cases the approach described by Guhl., Discussion: Because the medial malleolus is more anterior than the lateral malleolus, it allows a larger approach to the posterior part of the joint than the postero-lateral portal. We recommend it for the arthroscopic treatment of all the lesions of the postero-medial part of the joint.

The Holmium:YAG laser has been in use at the regional hospital of Montreux, Switzerland. A balance has been drawn at the end of 9 months. 68 surgical operations have been performed; 23 in abdominal surgery, mainly through laparoscopy, and 45 in orthopaedics using scopic viewing. The Holmium:YAG laser is a modern and up-to-date system. It is well adapted to endoscopic surgery owing to its features, its wide scope and safe use. Its price is rather high if used for laparoscopic cholecystectomy only; but the purchase thereof is proving to be a profitable asset for a multiservice surgical team.

Arthroscopy is an interesting and enlarging technique that visualise the temporomandibular joint and allows surgical technics such as lysis and lavage, prediscal section, retrodiscal cauterisation, oblic protuberance cauterisation, disc suturing or shavering of the articular surfaces.

The arthroscopy of the T.M.J. is a mean of diagnosis and treatment of some lesions but it cannot claim to bring about the diagnosis or the treatment of all lesions. After the experience resulting from 29 cases, the value of this technic among the element of diagnosis and treatment is discussed.