382 ABSTRACTS

Method: 75 consecutive patients with shoulder stiff- ness refractory to at least four months of conservative management were reviewed in this study. Mean age was 50 years, 32 female and the remainder male. These were divided into three categories: 1) 41 patients with idiopathic adhesive capsulitis 2) 24 patients with post operative stiffness divided into a) post arthroscopic b) post open subacromial surgery and c) post open ante- rior capsulorrhaphy surgery and 3) 10 patients with stiffness secondary to neurologic injury. All patients were arthroscoped in the lateral position with general anesthesia, with initial diagnostic arthroscopy per- formed. Arthroscopic capsular release was then per- formed as described by Oglivie-Harris as needed, with release of the anterior and inferior capsule to gain ex- ternal rotation and posterior capsule to gain internal rotation. Arthroscopic release of the subscapularis was not performed, as this muscle unit was felt to have significant functional value. Gentle range of motion was then performed to complete the capsulotomy. Bur- soscopy was then performed with lysis of adhesions as indicated. Patients were started on oral narcotic and therapy in recovery, and discharged as outpatients.

Results: No complications occurred; specifically no neurologic injuries secondary to capsular release, no damage to osseous or soft tissue structures, and no infec- tions. Arthroscopic capsular release was universally suc- cessful in gaining motion intraoperatively for the adhe- sive capsulitis group, post surgical arthroscopic and open subacromial group. It was rarely successful in the neuro- logic group and never successful in the open capsullor- rhaphy group, where open capsular release with z-plasty of the subscapularis was usually required. Maintenance of motion gained at surgery was good, with 90% good or excellent UCLA scores at one year post op.

Discussion: Arthroscopic surgery can be highly suc- cessful for restoring motion in the idiopathic adhesive capsulitis, post surgical arthroscopic, and open sub- acromial surgical patients with stiffness; allowing this to be predictably performed in an outpatient setting without complex post operative means for pain control. While initial arthroscopy may allow assessment of in- traarticular problems for planning, patients with stiff- ness secondary to neurologic injury and open anterior capsullorhaphy will require open surgery if the func- tion of the subscapularis is not to be sacrificed.

Assessment of Morbidity of Semitendinosus and Gracilis Tendon Harvest for Anterior Cruciate Lig- ament Reconstruction. Peter T. Simonian, Vernon J. Cooley, David Deneka, and Roger V. Larson. Seattle, Washington, U.S.A.

Purpose: The purpose of this study was to evaluate the morbidity of harvest of both the semitendinosus and gracilis tendons for anterior cruciate ligament re- construction on nine patients at a minimum of three year follow-up.

Methods and Results: Specifically, the effect on knee function, knee extension and flexion strength, the size of the individual posterior thigh muscles, and the extent of retraction of the semitendinosus and gracilis tendons were evaluated. At final follow-up, each pa- tient was evaluated by four functional scales (IKDC, Hospital for Special Surgery (HSS), Lysholm, and Tegner). Each patient also had a dynamometer evalua- tion and a comprehensive MRI study of both the oper- ated and non-operated knees. The average functional evaluation scores were: HSS--47 .9 ; Lysholm--88; and Tegner--0.27. The average percent quadriceps and hamstring strength of the operated compared to the non-operated extremities were 93.7 and 95.3 re- spectively; neither decrease was significant. MRI eval- uation of the cross sectional areas of the biceps femo- ris, semimembranosus, and sartorius muscles of both thighs at the same level above the joint were not sig- nificantly different. The distal most insertion of the semitendinosus and gracilis tendons after harvest were always more proximal than the non-operated side; the average difference was 26.7 mm (range 11-32 mm) for the semitendinosus (unable to calculate in three patients) and 47.1 mm (range 17-72 mm) for the graci- lis.

Conclusion and Significance: We conclude that tendon harvest of the semitendinosus and gracilis mus- cles does not significantly compromise function and strength despite (based on the measured parameters of this study) a more proximal insertion of the retracted tendons, and that the majority of cases demonstrated some but never complete regrowth of these tendon remnants.

Serial Magnetic Resonance Imaging of the Patellar Tendon Defect During the First Year Following ACL Reconstruction. Jeffrey P. Bernicker, David M. Lintner, James R. Bocell, John L. Haddad, and Thomas C. Diliberti. Houston, Texas, U.S.A.

Introduction: Currently, use of the central one-third patellar tendon is the gold standard for anterior cruciate ligament (ACL) reconstruction. Until recently, the fate of the the patellar tendon following graft harvest has been largely ignored, despite concerns that the sacrifice of the central one-third carries with it a significant attendant morbidity. The purpose of this study was

Arthroscopy, Vol 13, No 3, 1997