ABSTRACTS

provement, increasing from 68% satisfactory preop- eratively to 100% postoperatively. Patients with posttraumatic degenerative changes were the least- improved group.

Posterior impingement is a clinical entity in which chronic pain on full elbow extension is the chief complaint. Patients with this condition have a nor- mal range of motion, minimal objective findings, and normal radiographs. Use of the arthroscope has proved effective in the management of these poste- rior impingement lesions. Elbow arthroscopy there- fore continues to remain a useful procedure with increasing indications.

Anatomical Variations of the Glenohumeral Liga- ments. Richard D. Rames, Craig D. Morgan, and Stephen J. Snyder. Chesterfield, Missouri, Wil- mington, Delaware, and Van Nuys, California, U.S.A.

Our purpose was to document and classify ana- tomical variations of the anterior glenohumeral lig- aments in a large number of cadaver specimens.

Before arthroscopy, several authors have de- scribed anatomic findings of the shoulder based on cadaver dissections. With the advent of arthros- copy, many anatomical variations have been dis- covered throughout the shoulder, and the signifi- cance of these variations is the subject of consider- able study. The significance of the anterior glenohumeral ligaments has recently gained much attention with regard to anterior instability.

To document and classify anatomical variations of the anterior glenohumeral ligaments, we recently examined 182 cadaver specimens. In an attempt to delete cadaver specimens with previous instability, we excluded specimens that had Hill-Sachs lesions and/or labral pathology. From these dissections, we found four distinct patterns. Group I consisted of the normal or classic arrangement with the inferior, middle, and superior glenohumeral ligaments in the often-described location. One hundred twenty-one of 182 specimens (66%) had this arrangement. Group II specimens had a confluent middle and in- ferior glenohumeral ligament with no separation be- tween the two. Thirteen of 182 specimens (7%) had this type of configuration. Group III shoulders had a cord-like middle glenohumeral ligament with a high-riding attachment and a foramen below it. Thirty-four of 182 (19%) had this arrangement. Group IV specimens had no discernible glenohu- meral ligaments but rather one confluent anterior

Arthroscopy, Vol. 7, No. 3, 1991

capsular sheath. Fourteen of 182 (8%) had this ar- rangement .

Based on this large series of cadaver dissections, we note variations from the classic arrangement in approximately 34% of “normal shoulders.” Having documented and classified these variations, we may now be able to determine whether certain gleno- humeral ligament configurations may indeed pro- tect the shoulder from anterior instability whereas at the same time others may indeed predispose the shoulder to instability.

Approximately 30% of “normal shoulders” have variations from the classic arrangements.

Certain anatomical variations of the glenohu- meral ligaments may protect the shoulder whereas other variations may make the shoulder more prone to anterior instability.

Interpretation of Anterior Cruciate Ligament (ACL) Surgery Data: Comparison and Evaluation of Exist- ing Knee Ligament Rating Systems in 65 Patients. Nicholas A. Sgaglione, Wilson DelPizzo, James M. Fox, and Marc J. Friedman. Manhasset, New York, and Van Nuys, California, U.S.A.

Sixty-five patients (mean age 25 years; range 14- 46 years) consecutively underwent ACL recon- struction with pes tendon autografts. Ninety-one percent maintained at least a recreational sports level before injury. Mean follow-up was 35 months (range 24-58 months). Subjective success as mea- sured by patient response was reported by 82% and functional success as measured by return to sports without limits was reported by 64%. A negative or 1 + Lachman test result was noted in 83%, whereas an absent pivot shift test was noted in 87%. Seventy percent had a ~3 mm KT-1000 result. All patients were graded using the Hospital for Special Surgery (HSS), Lysholm (Lys), Tegner Activity (Teg), and Cincinnati Knee Ligament Rating Systems (CKRS), and all results were statistically analyzed. The mean follow-up HSS score was 90 (31-loo), mean Lys score was 91 (45-loo), and mean Teg level was 5.4 (l-lo). The CKRS scores were categorized and the mean sports activity rating was 65 (20-100) and the mean sports participation score was 71 (20-100). The mean activity of daily living function score was 36 on 40 (2340) whereas the mean sports activity function score was 89 (20-100). The assessment of change in sport activity revealed 49% returned to preinjury level without symptoms and 17% did so with symptoms. Eleven patients (17%) changed ac-

ABSTRACTS

tivity levels because of factors not related to their knee, whereas 7% decreased sports levels due to their knee and 9% reported being unable to partic- ipate at all. The symptom rating scores (for absence of) were 83 for pain, 93 for swelling, and 90 and 89 for partial and full giving way. Statistical analysis reveals that the HSS and Lys scores, which are highly correlative (p = 0.9), do not correlate with patient overall subjective response (p = 0.0006) or the Symptom Rating scores (p = 0.0007). The scores may inflate overall results to the extent that significant differences in subjective, objective, and functional outcome exist. The CKRS correlates more highly with individual grading criteria (p = 0.07) and more precisely defines functional assess- ment in athletically active patients. A categorical grading is suggested and avoidance of data general- ization remains the optimal method for studying ACL surgical outcome.

Long Term Strength of New Slow Absorption Su- tures. F. Alan Barber and James N. Click. Plano, Texas, U.S.A.

The effect of inflammatory synovial fluid on sev- eral absorbable sutures potentially useful for vari- ous arthroscopic procedures (meniscus repair or shoulder stabilization) was studied by implanting lengths of these sutures into unstable, arthritic rab- bit knees and after varying lengths of time (up to 18 weeks) testing their breaking strength. Both poly- glactin-910 (Vicryl) and polyglycolic acid (Dexon) sutures retained only minimal breaking strength 3 weeks after implantation. Polyglyconate (Maxon) and chromic gut sutures retained no significant strength at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 2 weeks and re- tained only 40% of their original strength at 6 weeks and no measurable strength 9 weeks after implan- tation. Polycaprolactone (LTS) sutures showed a slow reduction in strength and retained approxi- mately 90% of their original breaking strength after 18 weeks of implantation. Braided polyester sutures showed no loss of breaking strength over the dura- tion of this test. The decline in molecular weight as indirectly determined by measurement of the inher- ent viscosity was determined for polydioxanone, polyglyconate, and polycaprolactone sutures. Us- ing this method, the rate of degradation was consis- tent with the decline in breaking strength for these three absorbable sutures. Polyglyconate dropped to 17% at 6 weeks, polydioxanone dropped to 30% at

9 weeks, and polycaprolactone retained 90% at 18 weeks. The surgeon selecting an absorbable suture must consider the length of time the suture will hold the target tissue. The outcome of a meniscus repair or shoulder reconstruction may be jeopardized if tissue approximation is not secure for a sufficient time. This information should assist the surgeon in making the most appropriate suture selection.

Synovial IL-1 In Early, Localized Arthriti+A Role for Surgical Synovectomy? Thomas D. Rosenberg, Daniel C. Wnorowski, and Vernon Cooley. Salt Lake City, Utah, Syracuse, New York, and Bos- ton, Massachusetts, U.S.A.

Interleukin-1 (IL-l) is a multifunctional cytokine. It is a mediator of arthritis. Mechanisms include stimulation of proteoglycan catabolism, and the in- hibition of proteoglycan release, as well as stimula- tion of prostaglandin E, release, and the induction of degradative enzymes, including collagenase, metalloproteases, and stomelysin. It has been shown to have been produced by synovial mono- cytes, synovial cells, and chondrocytes. IL-l has been isolated from the synovial fluid and synovium of patients with frank osteoarthritis (OA), as well as from rheumatoid variants. It is proposed that con- trol of IL-I production may result in inhibition of progressive arthritis. The purpose of this study is to document existence of IL-l in the synovium of pa- tients with the earliest signs of OA: localized ad- vanced chondrosis with associated synovitis. To date, studies have demonstrated IL-l in joints with significantly advanced OA, i.e., the total knee re- placement (TKR) patient. In this preliminary study, a total of 15 patients were evaluated. There were 6 controls and 9 experimental patients. Controls were divided equally into two groups: positive controls, i.e., tricompartmental OA knee presenting for TKR; and negative controls, i.e., knees undergoing arthroscopy without hyaline cartilage changes or synovitis. Criteria for entry into the experimental group included unicompartmental chondrosis of a minimum of grade III or IV, with associated local- ized synovitis. Biopsies were done of the synovium of the knee in this group in grossly proliferative areas adjacent to chondritic regions, as well as in grossly uninvolved sites. The IL-l concentrations were higher in synovial specimens obtained from areas of synovitis associated with advanced chon- drosis, and these approximated IL-l levels in the frankly arthritic knees. Conversely, IL-I levels in

Arthroscopy. Vol. 7, No. 3, 1991