The incidence of horizontal cleavage lesions of the menisci was studied in 100 random necropsy examinations. Sixty per cent of subjects had at least one such tear, the incidence being 29 per cent out of the 400 menisci. Eighty-five per cent of the subjects showed changes of osteoarthritis in the patello-femoral or tibio-femoral joint compartments. The coincidence of horizontal cleavage lesion and osteoarthritis was frequent. Horizontal cleavage lesions were commoner in medial or larger menisci and in males. Eighteen per cent of the menisci were calcified and this was twice as common in those menisci with a degenerate tear. Because the horizontal cleavage lesion was so common in the older knee, it must usually remain unrecognised clinically with other factors causing symptoms of night pain and tenderness.

F rozen shoulder is a chronic fibrosing condition of the capsule of the joint. The predominant cells involved are fibroblasts and myofibroblasts which lay down a dense matrix of type-I and type-III collagen within the capsule. This subsequently contracts leading to the typical features of pain and stiffness. Cytokines and growth factors regulate the growth and function of the fibroblasts of connective tissue and remodelling of the matrix is controlled by the matrix metalloproteinases (MMPs) and their inhibitors. Our aim was to determine whether there was an abnormal expression or secretion of cytokines, growth factors and MMPs in tissue samples from 14 patients with frozen shoulder using the reverse transcription/polymerase chain reaction (RT/PCR) technique and to compare the findings with those in tissue from four normal control shoulders and from five patients with Dupuytren's contracture. Tissue from frozen shoulders demonstrated the presence of mRNA for a large number of cytokines and growth factors although the frequency was only slightly higher than in the control tissue. The frequency for a positive signal for the proinflammatory cytokines Il-1 and TNF-and TNF-, was not as great as in the Dupuytren's tissue. The presence of mRNA for fibrogenic growth factors was, however, more similar to that obtained in the control and Dupuytren's tissue. This correlated with the histological findings which in most specimens showed a dense fibrous tissue response with few cells other than mature fibroblasts and with very little evidence of any active inflammatory cell process. Positive expressions of the mRNA for the MMPs were also increased, together with their natural inhibitor TIMP. The notable exception compared with control and Dupuytren's tissue was the absence of MMP-14, which is known to be a membrane-type MMP required for the activation of MMP-2 (gelatinase A). Understanding the control mechanisms which play a part in the pathogenesis of frozen shoulder may lead to the development of new regimes of treatment for this common, protracted and painful chronic fibrosing condition. The term 'frozen shoulder' was first used by Codman 1 who described the common features such as pain of gradual onset, which is felt near the insertion of the deltoid, inability to sleep on the affected side, painful restriction of elevation and external rotation and a normal radiological appearance. The disorder is characterised by dense fibrosis of the capsule of the shoulder, 2-4 in which the cellular element consists of fibroblasts and myofibroblasts, 5,6 leading to a contracture of the rotator interval and the coracohumeral ligament, which restricts movement. 7-9 Cytokines and other cellular growth factors are known to regulate the growth and function of fibroblasts in connective tissue. They are cell messengers derived from lymphoid cells, platelets, epithelial cells, endothelial cells, mesangial cells and fibroblasts and act in minute concentrations (nanomolar and femtomolar) by binding to cell receptors , causing a hormone-like acti...

Objective-To assess the likely importance of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the arthritic process. Methods-Synovial samples from seven joints with rheumatoid arthritis and three osteoarthritic joints were analysed by indirect immunofluorescence microscopy. Using specific human antisera, we documented the frequencies and distributions of collagenase, stromelysins 1 and 2, matrilysin, gelatinases A and B, TIMP-1, and TIMP-2.

Proprioceptive sensory feedback is utilized by the central nervous system for conscious appreciation of the position and movement of the body and limbs. In patients with the hypermobility syndrome (HMS), it has been suggested that there is alteration of proprioceptive acuity. Proprioceptive performance of the knee joint was investigated in 10 female subjects who suffered from HMS using a threshold detection paradigm (accurate determination of the onset and direction of knee joint displacement at constant angular velocity). Compared to age- and sex-matched controls, HMS subjects showed significantly higher detection levels at starting knee flexion angles of 30 degrees P < 0.001) and 5 degrees (P < 0.001). Control subjects showed no significant difference in threshold acuity between the sexes (at 5 degrees P = 0.63, at 30 degrees P = 0.48). The increased acuity in proprioception observed towards full extension in the control population (P < 0.001) was absent in the HMS subjects (P = 0.596). Findings reported here suggest that HMS subjects have poorer proprioceptive feedback than controls. Reduced sensory feedback may lead to biomechanically unsound limb positions being adopted. Such a mechanism may allow acceleration of degenerative joint conditions, and may account for the increased prevalence of such conditions seen with HMS subjects.

No abstract

Received 4 February 1999; Accepted after revision 2 July 1999The term 'frozen shoulder' was first used by Codman 1 who described the common features such as pain of gradual onset, which is felt near the insertion of the deltoid, inability to sleep on the affected side, painful restriction of elevation and external rotation and a normal radiological appearance. The disorder is characterised by dense fibrosis of the capsule of the shoulder, 2-4 in which the cellular element consists of fibroblasts and myofibroblasts, 5,6 leading to a contracture of the rotator interval and the coracohumeral ligament, which restricts movement. 7-9Cytokines and other cellular growth factors are known to regulate the growth and function of fibroblasts in connective tissue. They are cell messengers derived from lymphoid cells, platelets, epithelial cells, endothelial cells, mesangial cells and fibroblasts and act in minute concentrations (nanomolar and femtomolar) by binding to cell receptors, causing a hormone-like action. One of their basic functions is the control of healing in damaged tissues. This process involves the accumulation of fibroblasts at the site of healing and is brought about by chemotaxis (attracting fibroblasts from elsewhere) and proliferation of fibroblasts. Cytokines and growth factors can also modulate the synthesis of collagen by fibroblasts.The histological feature of frozen shoulder is a matrix of type-I and type-III collagen populated by fibroblasts and myofibroblasts which suggests that the condition may be modulated by an abnormality in the production of cytokines and growth factors. Previous studies have shown a striking resemblence between the histology, immunocytochemistry,

The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.

A case of sclerosing epithelioid fibrosarcoma arising in the thigh of a 40-year-old man is reported. This recently described sarcoma has a distinctive histological appearance which may cause confusion with a variety of other sarcomas with an epithelioid pattern, and indeed with benign soft tissue tumours showing hyalinization. Despite its bland cytology, sclerosing epithelioid fibrosarcoma is capable of metastases, often several years after surgical removal. The patient described here developed lung metastases five years after excision and remains alive a further three years later. The differential diagnosis and possible histogenesis are discussed.