Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2011

01.06.2011 | Elbow

Arthroscopic treatment for limitation of motion of the elbow: the learning curve

verfasst von: Sung-Jae Kim, Hong-Kyo Moon, Yong-Min Chun, Ji-Hoon Chang

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstracts

Purpose

The aim of this study was to demonstrate our learning curve in arthroscopic treatment for limitation of motion of the elbow.

Methods

To verify the surrogates for learning curve, operative time in 120 consecutive elbows were plotted by case number and the learning curve was illustrated by the best-fit curve. The study population was divided into eight consecutive blocks (15 patients per block) by observing a notable change in the learning from the curve. Mean operative time and mean improvement in motion and clinical score in each block were compared.

Results

Mean operative time decreased significantly from the first block to the second block (133–98). No further significant change was noted thereafter. Contrarily, no significant increase in motion improvement or clinical score improvement was identified but a significant decrease was found between the fourth and fifth block (47–36 and 30–24, respectively). Operative time was negatively correlated with preoperative range of motion (P = 0.003). Clinical score improvement was also negatively correlated with preoperative range of motion (P < 0.001). Motion improvement was more strongly correlated with preoperative range of motion (P < 0.001).

Conclusions

This study demonstrated a learning curve in which a significant decrease in operative time was shown after an initial 15 patients. Motion and clinical score improvement were not satisfactory surrogate for learning curve and found to be closely related to preoperative range of motion. Qualification of the learning curve for arthroscopic treatment for limitation of motion of the elbow provides a guide for surgeons assuming the expected time line to become proficient in this technique.
Literatur
1.
Zurück zum Zitat Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJ (1998) Reliability of range-of-motion measurement in the elbow and forearm. J Shoulder Elbow Surg 7:573–580PubMedCrossRef Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJ (1998) Reliability of range-of-motion measurement in the elbow and forearm. J Shoulder Elbow Surg 7:573–580PubMedCrossRef
2.
Zurück zum Zitat Ball CM, Meunier M, Galatz LM, Calfee R, Yamaguchi K (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629PubMedCrossRef Ball CM, Meunier M, Galatz LM, Calfee R, Yamaguchi K (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629PubMedCrossRef
3.
Zurück zum Zitat Byrd JW (1994) Elbow arthroscopy for arthrofibrosis after type I radial head fractures. Arthroscopy 10:162–165PubMedCrossRef Byrd JW (1994) Elbow arthroscopy for arthrofibrosis after type I radial head fractures. Arthroscopy 10:162–165PubMedCrossRef
4.
Zurück zum Zitat Cohen AP, Redden JF, Stanley D (2000) Treatment of osteoarthritis of the elbow: a comparison of open and arthroscopic debridement. Arthroscopy 16:701–706PubMedCrossRef Cohen AP, Redden JF, Stanley D (2000) Treatment of osteoarthritis of the elbow: a comparison of open and arthroscopic debridement. Arthroscopy 16:701–706PubMedCrossRef
5.
Zurück zum Zitat Cohen MS, Hastings H 2nd (1999) Operative release for elbow contracture: the lateral collateral ligament sparing technique. Orthop Clin North Am 30:133–139PubMedCrossRef Cohen MS, Hastings H 2nd (1999) Operative release for elbow contracture: the lateral collateral ligament sparing technique. Orthop Clin North Am 30:133–139PubMedCrossRef
6.
Zurück zum Zitat Cook JA, Ramsay CR, Fayers P (2004) Statistical evaluation of learning curve effects in surgical trials. Clin Trials 1:421–427PubMedCrossRef Cook JA, Ramsay CR, Fayers P (2004) Statistical evaluation of learning curve effects in surgical trials. Clin Trials 1:421–427PubMedCrossRef
7.
Zurück zum Zitat Gallay SH, Richards RR, O’Driscoll SW (1993) Intraarticular capacity and compliance of stiff and normal elbows. Arthroscopy 9:9–13PubMedCrossRef Gallay SH, Richards RR, O’Driscoll SW (1993) Intraarticular capacity and compliance of stiff and normal elbows. Arthroscopy 9:9–13PubMedCrossRef
8.
Zurück zum Zitat Guttmann D, Graham RD, MacLennan MJ, Lubowitz JH (2005) Arthroscopic rotator cuff repair: the learning curve. Arthroscopy 21:394–400PubMedCrossRef Guttmann D, Graham RD, MacLennan MJ, Lubowitz JH (2005) Arthroscopic rotator cuff repair: the learning curve. Arthroscopy 21:394–400PubMedCrossRef
9.
Zurück zum Zitat Jones GS, Savoie FH 3rd (1993) Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow. Arthroscopy 9:277–283PubMedCrossRef Jones GS, Savoie FH 3rd (1993) Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow. Arthroscopy 9:277–283PubMedCrossRef
10.
11.
Zurück zum Zitat Kim SJ, Kim HK, Lee JW (1995) Arthroscopy for limitation of motion of the elbow. Arthroscopy 11:680–683PubMedCrossRef Kim SJ, Kim HK, Lee JW (1995) Arthroscopy for limitation of motion of the elbow. Arthroscopy 11:680–683PubMedCrossRef
12.
Zurück zum Zitat Kim SJ, Shin SJ (2000) Arthroscopic treatment for limitation of motion of the elbow. Clin Orthop Relat Res 375:140–148PubMedCrossRef Kim SJ, Shin SJ (2000) Arthroscopic treatment for limitation of motion of the elbow. Clin Orthop Relat Res 375:140–148PubMedCrossRef
13.
Zurück zum Zitat Lapner PC, Leith JM, Regan WD (2005) Arthroscopic debridement of the elbow for arthrofibrosis resulting from nondisplaced fracture of the radial head. Arthroscopy 21:1492PubMedCrossRef Lapner PC, Leith JM, Regan WD (2005) Arthroscopic debridement of the elbow for arthrofibrosis resulting from nondisplaced fracture of the radial head. Arthroscopy 21:1492PubMedCrossRef
14.
Zurück zum Zitat Lobato AC, Rodriguez-Lopez J, Diethrich EB (2002) Learning curve for endovascular abdominal aortic aneurysm repair: evaluation of a 277-patient single-center experience. J Endovasc Ther 9:262–268PubMedCrossRef Lobato AC, Rodriguez-Lopez J, Diethrich EB (2002) Learning curve for endovascular abdominal aortic aneurysm repair: evaluation of a 277-patient single-center experience. J Endovasc Ther 9:262–268PubMedCrossRef
15.
Zurück zum Zitat Lynch GJ, Meyers JF, Whipple TL, Caspari RB (1986) Neurovascular anatomy and elbow arthroscopy: inherent risks. Arthroscopy 2:190–197PubMedCrossRef Lynch GJ, Meyers JF, Whipple TL, Caspari RB (1986) Neurovascular anatomy and elbow arthroscopy: inherent risks. Arthroscopy 2:190–197PubMedCrossRef
16.
Zurück zum Zitat Mansat P, Morrey BF (1998) The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am 80:1603–1615PubMed Mansat P, Morrey BF (1998) The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am 80:1603–1615PubMed
17.
Zurück zum Zitat Marshall PD, Fairclough JA, Johnson SR, Evans EJ (1993) Avoiding nerve damage during elbow arthroscopy. J Bone Joint Surg Br 75:129–131PubMed Marshall PD, Fairclough JA, Johnson SR, Evans EJ (1993) Avoiding nerve damage during elbow arthroscopy. J Bone Joint Surg Br 75:129–131PubMed
18.
Zurück zum Zitat Menth-Chiari WA, Ruch DS, Poehling GG (2001) Arthroscopic excision of the radial head: clinical outcome in 12 patients with post-traumatic arthritis after fracture of the radial head or rheumatoid arthritis. Arthroscopy 17:918–923PubMedCrossRef Menth-Chiari WA, Ruch DS, Poehling GG (2001) Arthroscopic excision of the radial head: clinical outcome in 12 patients with post-traumatic arthritis after fracture of the radial head or rheumatoid arthritis. Arthroscopy 17:918–923PubMedCrossRef
19.
Zurück zum Zitat Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618PubMed Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618PubMed
20.
Zurück zum Zitat Morrey BF (2005) The posttraumatic stiff elbow. Clin Orthop Relat Res 431:26–35PubMed Morrey BF (2005) The posttraumatic stiff elbow. Clin Orthop Relat Res 431:26–35PubMed
21.
Zurück zum Zitat Nguyen D, Proper SI, MacDermid JC, King GJ, Faber KJ (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849PubMedCrossRef Nguyen D, Proper SI, MacDermid JC, King GJ, Faber KJ (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849PubMedCrossRef
22.
Zurück zum Zitat Nowicki KD, Shall LM (1992) Arthroscopic release of a posttraumatic flexion contracture in the elbow: a case report and review of the literature. Arthroscopy 8:544–547PubMedCrossRef Nowicki KD, Shall LM (1992) Arthroscopic release of a posttraumatic flexion contracture in the elbow: a case report and review of the literature. Arthroscopy 8:544–547PubMedCrossRef
23.
Zurück zum Zitat O’Neill PJ, Cosgarea AJ, Freedman JA, Queale WS, McFarland EG (2002) Arthroscopic proficiency: a survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs. Arthroscopy 18:795–800PubMedCrossRef O’Neill PJ, Cosgarea AJ, Freedman JA, Queale WS, McFarland EG (2002) Arthroscopic proficiency: a survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs. Arthroscopy 18:795–800PubMedCrossRef
24.
Zurück zum Zitat Phillips BB, Strasburger S (1998) Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy 14:38–44PubMedCrossRef Phillips BB, Strasburger S (1998) Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy 14:38–44PubMedCrossRef
25.
Zurück zum Zitat Sahajpal D, Choi T, Wright TW (2009) Arthroscopic release of the stiff elbow. J Hand Surg Am 34:540–544PubMedCrossRef Sahajpal D, Choi T, Wright TW (2009) Arthroscopic release of the stiff elbow. J Hand Surg Am 34:540–544PubMedCrossRef
26.
Zurück zum Zitat Salini V, Palmieri D, Colucci C, Croce G, Castellani ML, Orso CA (2006) Arthroscopic treatment of post-traumatic elbow stiffness. J Sports Med Phys Fitness 46:99–103PubMed Salini V, Palmieri D, Colucci C, Croce G, Castellani ML, Orso CA (2006) Arthroscopic treatment of post-traumatic elbow stiffness. J Sports Med Phys Fitness 46:99–103PubMed
27.
Zurück zum Zitat Savoie FH 3rd, Nunley PD, Field LD (1999) Arthroscopic management of the arthritic elbow: indications, technique, and results. J Shoulder Elbow Surg 8:214–219PubMedCrossRef Savoie FH 3rd, Nunley PD, Field LD (1999) Arthroscopic management of the arthritic elbow: indications, technique, and results. J Shoulder Elbow Surg 8:214–219PubMedCrossRef
28.
Zurück zum Zitat Timmerman LA, Andrews JR (1994) Arthroscopic treatment of posttraumatic elbow pain and stiffness. Am J Sports Med 22:230–235PubMedCrossRef Timmerman LA, Andrews JR (1994) Arthroscopic treatment of posttraumatic elbow pain and stiffness. Am J Sports Med 22:230–235PubMedCrossRef
29.
Zurück zum Zitat Van Zeeland NL, Yamaguchi K (2010) Arthroscopic capsular release of the elbow. J Shoulder Elbow Surg 19:13–19PubMedCrossRef Van Zeeland NL, Yamaguchi K (2010) Arthroscopic capsular release of the elbow. J Shoulder Elbow Surg 19:13–19PubMedCrossRef
Metadaten
Titel
Arthroscopic treatment for limitation of motion of the elbow: the learning curve
verfasst von
Sung-Jae Kim
Hong-Kyo Moon
Yong-Min Chun
Ji-Hoon Chang
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 6/2011
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1334-7

Weitere Artikel der Ausgabe 6/2011

Knee Surgery, Sports Traumatology, Arthroscopy 6/2011 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.