Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2018

01.07.2017 | Elbow

Arthroscopic arthrolysis provides good clinical outcome in post-traumatic and degenerative elbow stiffness

verfasst von: Lukas Willinger, Sebastian Siebenlist, Andreas Lenich, Franz Liska, Andreas B. Imhoff, Andrea Achtnich

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose and hypothesis

The purpose of this retrospective study was to report on the functional outcome after arthroscopic arthrolysis in patients with post-traumatic or degenerative elbow stiffness. It was hypothesized that this operative procedure leads to improved range of motion (ROM) and improved functional outcome in both groups.

Methods

Patients who underwent arthroscopic arthrolysis of the elbow between 2010 and 2015 were included in this study. Forty-two patients with an average age of 41.0 ± 13.5 years were available for evaluation. The mean follow-up was 28.3 ± 14.9 months. With regard to aetiology of elbow contractures, patients were divided into post-traumatic (group A) and degenerative (group B) cohort. General patients’ data, previous surgical treatment and ROM were recorded. At follow-up evaluation, the clinical outcome was assessed by the ROM, visual analogue scale (VAS) for pain assessment and the Elbow Self-Assessment Score (ESAS).

Results

The mean arc of motion of group A (n = 20) increased from preoperatively 74.3° to 120.5° postoperatively (p < 0.001); group B (n = 22) showed an improvement of 104.6° preoperatively to 123.4° after surgery (p = 0.002). Mean improvement was 46.3° ± 27.5° in group A and 16.4° ± 19.4° in group B. Mean post-operative VAS was 0.9 ± 1.5 in group A and 1.3 ± 2.2 in group B. 92.9% of patients achieved a functional arc of elbow motion >100°. The ESAS indicated good to excellent clinical outcome showing 88.8 ± 10.0 points in group A and 84.1 ± 21.4 points in group B. Thirty-six patients (85.7%) returned to their previous work level after surgery.

Conclusions

Arthroscopic arthrolysis is an effective treatment option for patients with restriction in elbow motion reasoned by post-traumatic or degenerative changes. Both groups showed a significant improvement of ROM and comparable outcome scores.

Level of evidence

Therapeutic study, Level IV.
Literatur
1.
Zurück zum Zitat Achtnich A, Forkel P, Metzlaff S, Petersen W (2013) Arthroscopic arthrolysis of the elbow joint. Oper Orthop Traumatol 25:205–214CrossRefPubMed Achtnich A, Forkel P, Metzlaff S, Petersen W (2013) Arthroscopic arthrolysis of the elbow joint. Oper Orthop Traumatol 25:205–214CrossRefPubMed
2.
Zurück zum Zitat Aldridge JM 3rd, Atkins TA, Gunneson EE, Urbaniak JR (2004) Anterior release of the elbow for extension loss. J Bone Joint Surg Am 86-A:1955–1960CrossRefPubMed Aldridge JM 3rd, Atkins TA, Gunneson EE, Urbaniak JR (2004) Anterior release of the elbow for extension loss. J Bone Joint Surg Am 86-A:1955–1960CrossRefPubMed
3.
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 11:624–629CrossRefPubMed Ball CM, Meunier M, Galatz LM, Calfee R, Yamaguchi K (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629CrossRefPubMed
4.
Zurück zum Zitat Beirer M, Friese H, Lenich A, Cronlein M, Sandmann GH, Biberthaler P, Kirchhoff C, Siebenlist S (2015) The Elbow Self-Assessment Score (ESAS): development and validation of a new patient-reported outcome measurement tool for elbow disorders. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3647-z Beirer M, Friese H, Lenich A, Cronlein M, Sandmann GH, Biberthaler P, Kirchhoff C, Siebenlist S (2015) The Elbow Self-Assessment Score (ESAS): development and validation of a new patient-reported outcome measurement tool for elbow disorders. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-015-3647-z
5.
Zurück zum Zitat Blonna D, O’Driscoll SW (2014) Delayed-onset ulnar neuritis after release of elbow contracture: preventive strategies derived from a study of 563 cases. Arthroscopy 30:947–956CrossRefPubMed Blonna D, O’Driscoll SW (2014) Delayed-onset ulnar neuritis after release of elbow contracture: preventive strategies derived from a study of 563 cases. Arthroscopy 30:947–956CrossRefPubMed
6.
Zurück zum Zitat Bruno RJ, Lee ML, Strauch RJ, Rosenwasser MP (2002) Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg 10:106–116CrossRefPubMed Bruno RJ, Lee ML, Strauch RJ, Rosenwasser MP (2002) Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg 10:106–116CrossRefPubMed
7.
Zurück zum Zitat Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg 20:434–439CrossRefPubMed Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg 20:434–439CrossRefPubMed
8.
Zurück zum Zitat Cikes A, Jolles BM, Farron A (2006) Open elbow arthrolysis for posttraumatic elbow stiffness. J Orthop Trauma 20:405–409CrossRefPubMed Cikes A, Jolles BM, Farron A (2006) Open elbow arthrolysis for posttraumatic elbow stiffness. J Orthop Trauma 20:405–409CrossRefPubMed
9.
Zurück zum Zitat Ehsan A, Huang JI, Lyons M, Hanel DP (2012) Surgical management of posttraumatic elbow arthrofibrosis. J Trauma Acute Care Surg 72:1399–1403CrossRefPubMed Ehsan A, Huang JI, Lyons M, Hanel DP (2012) Surgical management of posttraumatic elbow arthrofibrosis. J Trauma Acute Care Surg 72:1399–1403CrossRefPubMed
10.
Zurück zum Zitat Gosling T, Blauth M, Lange T, Richter M, Bastian L, Krettek C (2004) Outcome assessment after arthrolysis of the elbow. Arch Orthop Trauma Surg 124:232–236CrossRefPubMed Gosling T, Blauth M, Lange T, Richter M, Bastian L, Krettek C (2004) Outcome assessment after arthrolysis of the elbow. Arch Orthop Trauma Surg 124:232–236CrossRefPubMed
11.
Zurück zum Zitat Kamineni S, Savoie FH 3rd, Elattrache N (2007) Endoscopic extracapsular capsulectomy of the elbow: a neurovascularly safe technique for high-grade contractures. Arthroscopy 23:789–792CrossRefPubMed Kamineni S, Savoie FH 3rd, Elattrache N (2007) Endoscopic extracapsular capsulectomy of the elbow: a neurovascularly safe technique for high-grade contractures. Arthroscopy 23:789–792CrossRefPubMed
12.
Zurück zum Zitat Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D (2013) Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg 22:574–580CrossRefPubMed Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D (2013) Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg 22:574–580CrossRefPubMed
13.
Zurück zum Zitat Lindenhovius AL, Doornberg JN, Ring D, Jupiter JB (2010) Health status after open elbow contracture release. J Bone Joint Surg Am 92:2187–2195CrossRefPubMed Lindenhovius AL, Doornberg JN, Ring D, Jupiter JB (2010) Health status after open elbow contracture release. J Bone Joint Surg Am 92:2187–2195CrossRefPubMed
14.
Zurück zum Zitat Marti RK, Kerkhoffs GM, Maas M, Blankevoort L (2002) Progressive surgical release of a posttraumatic stiff elbow. Technique and outcome after 2–18 years in 46 patients. Acta Orthop Scand 73:144–150CrossRefPubMed Marti RK, Kerkhoffs GM, Maas M, Blankevoort L (2002) Progressive surgical release of a posttraumatic stiff elbow. Technique and outcome after 2–18 years in 46 patients. Acta Orthop Scand 73:144–150CrossRefPubMed
15.
Zurück zum Zitat Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618CrossRefPubMed Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618CrossRefPubMed
16.
Zurück zum Zitat Morrey BF (2005) The posttraumatic stiff elbow. Clin Orthop Relat Res 431:26–35 Morrey BF (2005) The posttraumatic stiff elbow. Clin Orthop Relat Res 431:26–35
17.
Zurück zum Zitat Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877CrossRefPubMed Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877CrossRefPubMed
18.
Zurück zum Zitat Nandi S, Maschke S, Evans PJ, Lawton JN (2009) The stiff elbow. Hand (N Y) 4:368–379CrossRef Nandi S, Maschke S, Evans PJ, Lawton JN (2009) The stiff elbow. Hand (N Y) 4:368–379CrossRef
19.
Zurück zum Zitat Nguyen D, Proper SI, MacDermid JC, King GJ, Faber KJ (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849CrossRefPubMed Nguyen D, Proper SI, MacDermid JC, King GJ, Faber KJ (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849CrossRefPubMed
20.
Zurück zum Zitat Papatheodorou LK, Baratz ME, Sotereanos DG (2013) Elbow arthritis: current concepts. J Hand Surg Am 38:605–613CrossRefPubMed Papatheodorou LK, Baratz ME, Sotereanos DG (2013) Elbow arthritis: current concepts. J Hand Surg Am 38:605–613CrossRefPubMed
21.
Zurück zum Zitat Park MJ, Chang MJ, Lee YB, Kang HJ (2010) Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg Am 92:2692–2699CrossRefPubMed Park MJ, Chang MJ, Lee YB, Kang HJ (2010) Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg Am 92:2692–2699CrossRefPubMed
22.
Zurück zum Zitat Pederzini LA, Nicoletta F, Tosi M, Prandini M, Tripoli E, Cossio A (2014) Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc 22:467–473CrossRefPubMed Pederzini LA, Nicoletta F, Tosi M, Prandini M, Tripoli E, Cossio A (2014) Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc 22:467–473CrossRefPubMed
23.
Zurück zum Zitat Pettersen PM, Eriksson J, Bratberg H, Myrseth LE, Bjornstad LG, Johansen M, Husby T (2016) Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows. BMC Musculoskelet Disord 17:74CrossRefPubMedPubMedCentral Pettersen PM, Eriksson J, Bratberg H, Myrseth LE, Bjornstad LG, Johansen M, Husby T (2016) Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows. BMC Musculoskelet Disord 17:74CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Ruch DS, Shen J, Chloros GD, Krings E, Papadonikolakis A (2008) Release of the medial collateral ligament to improve flexion in post-traumatic elbow stiffness. J Bone Joint Surg Br 90:614–618CrossRefPubMed Ruch DS, Shen J, Chloros GD, Krings E, Papadonikolakis A (2008) Release of the medial collateral ligament to improve flexion in post-traumatic elbow stiffness. J Bone Joint Surg Br 90:614–618CrossRefPubMed
25.
Zurück zum Zitat Sears BW, Puskas GJ, Morrey ME, Sanchez-Sotelo J, Morrey BF (2012) Posttraumatic elbow arthritis in the young adult: evaluation and management. J Am Acad Orthop Surg 20:704–714PubMed Sears BW, Puskas GJ, Morrey ME, Sanchez-Sotelo J, Morrey BF (2012) Posttraumatic elbow arthritis in the young adult: evaluation and management. J Am Acad Orthop Surg 20:704–714PubMed
26.
Zurück zum Zitat Williams BG, Sotereanos DG, Baratz ME, Jarrett CD, Venouziou AI, Miller MC (2012) The contracted elbow: is ulnar nerve release necessary? J Shoulder Elbow Surg 21:1632–1636CrossRefPubMed Williams BG, Sotereanos DG, Baratz ME, Jarrett CD, Venouziou AI, Miller MC (2012) The contracted elbow: is ulnar nerve release necessary? J Shoulder Elbow Surg 21:1632–1636CrossRefPubMed
27.
Zurück zum Zitat Wu X, Wang H, Meng C, Yang S, Duan D, Xu W, Liu X, Tang M, Zhao J (2015) Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness. Knee Surg Sports Traumatol Arthrosc 23:2715–2720CrossRefPubMed Wu X, Wang H, Meng C, Yang S, Duan D, Xu W, Liu X, Tang M, Zhao J (2015) Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness. Knee Surg Sports Traumatol Arthrosc 23:2715–2720CrossRefPubMed
Metadaten
Titel
Arthroscopic arthrolysis provides good clinical outcome in post-traumatic and degenerative elbow stiffness
verfasst von
Lukas Willinger
Sebastian Siebenlist
Andreas Lenich
Franz Liska
Andreas B. Imhoff
Andrea Achtnich
Publikationsdatum
01.07.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4630-7

Weitere Artikel der Ausgabe 1/2018

Knee Surgery, Sports Traumatology, Arthroscopy 1/2018 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.