ElbowArthroscopic arthrolysis for posttraumatic elbow stiffness
Section snippets
Materials and methods
Between June 2006 and December 2007, 27 consecutive patients (17 females) with a posttraumatic contracture of the elbow were treated with an arthroscopic release. Patients were an average age of 42 years (range, 14-65 years),
The study included patients with posttraumatic contracture (for details of traumatic deformities, see Table I) if they had a symptomatic loss of flexion of more than 20° and/or a loss of extension of at least 20°. Arthroscopic surgery was indicated when restricted elbow
Evaluation
Evaluation took place preoperatively, after 3, 12 and 24 months, using the Elbow Function Assessment (EFA; Appendix 1).4, 20
ROM and EFA are determined preoperatively after 3, 12, and 24 months. Pain at rest was evaluated on a visual analog scale (VAS) preoperatively and after 12 months. Plain radiographs and computed tomography (CT) were performed to evaluate the osseous abnormalities in all patients preoperatively, and plain radiographs in 2 views were taken at 3 months and 1 year after
Surgical technique
All patients were operated on by the same surgeon (D.E.). The time between surgical intervention and trauma varied from 6 to 339 months. Physical examination under anesthesia was routine. The patient was placed in the lateral decubitus position (Fig. 1). A tourniquet was used in all cases. The joint was distended with saline, and access was through a midposterior and a posterolateral portal. The posterior compartment was debrided using a 5.5-mm oscillating shaver and a 4-mm oval burr (Stryker
Results
The preoperative mean flexion and mean extension improved at at 3 months from 123° (SD, 8°) to 133° (SD, 5°) and 24° (SD, 9°) to 7° (SD, 6°), respectively (P < .0005). The mean total ROM improved from 99° (SD, 11°) to 125° (SD, 10°; P < .0005; Table II (A), Table II (C)). The mean EFA increased from 69 (SD, 4) preoperatively to 91 (SD, 4) 3 months postoperatively (Table II (A), Table II (E)). The postoperative ROM and EFA at 3, 12 and 24 months remained the same. The VAS score at rest 12 months
Discussion
Open release has traditionally had good clinical outcomes.18 However, open release leaves large scars and causes increased soft tissue trauma, which may lead to contracture recurrence and can delay the progress of physiotherapy programs.30 Good outcomes have been reported with arthroscopic capsular release.1, 10, 22, 24, 25, 26, 31, 32 Several authors have reported their results after arthroscopic arthrolysis in the treatment of elbow joint contracture (Table III).2, 10, 12, 14, 15, 21, 23, 25,
Conclusion
In conclusion, loss of motion is a common complication after elbow trauma and can significantly interfere with the ability to perform activities in daily life. Nonsurgical treatment, including physiotherapy and static splinting, can restore a functional arc of motion in some patients. Traditionally, open release has good clinical outcomes. Arthroscopic capsular release with debridement and anterior capsulectomy is a safe and an effective treatment for posttraumatic elbow contracture with an
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References (33)
- et al.
Arthroscopic treatment of post-traumatic elbow contracture
J Shoulder Elbow Surg
(2002) - et al.
Intra-articular capacity and compliance of stiff and normal elbows
Arthroscopy
(1993) - et al.
Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture
Arthroscopy
(1999) - et al.
Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow
Arthroscopy
(1993) - et al.
[Elbow arthroscopy] Rev Chir Orthop Reparatrice Appar Mot
(2006) - et al.
Arthroscopic debridement without radial head excision of the osteoarthritic elbow
Arthroscopy
(2007) - et al.
The posttraumatic stiff elbow: A review of the literature
J Hand Surg [Am]
(2007) - et al.
Neurovascular anatomy and elbow arthroscopy: inherent risks
Arthroscopy
(1986) - et al.
Arthroscopic release of a posttraumatic flexion contracture in the elbow: A case report and review of the literature
Arthroscopy
(1992) - et al.
Functional outcomes of arthroscopic capsular release of the elbow
Arthroscopy
(2006)
Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow
Arthroscopy
Arthroscopic treatment of arthrofibrosis of the elbow joint
Arthroscopy
Arthroscopic fenestration for osteoarthritis
Arthroscopy
Arthroscopic release of the stiff elbow
J Hand Surg [Am]
Arthroscopic management of the arthritic elbow: Indications, technique, and results
J Shoulder Elbow Surg
Elbow arthroscopy for arthrofibrosis after type I radial head fractures
Arthroscopy
Cited by (75)
Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryComparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness
2023, Orthopaedics and Traumatology: Surgery and ResearchComparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness
2023, Revue de Chirurgie Orthopedique et TraumatologiqueOutcomes of Arthroscopic Elbow Contracture Release: Improvement for Severe Prosupination and Flexion Contracture
2022, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Two patients presented with severe flexion contracture only. Reports in the literature demonstrate that patients typically reach a plateau in recovery 3 months postoperatively, and neither significantly increase or decrease their elbow ROM thereafter.6,15,28 Therefore, the authors recommend that the second stage of the planned two-stage release should occur at about 3 months after the first release.
The post-traumatic stiff elbow: A review
2021, Journal of Clinical Orthopaedics and Trauma
The study was approved by the Ethics Committee of our hospital, which stated that informed consent of each patient was not needed because this study is an anonymous, clinical evaluation of patients treated in a standardized way according to the current treatment protocol for stiff elbows in our institution.