Arthroscopic surgery in post-traumatic and degenerative elbow contractures can be considered a safe, useful, with a long learning curve procedure that offers important improvement of the ROM decreasing surgical morbidity.

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BackgroundLoss of motion of the elbow joint is a common finding after elbow trauma. It has been shown that arthroscopic treatment leads to excellent restoration of elbow motion, although it is still a demanding procedure. The aim of our cohort study was to assess clinical outcomes following treatment of posttraumatic elbow stiffness using arthroscopic arthrolysis with or without the associated use of a hyaluronan anti-adhesion gel.Materials and methodsA cohort of 36 consecutive patients undergoing elbow arthroscopic arthrolysis were enrolled: 17 patients in the hyaluronan gel group and 19 in the control group. The patients underwent prospective control visits 30 and 75 days after surgery. Functional outcome was measured by the range of motion and the Liverpool elbow score (LES), whereas pain and quality of life were evaluated using the visual analogue scale and the SF-36 questionnaire, respectively.ResultsThe range of motion and the overall LES score increased over time in both groups. The mean increase over time was statistically significant (p < 0.001) in both groups and there was no difference between the groups. There was also no interaction between time and treatment. The percentage of patients who reported pain decreased significantly over time (p = 0.0419) in the hyaluronan-treated group (suggesting limited contractions and better comfort during rehabilitation), but not in the control group. The intensity of pain decreased significantly over time in both groups (p < 0.0001) without any significant difference between the groups. All the changes in patient quality of life as measured by the SF-36 questionnaire were similar for the two groups of patients. No adverse event or complication related to the application of hyaluronan gel occurred.ConclusionsOur preliminary clinical experience showed promising results upon the use of hyaluronan gel, considering that it significantly reduced pain in the short term, facilitating a more comfortable rehabilitation. These findings should be confirmed by larger studies.

The pathology of elbow stiffness can be categorized into both intra-articular and extra-articular derangements, which commonly occur in combination. The etiology of the stiff elbow, likewise, can be classified into nonarthritic causes, such as surgery, trauma and certain systemic conditions, and arthritic causes, such as osteoarthritis and rheumatoid arthritis. Current arthroscopic techniques can be used to successfully manage both the arthrofibrotic and the arthritic elbow, when appropriately indicated. This article will review the indications, management principles and arthro-scopic techniques for treating the stiff elbow, highlighting anatomic considerations, and the differences in technical guidelines when treating arthrofibrosis versus arthritis.

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