Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow

Wang, Wei; Zhan, Yi; Yu, Shiyong; Zheng, Xianyou; Liu, Shen; Fan, Cunyi

doi:10.1016/j.jse.2016.01.015

Cited by 16 publications

(10 citation statements)

References 30 publications

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“…It becomes more challenging if the muscle has developed ischemic contracture after trauma. While mild contracture is usually concomitant with adhesion and can be released arthroscopically, moderate to severe muscle contracture usually requires open surgery 21 .…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Dai

et al. 2020

Orthopaedic Surgery

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Objectives: To evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems. Methods: A retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery-related complications were assessed. Results: Patients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean followup time of 10.1 months. The postoperative elbow ROM was 123.2 ± 19 , which was significantly different compared to the preoperative value of 68 ± 32. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow-up, a mean improvement of 22.5 (range, 0-55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow. Conclusion: With full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Dai

et al. 2020

Orthopaedic Surgery

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“…The techniques were applied as described previously 27, 44, 51. At the medial side, the ulnar nerve was released and transposed.…”

Section: Methodsmentioning

confidence: 99%

“…Elbow stiffness is a common post-traumatic complication that extensively reduces elbow activities, compromises quality of life, and decreases occupational function 14, 34, 37, 51. Surgical intervention, including open or arthroscopic elbow arthrolysis and elbow arthroplasty, are indicated for those who do not respond to conservative approaches7, 8, 35, 45, 49 to restore the arc of motion (AOM) and elbow functions.…”

mentioning

confidence: 99%

“…Complications of the procedure, such as elbow instability, wound infection, pin-related infections, and recurrence of elbow stiffness, have been studied 6, 22. Only a few studies,2, 9, 51, 53 however, have reported muscular strength compromise after the procedure, and they mainly focused on elbow flexors and extensors. We have observed clinically that all patients experience an abrupt strength decline for all elbow, wrist, and grip movements shortly after the operation and gradually recover afterward.…”

mentioning

confidence: 99%

“…Besides regular capsulotomy, heterotopic ossification removal, or remodeling of the olecranon,27, 28, 44 many authors6, 12, 23, 39, 55 reported excision of the posterior and transverse bundle of the medial collateral ligament and partial excision of lateral collateral ligament complex for better release of elbow stiffness. If release is unsatisfactory, lengthening 38 or pie-crusting of the triceps, 51 or detachment of common tendons of flexors would be applied. We hypothesized that open elbow arthrolysis and manipulation of surrounding soft tissues may permanently compromise the muscular strength of elbow flexors and extensors, wrist flexors and extensors, and handgrip.…”

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confidence: 99%

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Effect on muscle strength of the upper extremities after open elbow arthrolysis

Chen

Wang

et al. 2017

JSES Open Access

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BackgroundOpen elbow arthrolysis manipulates tendons and soft tissues surrounding the elbow and may lead to strength decline after the operation. We hypothesized that strength of elbow and wrist motions and handgrip could be compromised after the procedure and that the strength recovery pattern may differ between men and women and between the dominant and nondominant side.MethodsThis was a prospective cohort study. We monitored 32 patients with post-traumatic elbow stiffness who underwent open arthrolysis between June 2014 and December 2014. All patients underwent standardized postoperative physical therapy. Preoperative and postoperative isometric strength were measured by a handheld dynamometer. Mayo Elbow Performance Score (MEPS) and arc of motion (AOM) were also analyzed.ResultsMean follow-up was 26.13 months. Significant improvement was noticed in mean AOM (from 46° to 127°) and MEPS (from 67.97 to 96.86). No significant decline was noted in isometric strength at the last follow-up day. The strength ratios between men and women showed no significant difference from postoperative day 7 to the last follow-up day. At all follow-up assessments, isometric strength showed no significant difference between the dominant and nondominant side.ConclusionsAOM and MEPS achieved significant enhancement after open elbow arthrolysis. The procedure did not lead to isometric strength decline. Postoperative gain of strength was proportional to the baseline strength level of each muscle group, and men had a more prominent gain of strength than women during the entire follow-up. Dominance had no effect on postoperative strength recovery.

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Arthroscopic Management of Elbow Stiffness

2021

Arthroscopy and Endoscopy of the Hand, Wrist and Elbow

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Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow

Cited by 16 publications

References 30 publications

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Effect on muscle strength of the upper extremities after open elbow arthrolysis

Arthroscopic Management of Elbow Stiffness

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