Arthroscopic Treatment of Post-Traumatic Elbow Stiffness

Abstract

To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. Methods: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months afterwards and were rated using the Mayo elbow performance score (MEPS). Results: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3° and of MEPS, 85.4. Conclusion: Arthroscopic release might enable better intra-articular viewing and enhance the options for changing strategy during surgery, reducing surgical trauma and enabling early rehabilitation. This technique can reach similar or better results than open surgery. The disadvantages of arthroscopy are the long learning curve and higher cost of the procedure. Neurovascular complications are reported with both techniques. To avoid such problems, the protocol for portal construction must be rigorously followed. Arthroscopic release was shown to be a safe and effective option for achieving range-of-motion gains in cases of post-traumatic stiff elbow.

Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

“…Several surgical techniques have been described for the treatment of post-traumatic elbow stiffness, from the most aggressive, with extensive release associated with an external fixator, 15 to the minimally-invasive 5 and those by arthroscopic approach. 16 The authors report good results with significant gains both in function and elbow ROM, with complication rates ranging from 0% to 88%. 6 However, there are few studies with a good level of evidence, with only two prospective case series.…”

“…Diversas técnicas cirúrgicas já foram descritas para o tratamento da RPTC, desde as mais agressivas, com liberação extensa associada ao fixador externo, 15 até as minimamente invasivas 5 e por via artroscópica. 16 Os autores relatam bons resultados, com ganho significativo da função e ADM do cotovelo, com taxas de complicação que variam de 0% a 88%. 6 Porém, existem poucos estudos com bom nível de evidência, com apenas duas séries prospectivas de casos.…”

Arthroscopic release of the elbow joint

“…1. Інтраопераційні артроскопічні фотографії лівого плечового суглоба пацієнта С.: а) одразу після початку хірургічного втручання, артроскоп введено з передньо-медіального порталу, 1 -епіфіз плечової кістки (блок), 2вінцевий виросток ліктьової кістки, 3 -вільне кістковохрящове тіло в порожнині суглоба, 4 -гіпертрофована синовіальна оболонка; б) після видалення вільного кістково-хрящового тіла та парціальної синовкапсулектомії, розширення ямки вінцевого відростка на плечовій кістці за допомогою артроскопічного бура, 1 -епіфіз плечової кістки (блок), 2 -вінцевий виросток ліктьової кістки, 3 [1,2,4,[6][7][8][9]. Згідно з інформацією Jiangyu Cai та співавт.…”

Estudo randomizado para o tratamento da rigidez pós-traumática do cotovelo: liberação cirúrgica versus reabilitação

“…Diversas técnicas cirúrgicas já foram descritas para o tratamento da RPTC, desde as mais agressivas, com liberação extensa associada ao fixador externo 26 , até as minimamente invasivas 5 e por via artroscópica 27 .…”

“…A principal vantagem deste estudo é ser prospectivo e randomizado com avaliador cego em relação ao tratamento, sendo considerado nível I de evidência, além de ser o primeiro estudo a comparar essas duas opções de tratamento. Outro ponto favorável é o uso de escalas e questionários clínicos padronizados e amplamente utilizados na literatura 19,27,58,64,65,68,81,82,94,95…”