Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Abstract

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.

Range of motion progression patterns following open release for post-traumatic elbow stiffness

“… 7 , 22 ROM increases have been reported up to over 100°, with multiple authors reporting improvements in functional outcomes scores over time. 5 , 23 , 24 Our cohort received an average 35° of improvement in the arc of motion by 6 months postoperatively, which is less than many studies reported in the literature. One explanation for this is that our cohort had higher preoperative flexion values than patients in the aforementioned studies.…”

Complications in Elbow Arthroscopy: Management and Prevention

“…Strategies to prevent contracture following arthroscopy include preoperative evaluation of risk factors and to address those that may be modifiable, establish optimal motion intraoperatively, limit postoperative inflammation, and initiate physical therapy and ROM exercises as early as possible. 67…”

“…Studies have shown improvement in ROM after active and passive exercises and continuous passive motion during the recovery process. 33,67 In addition, it has been found that loss of ROM is more likely to occur in elbows with posttraumatic disorders or patients with underlying conditions of arthritis and obesity. In one study, Werner et al 50 found that postoperative stiffness was significantly greater in obese patients (suggesting that preoperative counseling is imperative in this patient population.…”

Elbow Kinematics and Function Following Treatment with Open Arthrolysis and Hinged External Fixator

“…Flexion/extension, varus/valgus, and pronation/supination are involved in controlling the spatial positions of the forearm and hand. The elbow is also notorious for being the most prone to stiffness after injury or surgery 1,2 . In order to adapt to modern lifestyles, a range of motion (ROM) of approximately 120° in flexion‐extension (from 27° ± 7° flexion to 149° ± 5° flexion) and another ROM of approximately 120° in pronation‐supination (from 20° ± 18° pronation to 104° ± 10° supination) are necessary, which may be greater than previously reported 3 .…”