Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 2

Can we Obtain Good Results in the Treatment of Elbow Stiffness of Degenerative or Posttraumatic Origin

Pablo Cañete San Pastorab*

Hospital de Manises, Clinica Gastaldi, Valencia Spain

*Corresponding Author: Pablo Cañete San Pastorab, Hospital de Manises, Clinica Gastaldi, Valencia Spain

Received: July 08, 2019; Published: January 21, 2020

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Abstract

Purpose: The purpose of this study is to evaluate the outcomes and the complication rates of arthroscopic arthrolysis of the stiff elbow. The hypothesis presented is that arthroscopic arthrolysis is a safe and effective technique that can return patients to high range of motion and function in their elbows and a great degree of patient satisfaction, whether the stiffness is of osteoarthritic or post-traumatic origin.

Methods: This is a retrospective study. We have made a review on 38 patients with stiff elbow due to degenerative or post-traumatic reasons, and who were treated by arthroscopic arthrolysis between 2013 and 2016, with a mean follow-up of 25 months (38-15). Elbow stiffness was classified following the Morrey scale and the Mayo Elbow Performance Index (MEPI) functional scale was used to evaluate pain, mobility, stability and elbow function pre- and post-operatively. The arthroscopic procedures performed on each patient are described, including synovectomy, debridement of fibrous tissue, anterior and/or posterior capsulotomy, resection of osteophytes in the anterior and posterior part of the elbow, extirpation of loose bodies and open release of the ulnar nerve.

Results: Mobility increased 40.13; 16.71 degrees in flexion and 23'42º in extension. The MEPI scale improved from 65 (+/- 15) to 93 (+/- 20). 35 patients achieved a functional range of motion of at least 100º (130º of flexion and -30º of extension). The patients of group 1 (degenerative origin of elbow stiffness) improved 35º and those of group 2 (posttraumatic origin of elbow stiffness) improved 45'83º. All of these results being statistically significant (p < 0´05) We had 1 case of superficial infection in a portal, which solved with antibiotic treatment; 3 cases of ulnar nerve neuritis, with spontaneous recovery before 6 months; and 2 cases in which a reoperation was necessary due to recurrence of stiffness: one with good results (from -40º of preoperative extension and 100º of flexion to -30º of postoperative extension and 120º of flexion) and the other continues with good mobility but pain that doesn´t allow him to do his job, he has requested for work disability and does not want a new surgical intervention.

Conclusion: Arthroscopic arthrolysis of the elbow is a safe and effective technique which enables good functional results to be obtained in the treatment of degenerative or post-traumatic stiff elbow, even in severe cases, with a low complication rate.

  In the patients of this study, the complete mobility of the elbow could not be restored with this technique; we must inform our patients of this risk Level of Evidence: IV

Keywords: Elbow Arthroscopy; Elbow Stiffness; Elbow Arthrolysis

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References

  1. Achtnich A., et al. “Arthroscopic arthrolysis of the elbow joint”. Operative Orthopädie und Traumatologie 25 (2013): 205-214.
  2. Aldridge JM., et al. “Anterior release of the elbow for extension loss”. Journal of Bone and Joint Surgery America 86.9 (2004):1955-1960.
  3. Antuña SA., et al. “Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: long-term outcome and complications”. Journal of Bone and Joint Surgery America 84 (2002):2168-7213.
  4. Blonna D and O’Driscoll SW. “Delayed-onset ulnar neuritis after release of elbow contracture: preventive strategies derived from a study of 563 cases”. Arthroscopy 30 (2014): 947-956.
  5. Bruno RJ., et al. “Posttraumatic elbow stiffness: evaluation and management”. The Journal of the American Academy of Orthopaedic Surgeons 10.2 (2002):106-116.
  6. Camp C., et al. “Basics of Elbow Arthroscopy Part I: Surface, Anatomy, Portals and Structures at Risk”. Artrhrocopy Techniques 5.6 (2016):1339-1343. 
  7. Cefo I and Eygendaal D. “Arthroscopic arthrolysis for posttraumatic elbow stiffness”. Journal of Shoulder and Elbow Surgery 20 (2011): 434-439.
  8. Gosling T., et al. “Outcome assessment after arthrolysis of the elbow”. Archives of Orthopaedic and Trauma Surgery 124.4 (2004): 232-236.
  9. Hilgersom NF., et al. “Tips to avoide nerve injury in elbow arthroscopy”. World Journal of Orthopedics 8.2 (2017): 99-106.
  10. Kayalar M., et al. “Elbow arthrolysis in severely stiff elbows”. Archives of Orthopaedic and Trauma Surgery 128.10 (2008):1055-1063. 
  11. Karunakar MA., et al. “Distal bíceps ruptures. A followup of Boyd and Anderson repair”. Clinical Orthopaedics and Related Research 363 (1999):110-107. 
  12. Kelly EW., et al. “Complications of elbow arthroscopy”. Journal of Bone and Joint Surgery America 83.1 (2001): 25-34.
  13. Kim SJ., et al. “Retrospective Comparative Analysis of Elbow Arthroscopy Used to Treat Primary Osteoarthritis with and Without Release of the Posterior Band of the Medial Collateral Ligament”. Arthroscopy 33.8 (2017): 1506-1511.
  14. Kim SJ and Shin SJ. “Arthroscopic treatment for limitation of motion of the elbow”. Clinical Orthopaedics and Related Research 375 (2000):140-148. 
  15. Kodde IF., et al. “Surgical treatment of post-traumatic elbow stiffness: a systematic review”. Journal of Shoulder and Elbow Surgery 22 (2013): 574-580. 
  16. Lim TK., et al. “Arthroscopic debridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome”. Journal of Shoulder and Elbow Surgery 23 (2014):1381-1387. 
  17. Lubiatowski P., et al. “Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture”. Journal of Shoulder and Elbow Surgery 27.9 (2018): 269-278.
  18. Marti RK., et al. “Progressive surgical release of a posttraumatic stiff elbow. Technique and outcome after 2-18 years in 46 patients”. Acta Orthopaedica Scandinavica 73 (2002):144-150.
  19. Morrey BF., et al. “A biomechanical study of normal functional elbow motion”. Journal of Bone and Joint Surgery America 63.6 (1981): 872-877.
  20. Morrey BF. “Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty”. Journal of Bone and Joint Surgery America 72.4 (1990): 601-618.
  21. Myden C and Hildebrand K. “Elbow joint contracture after traumatic injury”. Journal of Shoulder and Elbow Surgery 20.1 (2011): 39-44.
  22. O’Driscoll SW and Morrey BF. “Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards”. Journal of Bone and Joint Surgery American 74.1 (1992): 84-94.
  23. Olivier LC., et al. “Grading of functional results of elbow joint arthrolysis after fracture treatment”. Archives of Orthopaedic and Trauma Surgery 120.10 (2000): 562-569.
  24. Park MJ., et al. “Surgical treatment of posttraumatic stiffness of the elbow”. The Journal of Bone and Joint Surgery British 86.8 (2004):1158-1162.
  25. Pederzini LA., et al. “Elbow arthroscopy in stiff elbow”. Knee Surgery, Sports Traumatology, Arthroscopy 22 (2014): 467-473.
  26. Phillips BB and Strasburger S. “Arthroscopic treatment of arthrofibrosis of the elbow joint”. Arthroscopy 14 (1998): 38-44.
  27. Rex C., et al. “Analysis of results of surgical treatment of posttraumatic stiff elbow”. Indian Journal of Orthopaedics 42.2 (2008): 192-200.
  28. Savoie FH III. “Complication”. In: Savoie FH III, Field LD (eds) Arthroscopy of the elbow. Churchill-Livingstone, New York (1996): 151-156.
  29. Savoie III Felix H. “Editorial Commentary: Danger Zone: The Posteromedial Elbow: Don't Go Looking for Trouble and It Won't Find You! Arthroscopic Management of the Arthritis Elbow”. Arthroscopy 33.8 (2017): 1512-1513. 
  30. Sojdjerg JO. “The stiff elbow”. Acta Orthopaedica Scandinavica 67.6 (1996): 626-631.
  31. Steinmann SP., et al. “Arthroscopic treatment of the arthritic elbow”. Instructional course lectures 55 (2006):109-117.
  32. Verhaar J., et al. “Risks of neurovascular injury in elbow arthroscopy: starting anteromediallu or anterolaterally?”. Arthroscopy 7.3 (1991): 287-290.
  33. Williams BG., et al. “The contracted elbow: is ulnar nerve release necessary?” Journal of Shoulder and Elbow Surgery 21 (2012):1632-1636.
  34. Willinger L., et al. “Arthroscopic arthrolysis provides good clinical outcome in post traumatic and degenerative elbow stiffness”. Knee Surgery, Sports Traumatology, Arthroscopy (2017).
  35. Wilson PD. “Capsulectomy for the relief of flexion contractures of the elbow following fracture”. Clinical Orthopaedics and Related Research 2000 (1944): 3-8.
  36. Xinghuo Wu., et al. “Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness”. Knee Surgery, Sports Traumatology, Arthroscopy 23 (2015): 2715-2720.
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Citation

Citation: Pablo Cañete San Pastorab. "Can we Obtain Good Results in the Treatment of Elbow Stiffness of Degenerative or Posttraumatic Origin".Acta Scientific Orthopaedics 3.2 (2020): 01-13.



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