The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases (original) (raw)
Related papers
Open Elbow Arthrolysis for Post-traumatic Elbow Contracture
Upsala Journal of Medical Sciences, 2008
Background: Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, arthrolysis is indicated. The purposes of this study were to evaluate the clinical outcome of open arthrolysis for post-traumatic elbow contracture and to determine factors influencing the outcome. Methods: Twenty-seven patients with post-traumatic elbow contracture were followed-up after open arthrolysis for at least 12 months. Before surgery, the mean limitation in extension was 30° and the mean maximum flexion was 83°. A posterior surgical approach was used in 18 patients, and a lateral approach was employed in nine patients. Using the posterior approach, the fibrotic posterior capsule was excised and the ulnar collateral ligament was split. Both the anterior and posterior capsules were released with a lateral approach. Results: The mean flexion increased from 83° to 121°, but the mean extension improved little from-30° to-26°. The mean flexion-extension arc increased from 53° to 95°. According to the elbow evaluation score by the Japanese Orthopaedic Association, both pain and function scales improved significantly. By Hertel's subjective evaluation, the results were good in 13 patients, fair in ten patients, and poor in four patients. Twenty-three patients (85 percent) were satisfied with the results, but four were not satisfied because of residual contracture. These poor results were related to severe soft tissue trauma, residual displacement of intra-articular fragments, and recurrence of heterotopic bone formation. Conclusions: Tendon lengthening of stiff triceps, accurate reduction of intra-articular fragmens, and sharp epiperiosteal resection around the heterotopic bones are essential procedures of open arthrolysis to restore adequate motion in post-traumatic elbow contracture.
Outcome assessment after arthrolysis of the elbow
Archives of Orthopaedic and Trauma Surgery, 2004
Background: In the literature, the outcome after arthrolysis of the elbow is mainly assessed by range of motion (ROM). Our intention was to verify whether this parameter does sufficently estimate the outcome after surgical arthrolysis. Methods: We performed a retrospective study using the validated Disability of the Arm, Shoulder, and Hand Questionnaire (DASH) as our reference outcome parameter. This score was compared with other outcome parameters such as ROM, Mayo Performance Index (MPI) and SF-36. A total of 59 patients who underwent arthrolysis of the elbow was evaluated 53 months after surgery on average. Results: The mean ROM was 101°for flexion/ extension with a relative gain of 60% and 134°for pronation/supination with a relative gain of 58%. MPI was 84 points on average. The mean DASH was 17.6 and the mean SF-36 67.9. The correlation of these outcome parameters was calculated using Pearson's correlation (twotailed, significance set at p<0.05). We found a high correlation between DASH and the physical function part of the SF-36 (Cov=-0.87, p<0.05). The correlation of DASH and MPI was moderate (Cov=0.71, p<0.05) and of DASH and ROM poor (Cov=-0.25, p<0.05). Conclusion: ROM as a single parameter does not sufficently assess the outcome of arthrolysis of the elbow.
Results of open arthrolysis for elbow stiffness. A series of 22 cases
Acta orthopaedica Belgica
surgeons performed open elbow arthrolysis in 30 adult patients (6 women, 24 men, mean age 30.8 years). All cases resulted from severe initial trauma, which had occurred on average 15.5 months previously. Four patients had extrinsic and 18 had mixed contractures ; 13 had heterotopic ossifications. Operative complications included two peroperative joint instabilities and 3 transient nerve palsies. Seven elbows were remobilized under anaesthesia, one month after the arthrolysis. Twenty-two patients could be reviewed, on average 56 months after the arthrolysis. Seventy seven percent of the patients were satisfied. At final follow-up, the average arc of flexion-extension was 95° ± 15°( average flexion 120° ± 13°, average flexion contracture 31° ± 6°), with a mean improvement of 51° relative to the preoperative range (p < 0.001). The average arc of forearm rotation at final follow-up was 151° ± 23°, with a mean improvement of 41° (p < 0.05). No patient suffered persistent weakness or instability. The average VAS was 5/10, the average MEPI score 76, with 6 excellent, 6 good, 6 fair and 4 poor results, mainly because of persisting pain. The average DASH score was 31.6 and the average SF-36 was 66. Significant correlations were observed between VAS and DASH, MEPI and SF-36. This series demonstrates that open arthrolysis may restore acceptable elbow motion in young active patients presenting with elbow stiffness following major trauma. However, full restoration of motion is rare ; only 18% of the patients regained the functional arcs of motion reported by Morrey, but the majority were satisfied, given their preoperative degree of elbow stiffness. The ultimate result from both the patient's and the surgeon's perspectives is strongly dependent on persisting pain, which was frequent in this series and influenced the DASH, MEPI and the SF-36 scores. Arthrolysis did not address the issue, if pain was the chief complaint.
Journal of Clinical Orthopaedics and Trauma, 2021
Stiffness is a sequelae of elbow trauma. Arthrolysis may be considered to increase range of movement (ROM). Little is published on the outcomes/complications of elbow arthrolysis. We present our series of primary open arthrolysis in posttraumatic elbow stiffness. Methods: A consecutive series of patients that underwent primary open arthrolysis for posttraumatic elbow stiffness in our unit (2011e2018) were analysed. All procedures were performed by an elbow surgeon. Postoperative rehabilitation followed protocol with early motion; continuous passive motion (CPM) was utilised if requested. Data collected included patient demographics, traumatic injury type, arthrolysis technique, preoperative, intraoperative and postoperative elbow ROM, complications and postoperative Oxford Elbow Score (OES). Results: 41 patients were included. 59% were male. Mean age at time of arthrolysis was 43 years (range 12e79 years). Mean duration of follow-up was 53 months (range 8e100 months). Median duration from time of injury to arthrolysis was 11 months (range 2e553 months). Mean preoperative flexion-extension arc (FEA) was 70 , improving to 104 postoperatively (p < 0.001). Mean preoperative pronosupination arc (PSA) was 125 , improving to 165 postoperatively (p < 0.001). Mean postoperative OES was 37 (n ¼ 28). Complication rate was 24% with 7 recurrence requiring surgery, 2 nerve injuries and 1 infection. CPM, 10 patients, saw mean FEA improvement of 56. Mean PSA improvement was 36. Complication rate for these patients was 40%. Severe traumatic injury was associated with increased preoperative stiffness (FEA 61 vs 84 , PSA 111 vs 149) but larger improvements in ROM (postoperative FEA 98 [p < 0.001], PSA 165 [p < 0.001]). Conclusion: This series demonstrates improvement in elbow ROM following open arthrolysis with significantly higher gain in pronosupination for those withsevere injury. Moderate results were seen in a patient reported outcome measure. Patients considering arthrolysis should be counselled regarding expectations/complication rate.
Posttraumatic contracture of elbow treated with intraarticular technique
Archives of Orthopaedic and Trauma Surgery, 2003
Background: Posttraumatic contracture of the elbow (either flexion or extension) is sometimes very disabling. However, an absolutely convincing surgical technique has not yet been defined in the literature. We developed an intraarticular technique to concomitantly treat both intraarticular and extraarticular lesions with one posterior incision. Methods: Twenty consecutive adult patients were treated. After the olecranon was osteotomized, all intraarticular pathologies and the anteroposterior capsule were corrected completely. The olecranon was then stabilized with the modified tension band wiring technique. Immediately postoperatively, continuous passive movement was performed, and range-of-motion exercise of the elbow was encouraged continuously. Results: All 20 patients were followed up for a median of 3.8 (range 2.1-6.6) years. The satisfactory rate was 95% (19 of 20, p<0.001). The flexion contracture improved from an average of 42 to 13 deg (p<0.001), and the maximal flexion improved from an average of 89 to 131 deg (p<0.001). The arc of motion improved from an average of 47 to 118 deg (p<0.001). The sole unsatisfactory patient still had 20-110 deg of arc of motion. There were no evident complications noted. Conclusion: Compared with other techniques, we recommend this one due to its high satisfactory rate and low complication rate.
Open arthrolysis versus arthroplasty in the treatment of posttraumatic elbow stiffness
Romanian Journal of Rheumatology
Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only on...
Open Arthrolysis for a Stiff Elbow because of an unusual Etiology
We present a study of open arthrolysis of the elbow for Elbow stiffness due to an unusual aetiology. The range of movement of the elbow, pain scores and functional outcomes were recorded pre-and postoperatively. An improvement in the mean range of movement from 70° (0° to 95°) to 110°(55° to 135°) was obtained in our patients at one year. On the basis of this study, we believe that the results of open arthrolysis for posttraumatic stiffness of the elbow are durable over the medium term. INTRODUCTION In the Elbow Joint because of the presence of three articulations with a single synovial tissue lined capsule and close proximity of the joint capsule to the ligaments and extracapsular muscles and the intrinsic congruity of humeroulnar articulation predispose it to stiffness. The position of minimal intra articular pressure and maximum compliance of normal elbow (resting position) is 70 degrees. If the elbow is immobilized in this position for an extended period of time, the risk of elbow joint capsule, contracture might increase.
Functional Outcomes of Arthroscopic Capsular Release of the Elbow
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2006
Purpose: Elbow contracture is a common and difficult problem to manage. The purpose of this study was to determine the functional outcomes of arthroscopic capsular release in the management of elbow contractures. Methods: A total of 22 patients (14 males, 8 females; mean age, 42 years) undergoing arthroscopic contracture release were retrospectively reviewed at a minimum follow-up of 1 year (mean, 25 months). In all, 20 patients had a capsulectomy, and 2 underwent capsulotomy. Patient-rated questionnaires (Disability of the Arm, Shoulder, and Hand questionnaire [DASH], American Shoulder and Elbow Surgeons Elbow Form [ASES-e], and Short Form-36 [SF-36]) and clinical, radiographic, and objective evaluations were used to assess outcomes. Motion and strength were measured by independent evaluators through standard goniometry and the LIDO Isokinetic System (Loredan Biomedical, West Sacramento, CA). Results: Mean flexion significantly improved from 122° ± 15° to 141° ± 12° (P < .001). Mean extension significantly improved from 38° ± 18° to 19° ± 13° (P < .001). Mean arc improvement was 38° ± 23° (P < .001). None of the patients had instability, and no major neurovascular complications were reported. All patients had improved elbow function with a mean ASES-e score of 31 out of 36. Most patients were satisfied with their surgery, experienced minimal pain, and exhibited minimal impairment on the DASH. Conclusions: Arthroscopic debridement and capsulectomy of the contracted elbow is effective. Results are comparable with those of other reports in the literature in which both arthroscopic and open methods were used. Level of Evidence: Level IV.
Analysis of Long-Term Outcomes Following Surgical Contracture Release of the Elbow: A Case Series
Cureus
Background Elbow contracture is a debilitating condition with an incidence ranging from as low as almost 1% to as high as 20% and results in significant limiting consequences on a patient's activities of daily living (ADLs). Postoperative rehabilitation is important in maintaining the range of motion and sustaining an improved range of motion. The purpose of this study was to evaluate the long-term results of elbow contracture release surgery and the effect of an occupational therapy/physical therapy (OT/PT)-guided, self-directed rehabilitation program following surgery, without the use of continuous passive motion (CPM) devices. Methods We enrolled patients who had undergone elbow contracture release surgery from 2005 to 2016 at a single institution under the senior author. The evaluation included objective measurements of range-of-motion, strength, and neurological sensory testing. Provocative testing of the elbow and hand was performed. American Shoulder and Elbow Surgeons-elbow (ASES-e), Simple Shoulder Test-elbow (SST-e), Disabilities of the Arm and Shoulder (DASH), Mayo Elbow Performance Index (MEPI), Short Form-36 (SF-36), and an investigator questionnaire were completed. Results We enrolled 19 patients, six female and 13 male, with an average follow-up of 58.9 months (SD± 39.8, Range 22-117). We showed improvement and sustained motion between preoperative and postoperative research visit flexion (p<0.001) and flexion extension-arc (p<0.01). The mean increase in flexion was 98° to 131° and the flexion-extension arc was 36°. Patients were satisfied with the decision to undergo surgery and had sustained ability to complete ADLs. Discussion This patient cohort demonstrated a statistically significant increase, as well as long-term maintenance in the flexion and flexion-extension arc. A self-directed, OT/PT-guided, therapy program without CPM was effective. Patients showed good outcomes and were satisfied with their ability to perform ADLs, decreased pain, and the decision to undergo surgery.
Archives of bone and joint surgery, 2015
Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US. An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis) and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular). Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries. Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable...