Arthroscopic arthrolysis for posttraumatic elbow stiffness (original) (raw)
Related papers
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.
Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1993
Twelve patients with flexion contractures of the elbow were managed by arthroscopic release of the proximal capsule and debridement of the olecranon fossa. Postoperatively the mean flexion contracture improved from 38 to 3 ° with supination improving from 45 to 84 ° and pronation improving from 80 to 88 °. All patients reported a decrease in pain level as well as improvement in motion. There was one severe complication in this series, in which a patient sustained a permanent posterior interosseous nerve palsy. Arthroscopic limited capsular release appears to be satisfactory management modality for flexion contracture of the elbow. Key Words: Elbow--Contracture--Release--Capsule.
Acta Orthopaedica, 2002
We treated 46 consecutive patients (47 elbows) suffering from posttraumatic contracture of the elbow joint with operative release. A lateral approach was used to perform a capsulectomy after release of the extensor muscles in 23 elbows. An additional medial approach was used to excise ulnar adhesions and perform a more extensive capsulectomy and an ulnar nerve neurolysis in 24 elbows. Postoperative rehabilitation consisted of immediate passive range-of-motion exercises. The results were assessed after average 10 (2-18) years.
[Arthroscopic management of the stiff elbow]
Chirurgie de la main, 2006
Elbow stifness has diverse etiologies, the most common being post-trauma. It appears that both arthroscopic and open techniques can achieve satisfactory results when employed properly. Their use is dictated both by the surgeon's level of expertise and an accurate preoperative assessment. When the release is done arthroscopically, collateral ligament stability is not compromised and morbidity from surgical dissection is minimized. The technique of arthroscopic release is described with all steps and difficulties. Arthroscopic capsular release is a technically demanding procedure that requires meticulous attention to detail and should only be attempted by surgeons with extensive experience in elbow arthroscopy.
The Outcome of Elbow Release Surgery in Patients with Elbow Stiffness Caused by Different Etiologies
Shafa Orthopedic Journal
Background: Elbow stiffness is a debilitating condition with different etiologies including trauma, head injury, and burns, which seriously interferes with the patient's daily activities. Objectives: Here, we aimed to report the outcome of elbow release surgery in patients with elbow stiffness caused by different etiologies. Methods: In a retrospective study, the outcome of surgery was evaluated in 18 patients with elbow stiffness. The indication for surgery was the functional loss of elbow range of motion that failed at least six months of conservative management. Elbow range of motion was evaluated before and after the surgery. Mayo elbow performance score (MEPS) was used to assess elbow function at the final follow-up session. Results: The mean follow-up period of the patients was 4.5 ± 2.6 years, ranging from 2 to 10 years. The etiology of stiffness was trauma in 11 cases, central nervous system injury in six patients, and burns in one patient. The mean pre-operative supination, pronation, and flexion arc improved by 15.3°, 20.9°, and 62.2°at the final follow-up evaluation, respectively (P = 0.028, P = 0.008, and P < 0.001, respectively). The mean MEPS of the patients was 85 ± 9.1, ranging from 65 to 95. According to the MEPS scores, the functional outcome was excellent in 8 (44.4%) patients, good in 7 (38.9%) patients, and fair in 3 (16.7%) patients. Conclusions: The release of stiff elbow could be regarded as an effective treatment that provides an acceptable gain in the range of motion and considerable improvement of elbow function.
Mid-Term Outcomes of Arthroscopic Treatment in Patients with a Stiff Elbow
Cureus
Introduction Loss of function and pain are the main complaints at the time of hospital admission for patients with a stiff elbow. In this study, we present mid-term radiological and functional results for the use of the arthroscopic release technique in patients admitted to the outpatient clinic with a stiff elbow. Methods A total of 22 patients (six females, 16 males; mean age: 36 years, range: 18 to 56 years) who underwent an arthroscopic intervention for traumatic or non-traumatic stiff elbow and arthrosis between January 2005 and November 2015 were included in the study. All patients started elbow movement after the first day following surgery. Pre-and postoperative radiological evaluations of patients were carried out, in addition to functional evaluation to measure the range of motion of the elbow joint and the Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after surgery. Results The mean follow-up was 28.4 (range: 21 to 118) months. The mean preoperative flexionextension arc of the patients was 89° (range: 0° to 115°), and the mean flexion-extension arc increased to 103.5° (range: 52° to 128°) at the final follow-up visit (p < 0.05). The mean preoperative DASH score was 42.17 (range: 33 to 81), decreasing to 30.35 (range: 9.7 to 41.3) postoperatively (p<0.05). In the final visit, none of the patients were found to require additional surgical interventions for the elbow. Conclusions Arthroscopic release can be considered a safe and effective option to obtain range of motion in joints in post-traumatic stiff elbow cases.
Arthroscopic Treatment of Posttraumatic Elbow Pain and Stiffness
The American Journal of Sports Medicine, 1994
Nineteen consecutive cases of posttraumatic arthrofi brosis of the elbow secondary to a fracture or fracture- dislocation and treated with arthroscopic debridement and manipulation were retrospectively reviewed. All of the patients had pain and stiffness in their elbows, and all had failed a conservative therapy program. All 19 patients were followed postoperatively for an average of 29 months (range, 12 to 51). One hundred-point scoring systems were used to evaluate subjective (pain, swell ing, locking, and activities) and objective (range of mo tion) results. The average preoperative subjective score of 39 im proved to 91 postoperatively (P= 0.0001); the objective score improved from 46 preoperatively to 81 postop eratively (P = 0.0001). Extension improved from a mean of 29° to 11 °; flexion improved from an average of 123° to 134°. Fourteen patients had limitations in their sports activity preoperatively; 11 were able to return to their preinjury levels of activity after surgery....
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.
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 versus Arthroscopic Treatment of Post-Traumatic Stiff Elbow
Open Journal of Orthopedics, 2014
Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11˚ to 103.94˚. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46˚ to 101.53˚. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthroscopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.