Arthroscopic Release for the Severely Stiff Elbow

Abstract

Objective: Arthroscopic release for the stiff elbow is widely spreading recently, but no report is published concerning severely stiff elbows. We investigate the outcomes of the arthroscopic release for the severely stiff elbow. Methods: Eleven patients, 11 severely stiff elbows (flexion/extension arc ≤60°), were enrolled in this study, who had surgeries since 2008, mainly performed arthroscopically. They were 5 men and 6 women, and average age at the operation was 49.6 years (21-67 years). Etiologies of the stiffness were 2 posttraumatic stiffness, 4 osteoarthritis, and 5 rheumatoid arthritis. Operation was performed under general anesthesia in the prone position. Under arthroscopy, capsular release, resection of the intra-articular fibrous tissue, osteophyte resection, and partial excision of the radial head were performed. If necessary, mini-open procedure at the medial side was added for the release of the posterior oblique ligament of the medial collateral ligament and the release or the transposition of the ulnar nerve. Partial excision of the radial head was performed mainly in the patients of rheumatoid arthritis, who had pain with crepitus around the humeroradial joint in motion. We followed the patients for an average of 18 months (6-63 months), and investigated range of motion, Mayo Elbow Performance Index, and complications. Results: We performed the anterior capsular release in 8 patients, osteophyte resection in 7 patients, partial excision of the radial head in 5 patients, and the medial open procedure in 4 patients. Range of motion was significantly improved from 89° flexion and −53° extension to 110° flexion and −30° extension, respectively, after the surgery. Pronation was also improved from 56° to 64°. Supination was improved, although not significant, from 50° to 58°. Mayo Elbow Performance Index improved from 60 to 85 points. One case of osteoarthritis showed osteophyte re-formation, and needed open revision surgery 1 year after the initial surgery. There was no neurovascular injury. Another case of rheumatoid arthritis had the severely stiff elbow of 110° flexion, −70° extension, 30° pronation, and 10° supination. She had arthroscopic release including partial excision of the radial head, and the range of motion was improved. For the additional improvement, we had the second arthroscopic surgery 17 months after the initial surgery. Finally, she gained good range of motion; 125° flexion, −40° extension, 70° pronation, and 60° supination. Conclusions: The arthroscopic release is technically demanding, especially in the severe cases, but it may be the promising procedure for the rapid recovery with minimal invasion and the improvement of the range of motion. In the surgery, we need to suppress the complications, using all knowledge of the anatomy and experiences. Additional medial side mini-open procedure is sometimes necessary and effective for good outcomes.