Abstract
BackgroundElbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up.Materials and methodsIn this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated.ResultsIn the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected.ConclusionsElbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries.Level of evidenceLevel IV—case series.
Highlights
Elbow arthroscopy has only recently developed due to its technical difficulty, the complex joint anatomy, and the proximity of surrounding neurovascular structures [1]
In the study population, we found an improvement in range of motion (ROM) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and visual analog scale (VAS) of 3.8 ± 2.2 points)
Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon
Summary
Elbow arthroscopy has only recently developed due to its technical difficulty, the complex joint anatomy, and the proximity of surrounding neurovascular structures (such as the medial, ulnar, and radial nerves, as well as the brachial artery) [1]. Due to significant advances in arthroscopic technology and equipment, coupled with the expansion of knowledge about joint anatomy and increased experience of orthopedic surgeons, elbow arthroscopy has acquired an increasingly important role in recent years. Given the less invasive nature of arthroscopic surgical techniques, with reduced postoperative pain, lower rate of surgical wound complications, reduced infection risk, and easier postoperative rehabilitation program, surgeons prefer arthroscopic treatment for a wide range of acute and chronic elbow pathologies [2, 4,5,6,7]. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up
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