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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Long-term Outcomes Following Arthroscopic Elbow Contracture Release
Christina M Beck, PhD; Matthew J Gluck, BS; Todd A Rubin, MD; Michael R. Hausman, MD
Mount Sinai Medical Center, New York, NY

Introduction Elbow stiffness is common after trauma and/or concomitant upper extremity surgery, and may be addressed by open or arthroscopic means following failed non-operative management. Despite recent advances in elbow arthroscopy, there is a paucity of literature on the role of arthroscopy in the setting of elbow contracture release. The theoretical advantages of arthroscopic treatment of elbow pathology include improved visualization, greater precision due to magnification, and less "collateral damage" to normal tissue, especially critical ligamentous structures. In addition, arthroscopic release affords the ability to begin immediate therapy, which is essential in preventing recurrent contracture.

Methods This is a retrospective case series of 22 patients who underwent arthroscopic elbow contracture release by a single surgeon at our institution from 2003-2014. Patients were included in this study if they presented with elbow stiffness secondary to arthritis or trauma. Congenital cases were excluded from this study. Post-operative outcomes were recorded for all patients with minimum 1 year follow up, including range of motion and DASH scores. All complications and subsequent related procedures were reviewed.

Results The average patient age was 48 years (range 13-70) and average length of follow up was 4.8 years (range 1.5-13 yrs). Elbow stiffness was documented in all patients secondary to osteoarthritis (N=9) or trauma (N=13). Post-operative range of motion following arthroscopic contracture release averaged 19-129 degrees in the flexion/extension arc of motion (range 0-147 deg) and 82 degrees in the prono-supination arc of motion (range 53-98). Twenty one patients completed the DASH questionnaire with an average score of 2426. Four patients underwent reoperation: 1 for hematoma and 3 for subsequent release of recurrent contracture.

Conclusion Arthroscopic treatment for elbow contracture is technically challenging though safe compared with open release. Additionally, outcomes following arthroscopic release offer shorter recovery time, improved wound healing, and lower major complications rates compared with open release as reported in the literature. This study demonstrates good to excellent subjective and objective outcomes at long-term follow up. No major complications were reported in this cohort. Recurrence of elbow contracture following arthroscopic release was uncommon and addressed with subsequent arthroscopic release. All patients were ultimately able to achieve a functional arc of motion in both flexion/extension and pronation/supination.

References

Meislin MA, Wagner ER, Shin AY. A Comparison of Elbow Range of Motion Measurements: Smartphone-Based Digital Photography Versus Goniometric Measurements. J Hand Surg Am. 2016 Apr;41(4):510-515.e1. doi: 10.1016/j.jhsa.2016.01.006. Epub 2016 Feb 13.


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