Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

Abstract

Objectives: To evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems.

Methods: A retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery-related complications were assessed.

Results: Patients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow-up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow-up, a mean improvement of 22.5 (range, 0-55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow.

Conclusion: With full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.

Keywords: Arthroscopic arthrolysis; Intra-articular adhesion; Posttraumatic elbow stiffness; Soft tissue contracture.

Fig. 1

The common surgical portal and markings of elbow arthroscopic arthrolysis. ALP, anterolateral portal; DPP, distal posterior portal; PALP: proximal anterolateral portal; PAMP, proximal anteromedial portal; PLP, posterolateral portal; SSP, soft spot portal.

Fig. 2

A 35‐year‐old man before and after capsulectomy. (A) Arthroscopic view of the anterior compartment and capsule. (B) After capsulectomy, the brachialis muscle was exposed. (C) Intraoperative physical exam shows limited passive elbow extension. (D) Passive motion was improved after arthroscopic capsulectomy.

Fig. 3

Posttraumatic elbow stiffness with posterior bundle (PB) contracture in a 35‐year‐old man. (A) Arthroscopic view shows the contracture of PB of medial collateral ligament (MCL), which impairs elbow flexion. (B) The PB was released to improve elbow flexion. (C) Preoperative physical exam shows very limited elbow flexion. (D) Functional recovery at 1 month after arthroscopic elbow release. MCL, medial collateral ligament; PB, posterior bundle

Fig. 4

Sequence of arthroscopic arthrolysis for soft tissue related stiff elbow. (A) Ulnar nerve decompression and posterior capsulectomy. Prophylactic open ulnar nerve decompression was indicated when there was a limitation on elbow flexion. Posterior capsulaectomy (including ulnar–humeral and radial–capitulum joint) was then performed arthroscpically. (B) Posterior bundle (PB) of medial collateral ligament (MCL) release. Passive elbow flexion was examined and PB of MCL was explored after posterior capsulectomy. Once PB contracture was confirmed, this ligament could be released from the origin. (C) Triceps release. If elbow flexion was still limited after posterior capsulectomy and PB release, triceps adhesion needed to be evaluated and released from the dorsal aspect of the distal humerus. (D) Anterior capsulectomy When there is no bone problem, contracture of the anterior capsule is the major restriction for elbow extension. Arthroscopic anterior capsulectomy is a well‐established technique and can greatly improve elbow extension.