Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up

Abstract

Background: Elbow 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 methods: In 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.

Results: In 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.

Conclusions: Elbow 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 evidence: Level IV-case series.

Keywords: Elbow arthroscopy; Osteochondritis dissecans; Pediatric; Posterior impingement; Posttraumatic stiffness.

Fig. 1

Intraoperative arthroscopic pathological findings. Intraoperative arthroscopic pathological findings. a loose bodies identified during arthroscopic exploration of the joint cavity. b Some loose bodies removed from the anterior and the posterior compartments during the procedure. c, d extensive arthrofibrosis involving the radiocapitellar joint and the medial joint compartment (humeral trochlea)

Fig. 2

Patient satisfaction after elbow arthroscopy (five-level Likert scale). Reported patient satisfaction after elbow arthroscopy using five-level Likert scale (follow-up 60 months). No one was dissatisfied with the procedure, three patients were neutral, six were satisfied, and 17 were very satisfied after elbow arthroscopy

Fig. 3

Preoperative and postoperative sport activities of the study population. Reported sport activities before and after elbow arthroscopy (follow-up 60 months). Preoperatively, 23 patients practiced several kinds of sports as presented in Table 1 and only three patients practiced noncompetitive sport activities (hobbies). Postoperatively, 20 patients involved in competitive sports continued their activities, two patients changed their disciplines, and one was unable to return to sport. The three patients who practiced noncompetitive sports continued their activities

Fig. 4

Full elbow range of motion after arthroscopy. Postoperative ROM improvement achieved after arthroscopy by one of our young athletes, with complete arc of flexion (b) and extension (a)

Fig. 5

Heterotopic ossifications on X-ray examination. X-ray examination with heterotopic ossifications findings around both lateral and medial condyles (a, b)