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Review
. 2024 Aug 6;17(6):831-843.
doi: 10.1177/17585732241269807. eCollection 2025 Oct.

Characteristics of rehabilitation protocols following operative treatment of terrible triad elbow injuries and the influence of early motion: A systematic review and meta-analysis

Joseph Larwa  1 , Timothy R Buchanan  2 , Rachel L Janke  3 , Madison Q Burns  4 , Logan Wright  2 , Kevin A Hao  2 , Robert J Cueto  2 , Keegan M Hones  5 , William R Aibinder  6 , Thomas W Wright  5 , Bradley S Schoch  7 , Joseph J King  5
Affiliations
Free PMC article
Review

Characteristics of rehabilitation protocols following operative treatment of terrible triad elbow injuries and the influence of early motion: A systematic review and meta-analysis

Joseph Larwa et al. Shoulder Elbow. .
Free PMC article

Abstract

Background: As no consensus exists on the optimal postoperative rehabilitation protocol in terrible triad injuries, we sought to characterize the reported protocols and relate them to postoperative range of motion (ROM) measures and Mayo Elbow Performance Score (MEPS).

Methods: A systematic review was performed by searching PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles on the operative treatment of terrible triad injuries reporting postoperative rehabilitation protocols were included. Included studies were descriptively summarized. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies criteria. Meta-analysis compared postoperative ROM measures and the MEPS between patients initiating passive ROM exercises at ≤7 days vs. >7 days.

Results: Our review included 36 articles with 1123 elbows (66% male, mean age: 43 years, follow-up: 27 months). Of the studies reporting physical therapy protocols, it was most commonly initiated at 7 days postoperatively (6/36, 17%), passive ROM exercises at 7 days (3/25, 12%), and active ROM at 21 days (4/26, 15%). On meta-analysis, early passive ROM initiation was not associated with improved elbow ROM or MEPS.

Discussion: While rehabilitation protocols commonly advised passive ROM at one week post-operatively, meta-analysis did not support functional benefits of early passive ROM.

Study design: Systematic Review; Level of evidence, 4.

Keywords: Upper extremity; complex elbow fracture dislocation; elbow fracture; physical therapy; rehabilitation; terrible triad.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: K.A.H. has a consultancy agreement with LinkBio Corp. W.R.A. is a consultant for Exactech, Inc. T.W.W. is a paid consultant and receive royalties from Exactech, Inc. B.S.S. receives royalties from Exactech, Innomed and Responsive Arthroscopy. J.J.K. is a paid consultant for Exactech, Inc. and LinkBio Corp. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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