This is a retrospective review of 14 patients who underwent arthroscopic elbow release for elbow contracture. Follow- up averaged one year. Pain and range of motion were measured. Diagnoses included trauma involving fracture/dislocations (2), fractures of the radial head (3), fractures of the olecranon (1), and previous pediatric elbow fractures (2). The indications for surgery were failure to progress after a minimum of 6 months of physical therapy. All patients with significant intrinsic disease of the joint were excluded. Of note, the authors did not use a shaver to perform their capsulotomy, but rather a 15º upcutting basket resector in order to minimize inadvertent neurovascular injury due to suction through the capsule. In addition, the authors made a point not to progress past the mid-portion of the olecranon fossa in order to avoid injury to the ulnar nerve. Results demonstrated a mean gain of extension of 26 degrees, and a mean gain of flexion of 15º. The greatest improvement was found in those elbows that had a preoperative flexion arc of less than 80º. The gain in extension was usually greater than the gain in flexion. Functional outcomes and patient satisfaction were excellent.
This study supports the safety and efficacy of arthroscopic elbow release in selected patients. It must be appreciated that it can be much harder to perform arthroscopy on an elbow with a post-traumatic contracture than one without significant capsular involvement and motion loss. The risk of neurovascular injury is greater in these patients and one must carefully manage inflow and fluid used to distend the joint. In this regard, retractors can be helpful. The procedure requires advanced skills in elbow arthroscopy combined with an understanding of the principles of elbow release surgery.
Related Links
Journal of Shoulder and Elbow Surgery