Arthroscopic arthrolysis leads to improved range of motion and health-related quality of life in post-traumatic elbow stiffness

J Shoulder Elbow Surg. 2020 Aug;29(8):1538-1547. doi: 10.1016/j.jse.2020.01.099. Epub 2020 May 4.

Abstract

Background: Post-traumatic elbow stiffness is a frequent and disabling complication after elbow trauma. Surgical release is needed if conservative treatment fails. In contrast to open surgical release, arthroscopic arthrolysis is a good and least invasive option to restore joint mobility. The aim of this study was to evaluate the clinical outcomes, range of motion (ROM), and function of post-traumatic elbow contracture after arthroscopic arthrolysis and to assess health-related quality of life (HRQL).

Methods: Between 2007 and 2013, 44 patients with post-traumatic elbow stiffness were treated by arthroscopic arthrolysis and followed up in a consecutive series. Clinical (ROM) and functional analyses (Disabilities of the Arm, Shoulder, and Hand Questionnaire [DASH], Mayo Elbow Performance Index [MEPI]) were performed at final follow-up 3 (1-7) years postoperatively. Furthermore, HRQL was evaluated (EQ-5D, 36-Item Short Form Health Survey [SF-36]).

Discussion: The average arc of elbow motion increased from 84° ± 28° preoperatively to 120° ± 18° postoperatively. All applied scores significantly improved pre- to postoperatively: the MEPI (59.8 ± 17.3 / 84.3 ± 14.0), DASH (43.5 ± 23.1 / 16.8 ± 15.6), EQ-5D (72.8 ± 16.6 / 84.0 ± 13.6), and SF-36 showed improved results in all categories. Univariate logistic regression revealed that preoperative pain level predicts a poorer postoperative outcome measured with the MEPI score. Revision arthroscopy was needed in 1 case because of persistent pain.

Conclusions: Arthroscopic arthrolysis leads to good clinical and functional results in post-traumatic elbow stiffness regarding ROM, pain relief, functionality, and quality of life. The complication rate as well as the revision rate is very low.

Keywords: Arthroscopic; arthrolysis; elbow; post-traumatic; rigid elbow; stiffness.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arm Injuries / complications
  • Arthroscopy*
  • Contracture / etiology
  • Contracture / physiopathology
  • Contracture / surgery*
  • Elbow / injuries
  • Elbow Joint / physiopathology
  • Elbow Joint / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Diseases / etiology
  • Joint Diseases / physiopathology
  • Joint Diseases / surgery*
  • Male
  • Middle Aged
  • Pain / etiology
  • Postoperative Period
  • Quality of Life
  • Range of Motion, Articular
  • Surveys and Questionnaires
  • Young Adult