Clinical guideline on the open arthrolysis for post-traumatic elbow stiffness in adult patients

Abstract

Background: Post-traumatic elbow stiffness poses significant clinical challenges for upper limb surgeons and severely impairs patients' ability to perform essential daily activities, including eating, dressing, and personal hygiene, thereby imposing substantial socioeconomic burdens. Open arthrolysis is widely employed when conservative therapies fail, yet current literatures demonstrate considerable heterogeneity in treatment concepts, surgical techniques, and perioperative management. This evidence-based clinical practice guideline aims to standardize treatment profiles and improve surgical outcomes for open arthrolysis of post-traumatic elbow stiffness in adult patients globally.

Methods: The Chinese National Center for Orthopaedics (Shanghai and Beijing, China) and Asan Medical Center (Seoul, Korea) initiate, sponsor, and organize a collaboration among worldwide experts in the field of elbow to develop this guideline, adhering to the Reporting Items for Practice Guidelines in Healthcare. Evidence searches focus on meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control studies, and case series studies. The Grading of Recommendations Assessment, Development and Evaluation system and Delphi method process are used to assess the level of evidence and strength of recommendations.

Results: Finally, a total of 28 evidence-based recommendations for open arthrolysis in adult post-traumatic elbow stiffness are formulated in response to 13 most concerned important clinical questions. On the whole, recommendations span 4 domains: (1) Indications/Timing; Q1-Q2, 2 recommendations; (2) Surgical Techniques; Q3-Q8, 15 recommendations; (3) Perioperative Care; Q9-Q11, 8 recommendations; and (4) Complication Prevention; Q12-Q13, 3 recommendations.

Conclusion: This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult post-traumatic elbow stiffness. The recommendations provided herein are grounded in a comprehensive review of existing literatures, and they establish actionable standards for preoperative decision-making, intraoperative techniques, and postoperative care, ultimately hoping to enhance patients' functional recovery and quality of life.

Keywords: Elbow stiffness; heterotopic ossification; joint release; open arthrolysis; rehabilitation; soft tissue contracture.