gms | German Medical Science

Objective: Aim of this prospective study was to assess indications of the elbow arthroscopy in surgical treatment of posttraumatic changes of the elbow joint and to evaluate early functional and radiographic results of this technique.

Method: In the period from February 2010 to February 2013, there were performed 14 arthroscopies of the elbow joint in 14 patients in average age of 40 years (20-67). Indications for arthroscopy were consequences of intraarticular fractures in 5 cases, of forearm dislocation in 1 case, of severe contusion of the elbow joint in 4 cases and consequences of complex injury of the elbow in 4 cases. Surgery was performed on average 11 months after initial trauma (2-48 months), average follow-up was 12 months (6-25). Outcomes were assessed on the basis of radiographic (X-ray, CT) and functional scoring systems (Mayo Elbow Performance Score and Hospital For Special Surgery Score).

Results and conclusion: Preoperative range of motion of the elbow joint was 118°/33° (145°-90°/60°-5°), perioperatively it was improved to 131°/5° (150°-90°/15°-0°), which means improvement of 13°/28° (150°-90°/60-0°). Final stabilised range of motion was 126°/16° (145°-90°/70°-0°). Final improvement of ROM after follow up was 8°/17° (45°-0°/50°-0°), which means improvement of 25° compared to pre-surgical levels. X-ray finding was stable in 11 patients (79 %). Final functional outcomes were 89 points (55-100) for MEPS score and 88 points (50-100) for HSS score with average improvement of 19 points in MEPS and 16 points in HSS score.

In accordance with other authors, we have found that the improvement of the range of motion and of functional outcomes correlates with severity of posttraumatic changes of the elbow joint. Residual motion limitation is always present. Patients after complex injuries and displaced intraarticular fractures have achieved worse outcomes, which were also correlating with severity of primary injury. Patients with longer interval from primary injury to surgical treatment and patients with more severe types of injury have developed higher grade of osteoarthritis, higher grade of stiffness of the elbow joint, worse functional outcomes and smaller improvement of final range of motion.

Our results confirmed that the elbow arthroscopy is a safe and reliable procedure for treatment of mild and moderate grade of intrinsic posttraumatic stiffness of the elbow. This method cannot be recommended for treatment of high-grade intrinsic posttraumatic stiffness or an extrinsic stiffness of elbow joint. Improvement of the range of motion that was achieved perioperatively was not fully sustainable in long term, but nevertheless this method does eliminate pain and significantly improves final functional results.