Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up

Abstract

Background Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. Materials and methods In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. Results In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. Conclusions Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. Level of evidence Level IV—case series.

Adolescent elbow osteochondral lesions following prior elbow fracture pinning

“…12,13 Operative treatment of pediatric elbow chondral injuries includes a diverse array of treat ment options ranging from arthroscopy, microfracture, loose body removal, and chondroplasty to osteochondral autograft transfer (OATS), osteochondral allograft trans fer, and autologous chondrocyte implantation (ACI) with and without a matrix. 14 While the age of the patient, size and stability of the lesion, level of overhead activity, and surgeon preference help delineate surgical treatment, stud ies directly contrasting treatment arms have found similar results among operative cohorts. 15,16 While the specific cause of elbow osteochondral lesions may be multifactorial, there is increasing interest in identi fying risk factors for its development.…”