Pediatric elbow arthroscopy: indications and safety

Andelman, Steven M.; Meier, Kristen M.; Walsh, Amanda L.; Kim, Joung Heon; Hausman, Michael R.

doi:10.1016/j.jse.2017.07.005

Cited by 18 publications

(20 citation statements)

References 13 publications

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“…A failed trial of non-operative therapy is a strong indication for performing a surgical release [ 2 – 4 ]. Depending on the operating surgeon’s expertise level in elbow arthroscopy, status of the ulnar nerve, formation and location of HOs, extent of the contracture, and articular surface damage, arthroscopic techniques may be preferred to relieve simple contractures [ 23 , 24 ]. Therefore, an open arthrolysis is the most commonly reported, traditional treatment method [ 2 , 25 , 26 ], using which, a mean ROM of 103° (Range: 85°–129°) and a mean gain of 51° (Range: 38°–60°) have been achieved, with a mean complication rate of 23% (Range: 0–59%), as reported in a systematic review of 637 operated patients across 21 different studies [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Sun

Cui

Liang

et al. 2019

BMC Musculoskelet Disord

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BackgroundFollowing trauma, the elbow is the most susceptible to restricted motion among all joints. Open arthrolysis is often performed for post-traumatic elbow stiffness if that stiffness does not improve with non-operative management. However, the optimal timing for performing an open arthrolysis remains controversial. The purpose of this study was to compare the outcome (elbow motion and function) and the rate of complications among patients who had undergone early, median and late release procedures to establish an optimal time interval following the injury, after which, an effective open arthrolysis can be performed.MethodsIn this retrospective cohort study, we included total 133 patients, who had undergone open arthrolysis for post-traumatic elbow stiffness. The subjects were divided into 3 groups, with 31 patients in the early release group (arthrolysis performed at 6–10 months after injury), 78 patients in the median release group (at 11–20 months), and 24 patients in the late release group (at > 20 months). The release procedure in all patients was performed by the same surgeon, using the same technique. The general data, functional performance, and complications, if any, were retrospectively documented for all patients and statistically analysed.ResultsThe demographic data and disease characteristics of all patients were comparable at baseline. Postoperatively, no significant differences were found among the three groups with respect to the range of motion (p = 0.067), Mayo Elbow Performance Score (p = 0.350) and its ratings (p = 0.329), visual analog scale score for pain (p = 0.227), Dellon classification for ulnar nerve symptoms (p = 0.497), and each discrete complication (all p values > 0.05).ConclusionsAt the final follow-up, our results showed no significant difference in the postoperative elbow motion capacities, functional scores and the rates of complications among patients who had undergone an early, median, and late release. Therefore, we have recommended that an early arthrolysis would be preferable due to its multiple advantages, and the conventionally observed interval of > 1 year after the injury, could be shortened.Level of evidenceLevel III; Retrospective Cohort Design; Therapeutic Study.

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Section: Discussionmentioning

confidence: 99%

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Sun

Cui

Liang

et al. 2019

BMC Musculoskelet Disord

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“…For surgeons, the approach in pediatric elbow joints is more challenging than in adults. 1,[11][12][13][14] Because the position of the major neurovascular and size of elbow joints varies with age and growth, it is difficult to quantify the entry of portals in this patient population. In addition, although the lateral and medial epicondyles are used as bony landmarks in the general elbow scope, they can be difficult to identify because the formation of the ossification center varies with age.…”

Section: Discussionmentioning

confidence: 99%

“…With the advancement of experience, techniques, and instrumentation, elbow arthroscopy has emerged as a safe and effective option to treat patients with a wide range of acute and chronic elbow pathologies. 1 Previously, the role of elbow arthroscopy was primarily limited to treating patients with osteochondritis dissecans (OCD). 2 Given the minimally invasive nature of arthroscopic treatment for elbow pathology, pediatric patients stand to benefit from an expanded role of elbow arthroscopy by avoiding the complications and large dissections associated with open techniques.…”

Section: Introductionmentioning

confidence: 99%

“…2 Given the minimally invasive nature of arthroscopic treatment for elbow pathology, pediatric patients stand to benefit from an expanded role of elbow arthroscopy by avoiding the complications and large dissections associated with open techniques. 1 However, arthroscopic procedures of the elbow are challenging due to the intimate relation between nerves, vessels, and capsule, as well as portal sites and narrow joint space. 3,4 Iatrogenic nerve injury is one of the most common, and most serious, complications in elbow arthroscopy.…”

Section: Introductionmentioning

confidence: 99%

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Proper elbow arthroscopy portal placement in pediatric and adolescent patients

Yoo

Kim

Jung

et al. 2018

Journal of Orthopaedics

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We sought to evaluate proper elbow arthroscopy portal placement in pediatric and adolescent patients. Overall, 109 pediatric and adolescent patients who underwent elbow arthrography were included. Condylar width was measured and the proximal anterior joint capsule location was determined using the ulna-capsular distance. Condylar width and Bone mass index(BMI) also had a high positive correlation coefficient with the proximal joint capsule location. Proximal ulnar border is recommended new bony landmark in pediatric and adolescent patients who undergo elbow arthroscopy. In particular, condylar width and BMI were found to have a high positive correlation with the proximal joint capsule location.

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“…It has been found to have an acceptable safety profile when used by specialist surgeons. [104,105] Andelman reported good outcomes of arthroscopic contracture release in pediatric patients. Contractures were mostly after radial head fracture.…”

Section: Tennis Elbow (Lateral Epicondylitis)mentioning

confidence: 99%

Advances and future trends in elbow arthroscopy

Robinson¹

2020

JASSM

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Elbow arthroscopy has evolved since its inception and is now a commonly used technique in the diagnosis and treatment of elbow pathology. It has many indications, from the removal of intra-articular loose bodies to the management of elbow osteoarthritis and fractures. In this paper, we will discuss the full spectrum of elbow arthroscopy covering recent evidence, surgical techniques, advances, and future trends.

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Pediatric elbow arthroscopy: indications and safety

Cited by 18 publications

References 13 publications

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Proper elbow arthroscopy portal placement in pediatric and adolescent patients

Advances and future trends in elbow arthroscopy

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