Surgical arthrolysis of the stiff elbow: a systematic review

Abstract

Introduction Stiffness after elbow injuries can severely limit daily life. If adequate conservative treatment does not result in satisfactory improvement of elbow function, surgical intervention should be considered. Whether an open or arthroscopic procedure is preferable is still a topic of debate and a systematic review of functional outcomes is lacking. Materials and methods We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and EMBASE, for studies published between 2013 and 2021. Primary objective was to compare open and arthroscopic arthrolysis’ functional outcomes, respectively, especially ROM and MEPS, as well as the accompanied complications. The PRISMA guidelines were applied. Results 27 studies comprising 1666 patients were included. 1059 patients (63.6%) were treated with open arthrolysis, and 607 patients (36.4%) were treated with arthroscopic arthrolysis. The results presented indicate satisfactory outcomes in open and arthroscopic arthrolysis with regard to functional outcome parameters. Treatment success, defined as excellent or good results according to the Mayo Elbow Performance Score, among the patients treated with an open procedure was 88.8%; 6.3% required revision whereas 18.1% had complications without the need for revision surgery. Within the cohort of arthroscopically treated patients, treatment success was 91.8%. Revisions and complications without further surgical intervention were significantly less frequent than in the open cohort, at 1.6% and 9.1%, respectively. Conclusions Both open and arthroscopic arthrolysis provide good to excellent functional outcomes. Since the number of complications and revision increases with the invasiveness of the treatment, an arthroscopic procedure might be favored if feasible by indication. The role of forearm rotation and the use of a hinged external fixator remains of interest. Study design Level IV; Systematic review.

Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

“…6.3% of patients who underwent open arthrolysis required revision, while 18.1% experienced complications that did not necessitate revision surgery. On the other hand, individuals who underwent arthroscopic treatment had a revision rate of 1.6% and complications without revision of 9.1% [ 27 , 29 ].…”

Management of the stiff elbow: a literature review

“…Both methods yield similar results regarding functional outcomes, treatment success, and arc of motion, while complications and revisions are significantly lower with arthroscopic arthrolysis compared to open arthrolysis ( Table 1 ) ( 32 ). It was critically noted by the authors that arthroscopic arthrolysis has narrower indications than open arthrolysis.…”