[Elbow arthroscopy in the surgical treatment of post-traumatic changes of the elbow joint]

The aim was to determine indication criteria for use of arthroscopy in the treatment of post-traumatic changes in the elbow joint, to present the surgical technique and to evaluate the results of a prospective study involving early follow-up of functional and radiographic outcomes of this treatment.

Between February 2010 and February 2013, arthroscopic surgery was carried out on 14 elbows in 14 patients at the Clinic of traumatology of Masaryk hospital in Ústí nad Labem. The group comprised seven men and seven women, with an average age of 40 years (range, 20 to 67 years). The indications for elbow arthroscopy included conditions after intraarticular fractures in fie, elbow dislocation in one, severe elbow contusion in four and complex injury to the elbow joint in four patients. Arthroscopic surgery was performed at an average of 11 months after the primary injury. The prospective follow-up lasted for an average of 12 months (range, 6 to 25). The outcomes of surgery were evaluated on the basis of radiograms and multiplanar reconstructions of CT images, elbow function was assessed using two rating systems, i.e., the Mayo Elbow Performance Score (MEPS) and Hospital for Special Surgery (HSS) score.

The average active range of motion (ROM) at the elbow joint was 118°/33° (145°-90°/60°-5°) before surgery and improved to 131°/5° (150°-90°/15°-0°), i.e., by 13°/28° (150°-90°/60°-0°) intra-operatively. The average fial value of elbow ROM after functional stabilization was 126°/16° (145°-90°/70°-0°), which means improvement by 8°/17° (45°-0°/50°-0°) or a total of 25°. On post-operative radiograms, the fidings were stable in 11 (79%) patients; elbows in three patients (21%) showed progression of degenerative changes (osteophyte formation and periarticular ossifiation). The fial functional scores, as assessed using the MEPS and HSS score systems, were 88.93 (55-100) and 88.29 (50-100) points (average/ range), respectively.

The study showed, in agreement with other authors' reports, that the degree of improvement in active range of motion and functional performance of the elbow is directly related to the severity of post-traumatic conditions. A certain residual ROM restriction usually remains. The outcome was poorer in patients with complex injuries of the elbow or in those with displaced intra-articular fractures of the joint and was also related to the severity of joint injury. Patients who were treated after a longer injury-to-surgery period and who suffered a more serious joint injury had more advanced arthritis, higher degree of joint contracture, worse pre-operative functional scores and less improvement in post-operative ROM of the elbow joint.

From the results of early functional assessments and radiographic fidings it can be concluded that the elbow joint arthroscopy is a safe and reliable technique to treat post-traumatic conditions caused by intrinsic factors in mild and moderate elbow stiffness. However, this method cannot be recommended in severe stiffness of the elbow or in stiffness due to extrinsic causes. Although the improvement in ROM achieved during the surgical procedure cannot be maintained in its full extent, this technique relieves persisting pain and signifiantly improves ROM of the elbow joint.