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[Performance control after arthroscopic arthrolysis with capsulectomy in fresh-frozen elbow joints]
R Nietschke1, M M Schneider2,3, B Hollinger2
1Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland. nietschke@sportklinik.de.
Der Unfallchirurg
|November 28, 2018
Summary
Arthroscopic elbow capsulectomy can achieve significant capsule removal but may leave remnants, particularly posteriorly near the ulnar nerve. Careful technique and portal changes are crucial for complete elbow stiffness treatment.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Elbow Biomechanics
Background:
- Post-traumatic or postoperative elbow stiffness, including capsular contracture, limits daily function.
- Arthroscopic arthrolysis with capsulectomy is a treatment option for persistent elbow stiffness.
Purpose of the Study:
- To evaluate the efficacy of arthroscopic capsulectomy in removing elbow joint capsule portions.
- To assess the completeness of capsule removal using an in vitro anatomical study.
Main Methods:
- Standardized elbow arthroscopy with ventral and dorsal capsulectomy was performed on five fresh-frozen elbow specimens.
- Image documentation was used throughout the arthroscopic procedure.
- Open dissection followed to analyze residual capsule and photodocument specimens.
Main Results:
- Anterior and posterior capsule remnants were present in all specimens, irrespective of surgeon experience.
- Dorsal capsule remnants were frequently observed near the dorsolateral camera portal.
- Incomplete posterior capsulectomy occurred near the posterior medial ligament (PML) due to ulnar nerve proximity.
Conclusions:
- Arthroscopic arthrolysis can achieve a high degree of capsule resection, but self-critical assessment is necessary.
- Posterior medial ligament (PML) release via arthroscopy is challenging due to ulnar nerve injury risk.
- Portal modifications may improve visualization and reduce residual capsule, but open techniques may be needed for PML release.
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