Surgical treatments of post-traumatic elbow stiffness: a systematic review and meta-analysis

Surgeons may choose between open vs. arthroscopic arthrolysis to address a post-traumatic elbow stiffness (PTES) based on their proficiency in elbow arthroscopy, the ulnar nerve condition, the presence and location of heterotopic ossification, the degree of contracture, and the extent of articular surface damage. This systematic review and meta-analysis aims to compare the effectiveness, range of motion (ROM), and complication rates between open and arthroscopic release in patients with PTES.

The Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Sciences, Medline, and Scopus from their inception to January 2024. A total of 3,278 records were screened, of which 99 studies on the adult population were included. Outcome variables were changes in the ROM, visual analog scale score, Mayo Elbow Performance Index, and complication rate. Surgical techniques were grouped as arthroscopic, open arthrolysis, and open arthrolysis with external fixator.

ROM, visual analog scale, and Mayo Elbow Performance Index improved in patients with PTES after all surgical techniques. Open arthrolysis with external fixation had the highest ROM improvement but also the highest rate of nerve injury. Other variables did not show statistically significant differences among the modalities.

Since the overall results of open and arthroscopic arthrolysis for PTES are comparable, the surgeon's expertise and the patient's condition are more important factors to consider when choosing a surgical technique over another.