Manipulation under anesthesia for posttraumatic elbow stiffness: a propensity score matched retrospective cohort...

Post-traumatic elbow stiffness is a common complication limiting range of motion and function. Open surgical release is invasive and may not improve patient outcomes. Manipulation under anesthesia (MUA) is a less invasive way to break adhesions and restore motion, though high-level comparative evidence is lacking. This study evaluated whether early MUA plus rehabilitation improves elbow motion, pain, and function compared to rehabilitation alone in patients with postoperative elbow stiffness. This retrospective propensity score-matched cohort study included 240 post-ORIF elbow patients (120 receiving MUA at 6-12 weeks post-surgery and 120 matched controls with rehabilitation only) followed for 12 months. All patients underwent a standardized 3-month physiotherapy program; the MUA group also received a one-time elbow MUA under anesthesia followed by immediate rehab. The primary outcome was the percentage of lost elbow motion recovered at 6 months. Secondary outcomes (assessed at 3, 6, and 12 months) included flexion-extension arc, forearm rotation, flexion strength, ASES pain and function subscores, DASH, and EQ-5D-5L. One-year costs were compared, and an incremental cost-effectiveness ratio (ICER) was calculated. Linear mixed-effects models were used for longitudinal analysis (significance p < 0.05) By the 6-month primary endpoint, the MUA group had recovered 5.9% more of the lost elbow motion than controls; this difference further increased to 6.4% by 12 months. MUA patients achieved a significantly greater elbow flexion-extension arc, with an additional 6.1° gain at 1 year compared to rehabilitation alone, although this difference falls below the commonly accepted MCID for elbow ROM. Improvements in forearm rotation were small and not statistically significant. The MUA group reported higher functional scores: ASES function and pain subscores were better by 2.2 and 3.5 points, respectively, at 12 months. Upper-extremity disability and health utility were similar between groups (p > 0.1). Total one-year direct and indirect costs were nearly identical for MUA versus rehabilitation (mean 95,271 vs. 94,583 CNY, p = 0.792). The incremental cost of adding MUA was 688 CNY, yielding an ICER of 108 CNY per 1% of lost motion recovered, indicating that the gains in motion were achieved with minimal added cost. In this propensity-matched cohort, early MUA in addition to rehabilitation was associated with statistically significant but modest improvements in elbow ROM and functional scores compared to rehabilitation alone, without a significant increase in healthcare costs. However, the absolute magnitude of these differences fell below commonly accepted MCIDs, and the clinical relevance of these findings remains uncertain. These results should be viewed as preliminary, and adequately powered randomized controlled trials are needed to determine whether early MUA provides clinically meaningful benefit in this population.