ARTHROLYSIS OF THE ELBOW: ATHROSCOPIC VERSUS OPEN STUDY OF 139 CASES.

Abstract

Objective: This study compares the results obtained from arthrolysis of the elbow performed arthroscopically with those done open.

Material and Methods: 139 patients from 3 hospitals, who had undergone an arthrolysis of their elbow, were studied retrospectively. 58 had an arthroscopic arthrolysis and 81 were open. The patients included were aged between 18 and 65, had a loss of passive range of motion, due to either osteoarthritis or post trauma. Patients with previous extra articular osteotomy, septic or inflammatory synovitis were excluded. The clinical evaluation comprised measuring their: range of motion, pain, level of activities, presence of effusion or locking. The images obtained were standard radiographs, CT scan and bone scans to allow us to accurately determine the presence of loose bodies, fibrous tissue in the fossae, the presence of osteophytes or arthritis. All data was recorded in preoperative, postoperative and final assessment.

This study also discusses various issues regarding operative techniques (surgical approaches, debridement of joint and capsular releases).

Results: The two groups were similar on all points with the exception of their aetiologies. There was no clinical difference preoperatively. The arthroscopy was performed through 4 portals in 94% of cases; in the open cases the most common approach was lateral (53%). Intra operatively the significant differences were the removal of posterior osteophytes and capsular releases (p< 0.001) were performed more frequently in the open procedure. At the end of the procedure, the flexion and the gain in flexion-extension range was greater in the arthrotomy group; however the arthroscopic group lost less motion from end of procedure to the final result (8 versus 17 degrees). At the last review, the gain in range of motion remained greater in the group with the open arthrotomy. The number of complications in the 2 groups was identical, though the location of any nerve injury was different. The method of rehabilitation was the same; however this was continued for longer in the arthroscopic group. Final radiographic assessment showed that a less extensive debridement of bone was achieved arthroscopically.

Conclusion: A more extensive release and an easier intra operative evaluation resulting in a better improvement in range of motion at the end of procedure are achieved with arthrotomy. The subsequent loss of motion is more significant in this group however the final outcome showed the gain in range of motion remained greater. It was noted however, that even with less improvement in mobility, with either technique, the patients were equally satisfied.