Der steife Ellenbogen – Teil 1: Arthroskopische Arthrolyse und deren Grenzen

Background: Loss of elbow motion leads to substantial restrictions in arm function and hence interferes with activities of daily life (especially occupation and sports). Etiologically, elbow stiffness is classified into posttraumatic and degenerative forms and can be caused by intra-articular and/or extra-articular pathologies depending on the structures affected. Material and methods: Over the last years arthroscopic arthrolysis has become the standard treatment of mild to moderate restrictions of elbow motion (range of motion, ROM >60° in extension-flexion plane). In particular, intra-articular pathologies, such as arthrofibrosis, intra-articular loose bodies and osteophytes can be treated during arthroscopy. An additive decompression of the ulnar nerve (open or endoscopic) is recommended if a postoperative improvement of ROM of more than 30° is expected. A well-structured approach is a basic prerequisite in order to address all joint compartments and avoid intraoperative adverse events (e. g. nerve injuries). In general, osseous obstacles are treated before the joint capsule is released. An intensive rehabilitation program consisting of pain therapy and physiotherapy is necessary from the first postoperative day onwards to maintain the intraoperative results and to avoid recrudescence. Results and conclusion: The clinical results of arthroscopic arthrolysis of elbow stiffness have shown promising outcomes with an overall elbow ROM of over 120° that are similar to reports of open arthrolysis. Clinical outcome measures showed good to excellent postoperative scores in mid-term follow-up (improvement of ROM: 30–65°).