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Efficacy and Safety of Arthroscopic Contracture Release for Post-Traumatic Elbow Arthrofibrosis in the Pediatric Patient
Steven M. Andelman, MD; Kristen M. Meier, MD, MS; William J. Rubenstein, BS; Joung Heon Kim, BS; Michael R. Hausman, MD
Mount Sinai School of Medicine, New York, NY
Introduction: Post-traumatic elbow contracture is well-documented complication of elbow trauma. Previously, open capsulectomy and contracture release was considered the gold standard of care. More recently, good results have been obtained utilizing arthroscopic capsulectomy and contracture release as a more minimally invasive and less morbid treatment option in the adult population. Currently, there is no published data regarding the outcomes of this procedure in the pediatric population. We present a review of the efficacy and safety of arthroscopic elbow capsulectomy and contracture release for post-traumtic arthrofibrosis in the pediatric population.
Materials & Methods: A retrospective review was performed on patients under eighteen years old who had undergone arthroscopic capsulectomy and contracture release for post-traumatic elbow arthrofibrosis by a single surgeon from 2001-2015. Standard accepted arthroscopic elbow portals and techniques were utilized. Patient demographic information, indication for surgery, pre- and final post-operative range of motion, and any complications were documented.
Results: 26 arthroscopic elbow capsulectomies and contracture releases were performed on 22 patients (22 elbows) for post-traumatic arthrofibrosis. Two patients underwent further staged, planned arthroscopic contracture releases (three in one patient, one in another) thus accounting for the difference between the number of surgeries and the number of patients. The average age was 12.1 years old, 16 patients were male while 6 were female, and the average time to last documented follow-up was 64.8 weeks. The average preoperative flexion-extension and pronation-supination arc of motions were 91.0 +/- 41.9 degrees and 137.2 +/- 61.3 degrees, respectively. At final post-operative follow-up the average flexion-extension arc of motion increased to 130.7 +/- 14.1 degrees, an improvement of 39.7 degrees, while the average pronation-supination arc of motion increased to 155.3 +/- 44.6 degrees, an improvement of 18.1 degrees. The overall complication rate was 30.1% (8/26), with a minor complication rate of 7.7% (2/26) and a major complication rate of 23.1% (6/26).
Conclusion: We report on 22 patients who underwent 26 elbow arthroscopic capsulectomies with contracture release. The average flexion-extension and pronation-supination arc improved 39.7 and 18.1 degrees, respectively. While the overall complication rate of 30.1%, this was not unexpected given the complexity of the pathology with which the patients presented. In conclusion, arthroscopic capsulectomy and contracture release represents a safe, effective, and minimally invasive means by which to treat complex cases of post-traumatic arthrofibrosis in the pediatric population.
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