Abstract
Restoration of motion in a stiff elbow is complex, time-consuming, and costly. Traditionally, a stiff elbow has been defined as having less than 100 degrees of motion arc in the pronosupination and flexion-extension plane. However, this definition may not be sufficient and accurate anymore. Stiff elbow is often underestimated because the traditional belief is that the elbow is not a weight-bearing joint. However, recent studies have shown that the elbow bears loads created by gravity and muscle contraction, and stiffness of the elbow increases load-bearing during resting and arm swing motion.
Stiffness of the elbow can be caused by intrinsic and extrinsic components, which can later be mixed. If degeneration is the background of the disease, then the bony component is more dominant. At the same time, if post-traumatic is the background of the disease, then the soft tissue component is more dominant. Limitations of flexion are usually caused by a bony block in the anterior compartment and soft tissue contracture in the posterior part. On the other hand, a limitation in extension is usually caused by a bony block in the posterior compartment and soft tissue contracture in the anterior part.
Treatment of the stiff elbow ranges from debridement surgery to reconstruction surgery. Arthroscopic osteocapsular arthroplasty is one of the options for treating a stiff elbow. However, it has its challenges, such as a steep learning curve, limited working space, and limited indication in a stiff elbow with advanced-stage elbow osteoarthritis. It benefits patients because of less pain and less intra-articular bleeding, with the premise for early exercise and rapid return of function. During an arthroscopic osteocapsular release, release to the medial collateral ligament can improve flexion. However, good visualization during MCL release is mandatory to avoid ulnar nerve injury and perform adequate release. Prophylactic ulnar nerve release prior to arthroscopic osteocapsular release is recommended for patients with less than 90 degrees of preoperative elbow flexion. Arthroscopic osteocapsular release provides the same functional score compared to open osteocapsular release in primary elbow OA with a stiff elbow. However, the open group can expect a greater flexion arc due to better visibility during the MCL procedure. Arthroscopic osteocapsular release for post-traumatic stiff elbow showed better range of motion gain in extra-articular fracture cases compared to intra-articular fracture cases.
Stiff elbow is challenging, and arthroscopic limitations are especially significant for severely limited flexion motion cases or advanced cases. Arthroscopic management should be avoided if the anatomy is distorted.