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Der steife Ellenbogen – Teil 1

Arthroskopische Arthrolyse und deren Grenzen

The stiff elbow – Part 1

Arthroscopic arthrolysis and its limitations

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

Eine reduzierte Ellenbogenbeweglichkeit führt zur deutlichen Einschränkung der Armfunktion und so zur Beeinträchtigung der Alltagsaktivitäten (v. a. Beruf, Sport). Ursachen für eine Ellenbogensteife werden ätiologisch in posttraumatisch und degenerativ sowie in Abhängigkeit der betroffenen Strukturen in intrinsisch und/oder extrinsisch eingeteilt.

Material und Methoden

Zur Therapie von milden bis moderaten Bewegungsdefiziten (ROM [„range of motion“] >60°) hat sich die arthroskopische Arthrolyse in den letzten Jahren als Standardverfahren etabliert. Hierbei können insbesondere intrinsische Pathologien wie Kapselfibrose, intraartikuläre Gelenkkörper und osteophytäre Anbauten behandelt werden. Bei einer erwartenden ROM-Verbesserung über 30° ist additiv eine N.-ulnaris-Neurolyse (offen oder endoskopisch) zu empfehlen. Ein strukturierter Arbeitsablauf ist die Grundvoraussetzung, um alle Gelenkkompartimente zu adressieren und intraoperative Komplikationen (z. B. Nervenläsionen) zu vermeiden. Generell gilt der Grundsatz, zuerst knöcherne Hindernisse zu beseitigen und abschließend die dorsale und ventrale Kapsel zu inzidieren/exzidieren. Um das intraoperative Ergebnis zu erhalten und ein Rezidiv zu vermeiden, ist eine intensive Nachbehandlung aus einer kombinierten Schmerz- und Physiotherapie ab dem ersten postoperativen Tag notwendig.

Ergebnisse und Schlussfolgerung

Die klinischen Ergebnisse der arthroskopischen Arthrolyse sind vielversprechend und mit denen der offenen Arthrolyse vergleichbar. Zusammengefasst wird bei suffizienter Operationstechnik ein Zielwert von 120° als Bewegungsausmaß in aktuellen Untersuchungen nach arthroskopischer Arthrolyse erreicht (Verbesserungen der ROM: 30–65°).

Abstract

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°).

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    L. Willinger, L. Lacheta, A. B. Imhoff &  S. Siebenlist

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  1. L. Willinger
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  3. A. B. Imhoff
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  4. S. Siebenlist
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Correspondence to S. Siebenlist.

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Interessenkonflikt

A.B. Imhoff: Berater für medi GmbH und Arthrosurface. S. Siebenlist: Beratertätigkeit für die Firma Arthrex.L. Willinger und L. Lacheta geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Willinger, L., Lacheta, L., Imhoff, A.B. et al. Der steife Ellenbogen – Teil 1. Arthroskopie 32, 248–255 (2019). https://doi.org/10.1007/s00142-019-0271-9

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