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Prospektive 1‑Jahres-Ergebnisse der arthroskopischen Arthrolyse des Ellenbogens

Prospective short-term results of arthroscopic elbow arthrolysis

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Zusammenfassung

Hintergrund

Die arthroskopische Arthrolyse ist ein minimal-invasives, jedoch anspruchsvolles Therapieverfahren bei Ellenbogensteife. Die prospektive klinische Datenlage hierzu ist begrenzt.

Ziel der Arbeit

Ziel war es, klinische Kurzzeitergebnisse nach arthroskopischer Ellenbogenarthrolyse prospektiv zu analysieren und Einflussfaktoren auf das Outcome zu evaluieren.

Material und Methoden

Es wurden 28 Patienten nach arthroskopischer Arthrolyse eingeschlossen. Präoperativ, 6 Wochen und 12 Monate postoperativ wurden der VAS-Score (visuelle Analogskala), der Bewegungsumfang (ROM) und der DASH-Score erhoben. Das Patientenalter betrug 50 ± 14 Jahre. 16 Patienten waren männlich, 12 waren weiblich. Die Ellenbogensteife war in 15 Fällen posttraumatischer Genese, Folge einer primären Arthrose in 10 Fällen und bei 3 Patienten Folge sonstiger Pathologien. Der Arthrosegrad nach Broberg/Morrey betrug 0 in 1 Fall, 1 in 7 Fällen, 2 in 9 Fällen und 3 in 11 Fällen.

Ergebnisse

Der VAS-Score betrug präoperativ 5,3 ± 2,4 Punkte und verringerte sich auf 2,8 ± 2,7 Punkte nach 6 Wochen und 1,6 ± 1,8 Punkte nach 12 Monaten (p ≤ 0,001). Der ROM verbesserte sich von 86°± 30° auf 106°± 28° nach 6 Wochen und 121°± 18° nach 12 Monaten (p ≤ 0,01). Der DASH-Score verbesserte sich von 39,3 ± 17,8 Punkten auf 23,8 ± 15,7 Punkte nach 6 Wochen und 11,3 ± 8,7 Punkte nach 12 Monaten (p ≤ 0,001). Geschlecht, Alter, Arthrosegrad und Ursache der Ellenbogensteife stellten keine prädiktiven Faktoren für das Outcome dar. 2 Komplikationen (7 %) wurden beobachtet.

Diskussion

Die arthroskopische Arthrolyse stellt eine effektive Behandlungsmethode bei Ellenbogensteife dar, die unabhängig von Geschlecht, Alter, Arthrosegrad und Genese den Bewegungsumfang erhöht, Schmerzen lindert und so die Funktionalität der betroffenen Extremität verbessert.

Abstract

Background

Arthroscopic arthrolysis is a minimally invasive but technically demanding treatment option for elbow stiffness. Prospective clinical data are limited thus far.

Objectives

The aim was to analyze the clinical short-term results of arthroscopic elbow arthrolysis and to evaluate factors predictive of the outcome.

Materials and methods

28 patients (16 men, 12 women) following arthroscopic arthrolysis were enrolled in this study. The VAS (visual analogue scale) score, range of motion (ROM), and DASH score were obtained preoperatively as well as 6 weeks and 12 months after surgery. Posttraumatic elbow stiffness was present in 15 cases, elbow stiffness was due to primary osteoarthritis in 10 cases and due to other reasons in 3 cases. Osteoarthritis was absent in 1 case, grade 1 osteoarthritis was present in 7 cases, grade 2 in 9 cases and grade 3 in 11 cases according to the Broberg and Morrey classification.

Results

The VAS score was 5.3 ± 2.4 points preoperatively and decreased to 2.8 ± 2.7 points after 6 weeks and 1.6 ± 1.8 points after 12 months (p ≤ 0.001). The ROM increased from 86± 30° to 106± 28° after 6 weeks and to 121± 18° 12 months postoperatively (p ≤ 0.01). The DASH score improved from 39.3 ± 17.8 points to 23.8 ± 15.7 points after 6 weeks and to 11.3 ± 8.7 points 12 months postoperatively (p ≤ 0.001). Sex, age, grade of osteoarthritis and cause of elbow stiffness were not predictive of the clinical outcome. Complications were seen in 2 patients (7 %).

Conclusions

Arthroscopic arthrolysis represents an effective treatment method for elbow stiffness, which increases the range of motion, decreases pain levels and thus improves the functionality of the affected extremity regardless of sex, age, severity of osteoarthritis and etiology of elbow stiffness.

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Authors and Affiliations

  1. Schwerpunkt für Unfall-, Hand- und Ellenbogenchirurgie, Universitätsklinik zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    Michael Hackl,  Kilian Wegmann,  Tim Leschinger, Alexander Borda &  Lars Peter Müller

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  1. Michael Hackl
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  2. Kilian Wegmann
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  3. Tim Leschinger
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Correspondence to Michael Hackl.

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Interessenkonflikt

M. Hackl, K. Wegmann, T. Leschinger, A. Borda und L.P. Müller geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Hackl, M., Wegmann, K., Leschinger, T. et al. Prospektive 1‑Jahres-Ergebnisse der arthroskopischen Arthrolyse des Ellenbogens. Obere Extremität 11, 172–177 (2016). https://doi.org/10.1007/s11678-016-0367-z

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