Definition and indication of elbow arthrolysis::
The purpose of articular release surgery of the elbow, also called elbow arthrolysis, is to “unlock” the elbow: to give a stiffened joint some mobility back.
Stiffening implies a loss in mobility that may affect either the flexion-extension range or the prono-supination range, or both concurrently. Elbow stiffness can result from a disease (Osteoarthritis, osteochondritis), or an operated or unoperated injury (fracture, sprain, luxation) as the oedema and hematoma of the injury contribute to adhesions, which contribute to elbow stiffness.
Arthrolysis is unfortunately frequent for the elbow joint, which is the joint for which stiffening is the most rapid.
This is why the treatment of elbow injuries involves the earliest possible mobilization.
Compared with open arthrolysis, arthroscopic joint release surgery on the elbow allows faster motion range restoration, reducing pain and making bandaging a lot simpler.
Video of anterior elbow arthrolysis:
Surgical technique for arthroscopic arthrolysis:
When stiffness persists despite elbow rehabilitation, articular release surgery, which surgeons call elbow arthrolysis, is justified.
CT arthrography of the elbow is a prerequisite for this procedure; this diagnostic examination makes it possible to identify precisely the anatomical elements causing “catching”: adhesions on joint capsule and/or bony sources of impingement (filling of fossa). Arthroscopic elbow surgery will then consist in removing the elements causing stiffness (capsulectomy or burring out of bone structures).
Surgery is performed with the patient in a lateral decubitus position under regional anaesthesia (arm anaesthesia: from the shoulder down to the hand). The optics (camera) is introduced anteriorly first, allowing the causes of elbow stiffness to be assessed. Usually, introducing the optics is difficult due to the reduced size of the elbow's joint; the surgeon’s experience easily overcomes this. An instrumental portal can then be opened so as to section the anterior articular capsule or even excise it, taking care not to damage the nerves.
Any anterior bony blocks in the elbow (ossification of the olecranon process, ossification of the coronoid fossa) can then be removed with the burr of the shaver.
Once the stage of anterior elbow arthrolysis is complete, the resulting gain in range of motion can be assessed. If elbow stiffness remains and articular motion range is still limited, a second stage consisting in posterior elbow arthrolysis is possible. .
For this posterior arthroscopic surgery of the elbow, the arthroscope (camera) is introduced through the postero-lateral portal to assess ossification of the olecranon’s tip and possible congestion of the olecranon fossa. Adhesions of the elbow and soft tissues filling the fossa can be removed with a viper and then a surgical shaver. Bone spurs (calcification) are removed with a bur.
Elbow stiffness is often associated with intra-articular loose bodies, and this surgery facilitates the removal of these foreign bodies. Neurolysis surgery with or without transposition of the ulnar nerve at the elbow can also be performed depending on the preoperative examination.
The incisions are closed with absorbable sutures.
Mobilization will begin immediately during and after surgery.
Recovery and recuperation of the elbow after surgical arthrolysis
Elbow rehabilitation is essential and determines the quality of the final result. Rehabilitation starts on the day of surgery, just after the procedure, with early mobilization of the elbow by continuous passive motion (CPM) of the elbow.
To facilitate rehabilitation, the arm and the elbow will be kept under prolonged anaesthesia for nearly 24 hours.
Given this early mobilization, the elbow's bandages will be replaced every day. Daily rehabilitation sessions will be given at home. Postural splinting can be kept between the rehabilitation sessions to preserve as much as possible the range of motion gained in the target area, which is usually extension. Most daily life movements resume immediately. Allow 3 months to resume forceful activities with the elbow.