1
|
de Klerk HH, Verweij LPE, Sierevelt IN, Priester-Vink S, Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy 2023; 39:2363-2387. [PMID: 37146664 DOI: 10.1016/j.arthro.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To perform a systematic review of complications associated with elbow arthroscopy in adults and children. METHODS A literature search was performed in the PubMed, EMBASE, and Cochrane databases. Studies reporting complications or reoperations after elbow arthroscopy with at least 5 patients were included. Based on the Nelson classification, the severity of complications was categorized as minor or major. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized clinical trials, and nonrandomized trials were assessed using the Methodological Items for Non-randomized Studies (MINORS) tool. RESULT A total of 114 articles were included with 18,892 arthroscopies (16,815 patients). A low risk of bias was seen for the randomized studies and a fair quality for the nonrandomized studies. Complication rates ranged from 0% to 71% (median 3%; 95% confidence interval [CI], 2.8%-3.3%), and reoperation rates from 0% to 59% (median 2%; 95% CI, 1.8%-2.2%). A total of 906 complications were observed, with transient nerve palsies (31%) as the most frequent complication. According to Nelson classification, 735 (81%) complications were minor and 171 (19%) major. Forty-nine studies reported complications in adults and 10 studies in children, showing a complication rate ranging from 0% to 27% (median 0%; 95% CI, 0%-0.4%) and 0% to 57% (median 1%; 95% CI, 0.4%-3.5%), respectively. A total of 125 complications were observed in adults, with transient nerve palsies (23%) as the most frequent complication, and 33 in children, with loose bodies after surgery (45%) as the most frequent complication. CONCLUSIONS Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. Higher complication rates are observed after more complex surgery. The incidence and type of complications can aid surgeons in patient counseling and refining surgical techniques to further reduce the complication rates. LEVEL OF EVIDENCE Level IV; systematic review of Level I-IV studies.
Collapse
Affiliation(s)
- Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands.
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Clinics, Orthopedic Department, Amsterdam, the Netherlands; Department of Orthopaedics, Spaarne Gasthuis Academie, Hoofddorp, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Nick F J Hilgersom
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Guerra E, Marinelli A, Tortorella F, Flöter MDS, Ritali A, Sessa A, Carbone G, Cavallo M. Elbow Arthroscopy for the Treatment of Radial Head Fractures: Surgical Technique and 10 Years of Follow Up Results Compared to Open Surgery. J Clin Med 2023; 12:jcm12041558. [PMID: 36836092 PMCID: PMC9960197 DOI: 10.3390/jcm12041558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND This study aimed to describe the ARIF (Arthroscopic Reduction Internal Fixation) technique for radial head fractures and to compare the results with ORIF (Open Reduction Internal Fixation) at mean 10 years. METHODS A total of 32 patients affected by Mason II or III fractures of the radial head who underwent ARIF or ORIF by screws fixation were retrospectively selected and evaluated. A total of 13 patients were treated (40.6%) by ARIF and 19 patients (59.4%) by ORIF. Mean follow-up was 10 years (7-15 years). All patients underwent MEPI and BMRS scores at follow-up, and statistical analysis was performed. RESULTS No statistical significance was reported in Surgical Time (p = 0.805) or BMRS (p = 0.181) values. Significative improvement was recorded in MEPI score (p = 0.036), and between ARIF (98.07, SD ± 4.34) and ORIF (91.57, SD ± 11.67). The ARIF group showed lower incidence of postoperative complications, especially regarding stiffness (15.4% with ORIF at 21.1%). CONCLUSIONS The radial head ARIF surgical technique represents a reproducible and safe procedure. A long learning curve is required, but with proper experience, it represents a tool that might be beneficial for patients, as it allows a radial head fracture to be treated with minimal tissue damage, evaluation and treatment of the concomitant lesions, and with no limitation of the positioning of screws.
Collapse
Affiliation(s)
- Enrico Guerra
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Tortorella
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Alice Ritali
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Andrea Sessa
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Carbone
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6927
| |
Collapse
|
3
|
Abstract
With advances in the understanding of elbow anatomy, pathologies of the elbow, arthroscopic instrumentation, and surgical techniques over recent decades, elbow arthroscopy has become a valuable treatment modality for a variety of conditions. Elbow arthroscopy has gained utility for treating problems such as septic arthritis, osteoarthritis, synovitis, osteophyte and loose body excision, contracture release, osteochondral defects, select fractures, instability, and lateral epicondylitis. Accordingly, precise knowledge of the neurovascular anatomy, safe arthroscopic portal placement, indications, and potential complications are required to maximize patient outcomes and assist in educating patients. This comprehensive review provides the reader an understanding of the potential complications associated with arthroscopic procedures of the elbow and to describe strategies for prevention and management.
Collapse
|
4
|
Nowotny J, Löbstein S, Biewener A, Fitze G, Kasten P. Elbow arthroscopy in children and adolescents: analysis of outcome and complications. Eur J Med Res 2018; 23:42. [PMID: 30219090 PMCID: PMC6138926 DOI: 10.1186/s40001-018-0338-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Chondral or osteochondral lesions, post-traumatic contracture and loose bodies of the elbow are often associated with chronic pain, stiffness, repetitive swelling and joint blockages. Therefore, arthroscopy of the elbow is often used in the elderly for the treatment of osteochondral defects or arthrolysis. There are only a few reports and studies about arthroscopic therapy of the elbow in children and adolescents. This study assesses the clinical outcome of arthroscopic therapy in this age group. Methods In a retrospective study, children and adolescents who underwent an elbow arthroscopy in the period from 2010 to 2014 were included. The children were evaluated using the validated outcome measures Mayo Elbow Performance Score (MEPS), range of motion, pain on visual analog scale (VAS), Oxford Elbow Score (OES), quick dash and postoperative satisfaction. Furthermore, all complications were analyzed. Results In total, 27 patients were included. The mean (range) age was 14 (11–17) years, with a follow-up of 45 months. Fourteen (52%) were female and thirteen children (48%) were male. Twenty children had an arthroscopy due to osteochondritis dissecans and seven children for post-traumatic pain and stiffness. The mean (standard deviation) MEPS improved from 65 (15) to 96 (8; p = .005). The OES and quick dash were 93 and 5.4. The mean extension improved from − 15° (± 13.8) to 3° (± 10.2; p < .001). The mean flexion improved from 131° (± 13.4) to 137° (± 9.5; p = .003). Average pain on VAS was postoperative .2 (± .5), and 81.5% of all children had excellent or good results. There were no complications such as damage of nerves or blood vessels observed. Conclusion Elbow arthroscopy is an appropriate and safe treatment option in children and adolescents with good and excellent postoperative results.
Collapse
Affiliation(s)
- Jörg Nowotny
- Orthopaedic-Traumatology Centre (OUC), Carl-Gustav Carus University, Dresden, Germany.
| | | | - Achim Biewener
- Orthopaedic-Traumatology Centre (OUC), Carl-Gustav Carus University, Dresden, Germany
| | - Guido Fitze
- Paediatric Surgery, Carl-Gustav Carus University, Dresden, Germany
| | | |
Collapse
|
5
|
Arrigoni P, Cucchi D, D'Ambrosi R, Menon A, Aliprandi A, Randelli P. Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc 2017; 25:2264-2270. [PMID: 28337591 DOI: 10.1007/s00167-017-4531-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/20/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow. METHODS Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated. RESULTS SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up. CONCLUSIONS R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention. LEVEL OF EVIDENCE Retrospective case series, Level IV.
Collapse
Affiliation(s)
- Paolo Arrigoni
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| | - Davide Cucchi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. .,U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
| | - Riccardo D'Ambrosi
- IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| | - Alessandra Menon
- IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| | - Alberto Aliprandi
- Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy
| | - Pietro Randelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| |
Collapse
|
6
|
Hilgersom NFJ, Oh LS, Flipsen M, Eygendaal D, van den Bekerom MPJ. Tips to avoid nerve injury in elbow arthroscopy. World J Orthop 2017; 8:99-106. [PMID: 28251060 PMCID: PMC5314153 DOI: 10.5312/wjo.v8.i2.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy.
Collapse
|
7
|
Arrigoni P, D’Ambrosi R, Randelli P. Arthroscopic Treatment of Annular Drive Through and Radial Lateral Collateral Ligament Articular-Side Tear of the Elbow. Arthrosc Tech 2015; 4:e647-50. [PMID: 26870640 PMCID: PMC4738185 DOI: 10.1016/j.eats.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023] Open
Abstract
An elongation or partial articular-sided tear of the radial lateral collateral ligament (R-LCL) is a rare injury causing disability and instability of the elbow. In our experience this condition is often associated with a pathologic sign of the annular ligament named the "annular drive through" caused by a redundancy of the ligament. The benefits of performing an arthroscopic procedure for surgical stabilization of the R-LCL include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and elimination of the annular drive-through sign. The main steps of the operation are as follows: evaluation of annular drive through, inspection of the radial side of the joint, anterior capsulotomy, insertion of a suture anchor through the anterolateral portal, shuttling of the suture anchor through the ligament, and elimination of the annular drive-through sign. By use of this technique, it is possible to repair a lesion of the R-LCL with a suture anchor that ensures an anatomic repair and, at the same time, returns the annular ligament to its physiological tension.
Collapse
Affiliation(s)
| | - Riccardo D’Ambrosi
- IRCCS Policlinico San Donato, Milan, Italy,Università degli Studi di Milano, Milan, Italy,Address correspondence to Riccardo D’Ambrosi, M.D., IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, 20097 San Donato Milanese, Milan, Italy.
| | - Pietro Randelli
- IRCCS Policlinico San Donato, Milan, Italy,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|