A retrospective comparison of open and arthroscopic surgery for elbow joint stiffness; a single centre pragmatic study over 15 years.

Abstract

BACKGROUND: There is ample evidence but conflicting reports to justify decision making for open versus arthroscopic elbow debridement and release for stiffness and pain once non-surgical measures have failed. The aim of this retrospective study is to report the clinical and functional outcomes of arthroscopic and open surgery for patients presenting with elbow pain, stiffness and loss of function. METHODS: A consecutive series of patients who had completed a minimum of 6 months of non-surgical treatment of elbow stiffness were identified over a 15-year period between July 2008 and January 2023 from a single centre. RESULTS: 96 patients were treated with arthroscopic surgery with 75 open surgery. Mean age was 51 years. Pre-operative pathology included osteoarthritis, inflammatory arthropathy and post-traumatic stiffness. Post-traumatic stiffness was more commonly treated with open surgery. The flexion-extension arc, pronosupination arc, pain score, Mayo elbow performance score (MEPS) and satisfaction scores improved in all patients (p < 0.05). The arthroscopic group had a lower pain score (p < 0.05), a higher satisfaction score (p < 0.05), higher MEPS (p < 0.05), greater flexion-extension arc (P < 0.01), greater pronosupination arc (P < 0.01) and fewer patients had ongoing symptoms of pain and stiffness which limited function (P < 0.05) with fewer repoerations (p > 0.05) than the open group. CONCLUSIONS: Both arthroscopic and open surgical approaches for elbow stiffness improved elbow range of movement and function. Arthroscopic treatment was better than open surgery and may represent a more favorable approach. LEVEL OF EVIDENCE: Level 4 (case series).