Arthroscopic Management of the Stiff Elbow

Abstract

Arthroscopic osteocapsular arthroplasty (OCA) of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain (O’Driscoll, Advanced reconstruction elbow. American Academy of Orthopedic Surgeons, Rosemont, 2007; Steinmann, Arthroscopy 23(11):1231-1236, 2007). This technique has become a more common procedure in recent years since it is generally believed to provide results that are at least comparable to those of traditional open procedures (Kwak et al., Arthroscopy 35(4):1083-1089, 2019), but it allows better visualization of intra-articular lesions, a quicker recovery, and better cosmetic results. There are seven key principles in successful arthroscopic OCA: (1) Use a step-wise, safety-driven, and standardized technique. (2) Perform a prophylactic ulnar nerve decompression to avoid delayed-onset ulnar neuritis (Blonna et al., Am J Sports Med 42(9):2113-2121, 2014; Blonna and O’Driscoll, Arthroscopy 30(8):947-956, 2014). (3) Constantly control the fluid inflow to avoid swelling. (4) Remove the bone in order to recreate conforming joint surfaces. (5) Remove the capsule. (6) Use retractors. (7) Stay under your learning curve.