ABSTRACTS
Paper 107: Elbow Arthrolysis: Arthroscopic vs Open
Technique: Results of a Multicentric Study FRANCOIS
M. KELBERINE, MD, FRANCE, PRESENTING AUTHOR
JL MARMORAT, FRANCE THIERRY
JUDET, FRANCE
FRANÃOIS BONNOMET, MD, FRANCE
ABSTRACT
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The post-operative ROM was similar for extension (10
degrees) pronation (83 degrees) and supination (83
degrees). But the the flexion was better in group O (132
degrees vs 127 degrees, p0,03) and the global gain in FE
was clearly better (60 degrees vs 34 degrees p0,001) as
the initial lack of flexion was highter.
Radiologically, anterior (p 0,03) and medial (p 0,04)
spurs resection was more extensive in group O despite
ABSTRACTS
Introduction: The goal of this study is to compare the
efficacy of two techniques of elbow arthrolysis: 59
arthroscopically performed (group A) and 80 through
open surgery (group O). Based upon a multicentric
retrospective study (levelXXX), it is, in our knowledge,
the largest comparative survey reported up to now.
Material and Methods: To avoid the influence of
learning curve, we selected specialized surgeons (for both
groups) who performed the technique they were used
with. Patients selection was mandatory strict to keep the
two groups comparable. Inclusion criteriae were from 18
to 65 years old, mechanical passive stiffness, radiological
assessment. Exclusion criteriae were extraarticular
causing factor or surgical procedure (eg ostetomy),
synovitis, infection or Sudeck syndrom.
The datas assessed preop, postop and at the final follow
up were clinical (ROM, pain, swelling, locking, unability
in daily living activities) and radiological (loose bodies,
bony and/or fibrous filling of fossae, spurs, arthosis).
Time to resume to activities and subjective opinion were
finally checked. Two groups were considered: posttrauma stiffness and arthritis (localized or global).
Groups A & O were comparable for age, sex, dominant
side, delay to surgery, clinical signs, rate of worker
compensation. But they were different in etiology: group
A was rather sport related with microtrauma and arthritis
which was confirmed at surgery (more cartilaginous
damages). Group O was more posttrauma related with a
worse and significant lack of flexion (107 vs 116). The
mean lack of extension was 42 degrees, mean pronation
73 degrees and supination 70 degrees.
On the operative point of view, we note more capsular
release, more posterior spurs removal and ulnar nerve
release and more postoperative analgesic block in group
O. In group A, even in experts hands only capsulotomy
and no capsulectomy was performed. There was no
difference regarding fenestration (22%) and radial head
excision (11%).
Results: 13% of complications occured in both groups
(e.g: One radial nerve palsy, transient ulnar or radial nerve
palsy, sudeck syndrom, superficial infection)
there arthritis was less frequent.
At 6 years FU (1-14y), there was no difference
regarding PS, gain in PS (20 degrees) nor extension (19
degrees). Final flexion was better in group A (129 degrees
vs 124 degrees, p 0,02). The overall improvement of FE
remains better (p 0,001) for group O (43 vs 31 degrees)
splitted in both flexion (5 degrees, p0,05) and extension
(7 degrees, p0,01). Finally, open surgery got a better ROM
with a larger loss of mobility after surgery (17 degrees vs
8 degrees).
Patients reported occasional and few complains in
ADL. Return to activities was 18 weeks. However,
subjective opinion was only scored 3/5.
Other remarkable results: return to work was delayed
for worker compensation (52 weeks vs 13 weeks),
previous surgery or mobilization under anesthesia do not
influence the results.
Improvement of ROM was significantly better when
surgery was done prior the second year after first
symptoms.
Conclusion: Arthro CT scan is in our opinion the best
examination to assess preoperatively the stiff elbow.
Paper 108: Comparison of Elbow Valgus Laxity Using
Radiographic and Non-Radiographic Objective
Measurements MARC RAYMOND SAFRAN, MD, USA, PRESENTING AUTHOR
THAY Q. LEE, PHD, USA
ABSTRACT
Introduction: Diagnosis of ulnar collateral ligament
(UCL) injury is difficult. Stress radiographs are currently
the only objective tool to confirm the diagnosis, but can
be misleading. This study compares a clinical testing
device with the current gold standard Telos Stress Test
Radiographic Device.
Methods: 18 subjects, 7 subjects (6 male, 1 female) with
an average age of 33 (range 19 - 52) with a history of UCL
injury, but not symptomatic enough to undergo surgical
reconstruction, and 11 (10 male, 1 female) normal
subjects with an average age of 29 years (range 19 41)
underwent valgus laxity testing of both elbows. All
patients filled out an elbow questionnaire, including
information about injury and surgery and sports
participation. All subjects then underwent a clinical
examination of both elbows, including range of motion,
carrying angle, location of tenderness, and valgus stress
tests.
Subjects with current elbow pain, elbow arthritis or
elbow surgery were excluded. All patents underwent the
same testing protocol. Both arms of each subject were
placed in a custom non-invasive instrumented testing
device that permits the application of varus-valgus force
and measurement of laxity. Angular displacement was
measured with a Microscribe Digitizing system connected
to a laptop computer after applying a 2N-m valgus force
from a neutral starting position. Neutral starting postion
was identified by applying a 1N-m varus force before
each application of valgus force. This was repeated 5
times for each elbow. Lastly, a manual maximum valgus
force (approximately 7.7 N-m) was applied and the
resulting displacement measured.
These subjects also underwent instrumented valgus
stress radiographs (Telos GA-/IIE Stress Device) using
zero and 12 decaNewtons force (27 lbs). Radiographs
were recorded using a PACS system and medial joint
space was digitally measured on the PACS system.
Comparisons were then made.
Results: The stress radiographs failed to show a
significant difference between normal [3.3mm (0.52)] and
injured [3.0mm (0.63)] elbows (p0.6). The clinical noninvasive device was able to show a significant difference
(p.03) in laxity on manual maximum testing when
comparing the normal [0.46 (SD 0.17)] to the injured
[0.56 (SD 0.22)] elbow. No significant difference was
found in normals subjects on non-invasive and stress
radiographs when comparing dominant [0.23 radians
(0.14), 3.7mm (0.79)] to non-dominant [0.21 radians
(0.12), 3.7mm (0.65)] elbows. Spearman rank
correlations were performed to evaluate the relationship
between the stress radiographs and clinical stress device
revealing poor correlation (r0.07 and r0.15).
Conclusions: The non-invasive device is more sensitive
in detecting valgus elbow laxity than standardized stress
radiographs. This device may increase a clinician’s ability
to accurately diagnosis UCL laxity without the expense
and invasiveness of radiography.