Handheld Osteotomes Facilitate Arthroscopic Treatment of Elbow Valgus Extension Overload.
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ABSTRACT:
SUBMITTER: O'Connell RS
PROVIDER: S-EPMC7093706 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Injury to the medial collateral ligament of the elbow (MCL) can be a career-threatening injury for an overhead athlete without appropriate diagnosis and treatment. It has been considered separately from other athletic injuries due to the unique constellation of pathology that results from repetitive overhead throwing. The past decade has witnessed tremendous gains in understanding of the complex interplay between the dynamic and static stabilizers of the athlete's elbow. Likewise, the necessity to treat these problems in a minimally invasive manner has driven the development of sophisticated techniques and instrumentation for elbow arthroscopy. MCL injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans (OCD) of the capitellum have all been described as sequelae of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can all be present in conjunction with these problems or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these problems in order to form a comprehensive differential diagnosis for an athlete presenting with elbow pain, and he or she must be comfortable with the variety of open and arthroscopic treatments available to best serve the patient. An understanding of the anatomy and biomechanics of the thrower's elbow is critical to the care of this population. The preoperative evaluation should focus on a thorough history and physical examination, as well as on specific diagnostic imaging modalities. Arthroscopic setup, including anesthesia, patient positioning, and portal choices will be discussed. Operative techniques in the anterior and posterior compartments will be reviewed, as well as postoperative rehabilitation and surgical results. Lastly, complications will be reviewed.
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Project description:Valgus extension overload syndrome (VEO) is the result of supraphysiologic stresses placed across the posterior elbow during pitching. Following failure of nonoperative measures, surgical options consist of arthroscopic or limited incision posteromedial decompression. Although technically challenging, arthroscopic treatment offers many advantages over open treatment, including improved joint visualization, decreased soft-tissue dissection, decreased postoperative pain, and quicker rehabilitation. Arthroscopic treatment of VEO consists of soft tissue and bony debridement, loose body removal, and osteophyte resection. This technique report details the steps of arthroscopic treatment of VEO in a patient with a subluxating ulnar nerve.
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Project description:Arthroscopic elbow surgery is a challenging procedure in part because of the limited intra-articular volume of the joint, the congruence of the elbow articulation, and the close proximity of the neurovascular structures. Arthritic conditions that result in the development of bony prominences and osteophytes are usually amenable to arthroscopic management and include diagnoses such as osteoarthritis, rheumatoid arthritis, and valgus extension overload syndrome. Safe and efficient removal of these osteophytes can be problematic, however, because of technical difficulties often encountered while using arthroscopic burrs and shavers as well as the risks of inadvertent, iatrogenic injury to adjacent articular cartilage and other structures. A valuable and effective technique using small handheld osteotomes to facilitate the arthroscopic removal of intra-articular osteophytes and other bony prominences is described and shown.
| S-EPMC6203231 | biostudies-literature
Project description:Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed. Arthroscopic access to the elbow in the supine-suspended position is simple and reproducible with the technique described in this report. Synovial tissue can be cleared, optimizing visualization of the anatomic structures in the elbow including the posterior ulnohumeral joint. This report describes, in detail, arthroscopy of the elbow in the supine-suspended position and basic principles for arthroscopic decompression of the posterior elbow for valgus extension overload.
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Project description:Treatment of primary elbow osteoarthritis in the young active patient less than 50 years old presents a treatment challenge to the practicing orthopaedic surgeon. Following failure of nonoperative management, surgical goals are aimed at reducing pain and improving joint mobility from bony impingement. Arthroscopic osteocapsular arthroplasty is a viable treatment option with few post-operative limitations. In contrast, total elbow arthroplasty is considered a salvage option in this patient population given the activity restrictions imposed. Osteocapsular arthroplasty combines soft tissue and bony debridement, osteophyte/loose body removal, synovectomy, capsular release, and bony contouring of the humerus and ulna to allow impingement-free range of motion.
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Project description:PurposePosterior elbow impingement can cause disabling pain and limited motion during activities involving elbow extension. Less understood is whether arthroscopic treatment, compared to open surgery, can result in effective management of pain, loss of range of motion, and return athletes to previous levels of activity. This study determined whether arthroscopic debridement is a safe and effective treatment for posterior elbow impingement and whether it enables athletes to return to a previous level of function.MethodsA retrospective review of 36 consecutive patients that underwent arthroscopic debridement of the posterior elbow was performed. There were 34 male and 2 female patients, with a median age of 32 years (17-54 years). There were 7 professional athletes, 6 college athletes, and 23 high school or recreational athletes. All patients had a positive posterior impingement test for posterior pain with extension and limitations of activity. Arthroscopic debridement and additional surgical procedures were performed, and patients underwent follow-up visits at a median 51 months (range 14-81).ResultsSignificant improvements were seen in pain, motion, and function. No neurovascular complications were seen related to the arthroscopic debridement. The mean Andrews and Timmerman elbow score improved from 159 ± 27 to 193 ± 11 (p < 0.01). Thirty-five of thirty-six (97%) patients returned to their previous level of activity, including all professional athletes.ConclusionsArthroscopic management of posterior elbow impingement is safe and effective and can return patients, including professional athletes, to high-level athletic activity. Athletes with symptomatic posterior elbow impingement can be successfully and safely treated with arthroscopic debridement and typically will return to preinjury levels of activity.Level of evidenceIV.
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Project description:Elbow stiffness is defined as an arc of flexion-extension motion of less than 100° and/or a contracture of more than 30° in flexion. Stiff elbow is common and can be very disabling, preventing individuals from carrying out the basic activities of daily living. The most common cause of stiff elbow is the sequela of an injury, but osteoarthritis can also produce limitations of mobility, which can benefit from surgical treatment The treatment of stiff elbow is initially orthopedic. If the patient still has functional limitations of the elbow after 6 months of suitable rehabilitation treatment , the option of surgical treatment must be considered. Surgical arthrolysis of the elbow can be performed with open surgery as well as with arthroscopic surgery. Good results can be obtained with both techniques achieving a functional arc of at least -30° extension to 130° of flexion. Arthroscopic surgery enables results comparable with those of open surgery but with a lower percentage of complications.
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Project description:IntroductionLipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa.Case's descriptionWe describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension.DiagnosisThe diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy.InterventionsAfter a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis.OutcomeAt 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores.ConclusionThis is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.
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Project description:Knee osteoarthritis may lead to narrowing of the intercondylar notch due to osteophyte formation, thereby causing changes in native knee biomechanics. The normal close contact between the condyles and the anterior cruciate ligament (ACL) during knee extension may be compromised due to narrowing of the notch and result in ACL damage, progression of knee osteoarthritis, and loss of knee extension. Outcomes after a notchplasty procedure are well reported for ACL reconstruction in young patients. However, there remains a lack of studies evaluating this procedure in the setting of knee osteoarthritis in patients with a symptomatic loss of knee extension. The purpose of this Technical Note is to present our preferred surgical technique for the treatment of loss of knee extension in the setting of knee osteoarthritis in conjunction with osteophyte formation in the intercondylar notch.
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Project description:Arthroscopic debridement for elbow osteoarthritis has been widely used as a minimally invasive treatment; however, in some cases, it can be a technically demanding procedure, such as in patients with severe osteoarthritis with large spur formation and severe synovitis. The anterocentral transbrachialis portal is a recently developed portal for elbow arthroscopy, which allows easy and convenient access to the anterior compartment for sufficient debridement. This report describes in detail the anterocentral transbrachialis portal and its usefulness for debridement of the elbow joint in osteoarthritis.
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