Anterior Capsulectomy Through Humeral Fenestration in Arthroscopic Arthrolysis for Elbow Stiffness Is Safe and Effective

Abstract

Purpose

To evaluate arc of motion and complications following transhumeral anterior capsulectomy through a purely posterior approach with the Outerbridge-Kashiwagi procedure in treating elbow stiffness.

Methods

Patients who were treated for elbow stiffness between April 2003 and February 2023 were retrospectively identified. The inclusion criteria were an extension/flexion arc deficit of at least 30° and treatment with arthroscopic arthrolysis through posterior and posterolateral portals with humeral fenestration. Elbow joint range of motion and the Mayo Elbow Performance Score were assessed preoperatively, intraoperatively, at 6 weeks, and at final follow-up. The follow-up ended when the elbow became asymptomatic again or when the recovery was considered stable. Postoperative complications were recorded.

Results

A total of 30 patients (23 men/7 women; 31 elbows; 1 bilateral/29 unilateral) were included. Mean follow-up was 11.1 months (1-64). Mean joint amplitudes intraoperatively increased in all areas of mobility, including extension/flexion from 86° to 132.6° (P = .001) and pronation/supination from 163.9° to 179.7° (P = .025). At the longest follow-up, mean joint amplitude was increased from 86° to 118.9° (P = .002) in extension/flexion and from 136.9° to 173.9° (P = .022) in pronation/supination. The mean deficit was reduced from 54° to 21.1° (P = .001) in extension/flexion and from 16.1° to 6.1° (P = .006) in pronation/supination. The mean gain in the extension/flexion arc was 31.5° and 10° for the pronation/supination arc. Loss in flexion/extension was limited (mean: 14.2°, extreme: 50°). The study showed no neurologic complications.

Conclusions

Arthroscopic arthrolysis of a stiff elbow using a purely posterior approach with anterior capsulectomy via the Outerbridge-Kashiwagi procedure was safe and effective. Clinical results showed improvement in joint range of motion in flexion/extension and pronation/supination, both intraoperatively and postoperatively, with no postoperative neurologic complications.

Level of Evidence

Level IV, therapeutic case series.