J Korean Soc Surg Hand.  2017 Jun;22(2):73-80. 10.12790/jkssh.2017.22.2.73.

Surgical Treatment of the Primary Osteoarthritis of the Elbow: Open vs. Arthroscopy

• Lee JS

• KMID: 2383798
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.73

Abstract

The characteristic of primary osteoarthritis of the elbow is marginal osteophyte and loose body formation with relatively preserving cartilage, manifesting as a painful and limited motion arc. In moderate degenerative changes, a debridement that remove the bony impingement as a basis of the surgical treatment can be performed by arthroscopic as well as open procedure. This article tries to suggest the indication of arthroscopic or open procedure by comparative analyzing the advantages and disadvantages of each method. As a result, arthroscopic procedure may be recommended when the range of motion is greater than 100° and main symptom is pain, on the other hand open debridement may be recommended when the range of motion is less than 100°, main symptom is limited motion, especially further flexion and ulnar neuropathy is accompanied.

Keyword

Elbow; Osteoarthritis; Treatment; Arthroscopy

MeSH Terms

Arthroscopy*
Cartilage
Debridement
Elbow*
Hand
Methods
Osteoarthritis*
Osteophyte
Range of Motion, Articular
Ulnar Neuropathies

Figure

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  Fig. 1 Osteoarthritis of the elbow. (A) Three dimensional computed tomography demonstrated osteophyte in olecranon and coronoid fossa with multiple loose body. (B) Sagittal view showed thickened olecranon membrane.

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  Fig. 2 Anterior compartment. (A) Large osteophytes of the coronoid tip and the coronoid fossa are observed from proximal anterolateral portal. (B) An arthroscopic burr is used to resect osteophyte in the coronoid fossa. (C) A remained osteophyte of the coronoid tip is removed using the microfracture instrument or small osteotome. (D) Coronoid tip after fully resecting osteophyte.

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  Fig. 3 Posterior compartment. (A) Osteophytes of the olecranon tip and the olecranon fossa are visualized from a posterolateral portal in elbow flexion position. (B) Bony impingement occur in elbow extension. (C) An osteotome is used to resect osteophyte of the olecranon tip. (D) Olecranon tip after fully resecting osteophyte.

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  Fig. 4 Author's method. (A) Triceps splitting approach after making 2–3 cm skin incision in posterior midline. (B) Olecranon fenestration is performed using 16–18 mm drill reamer.

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  Fig. 5 Open debridement through a medial approach. (A) Posterior band of the medial collateral ligament is resected for improvement of further flexion (arrow). (B) Multiple loose body in the olecranon fossa (arrow) and osteophyte of the olecranon tip are observed. (C) Olecranon fenestration is performed using a 16–18 mm drill reamer. (D) Approach between common flexor and pronator teres for exposure anterior compartment. (E) Osteophytes of the coronoid tip and the coronoid fossa are observed (arrows). (F) Anterior transposition of the ulnar nerve.

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