Stepwise Posterior-Based Arthroscopic Release for Severe Elbow Stiffness: Intraoperative Identification of a Critical Posteromedial Restraint

Abstract Background Arthroscopic release for elbow stiffness is considered a minimally invasive and effective treatment. However, the extent to which each intraoperative step contributes to improvement in range of motion (ROM) has not been well investigated. Purpose To sequentially evaluate the relationship between intraoperative surgical steps and changes in elbow ROM during arthroscopic release for severe elbow stiffness, and to identify the key procedural stage contributing most significantly to ROM improvement. Methods Five elbows in five patients with severe elbow stiffness following fracture or dislocation were retrospectively reviewed. Arthroscopic release was performed using a stepwise posterior-based approach, starting from the posterior soft-spot portal, followed by exposure of the olecranon fossa and progression into the posteromedial compartment. Changes in elbow ROM were assessed at each intraoperative step, and ROM at final follow-up was also evaluated. Results All patients demonstrated improvement in elbow ROM at final follow-up. Intraoperative ROM improvement did not occur in a continuous manner but rather in a stepwise fashion. Gradual improvement was observed with establishment of the posterior and posteromedial working spaces, followed by the most substantial increase in ROM immediately after release of the soft tissue attached to the posterior aspect of the humeral medial epicondyle. Although the maximum ROM achieved intraoperatively was not fully maintained at final follow-up, no patient experienced deterioration to preoperative ROM levels. Conclusions In arthroscopic release for severe elbow stiffness, improvement in elbow ROM occurs in a stepwise rather than continuous pattern. Release of the posteromedial structures attached to the posterior aspect of the humeral medial epicondyle may represent a critical turning point contributing significantly to ROM improvement.