Sage Journals: Discover world-class research

Abstract

Background:

Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications.

Purpose:

To evaluate the rate of complications after elbow arthroscopic surgery.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs.

Results:

A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures).

Conclusion:

The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates.

Keywords

elbow arthroscopic surgery complications

Elbow arthroscopic surgery was first introduced in 1931 and initially considered as a diagnostic tool for various elbow abnormalities.⁷⁰ Nowadays, because of the recent advancements in equipment and improved techniques in elbow arthroscopic surgery, its utilization has gained more popularity and accounts for 11% of all arthroscopic procedures, with a 2-fold increase over the past decade.¹⁰ Elbow arthroscopic surgery has gained popularity as the preferred method to manage several intra- and extra-articular elbow conditions.^10,70 It is widely utilized in loose body extraction, synovectomy, synovial biopsy, osteophyte removal, contracture release, osteochondral defects, and lateral epicondylitis. Additionally, indications have expanded to address complex conditions such as radial head resection, arthroscopically assisted open reduction of intra-articular fractures, total synovectomy, and ligament repair/reconstruction.^8,46,80

Elbow arthroscopic surgery is technically demanding because of the complexity of the elbow joint’s geometry and the proximity of major neurovascular structures.²⁸ The reported complications for elbow arthroscopic surgery include neurological injuries, postoperative stiffness, infections, wound-healing complications, nerve injuries, subsequent procedures, and instability. Risk factors for complications have also been described, including a history of trauma, prior elbow surgery, inflammatory arthritis, hypercoagulable disorders, and intra-articular corticosteroid injections at the time of surgery.^6,55,86 Identifying risk factors that result in complications, pathological considerations, technical considerations (learning curve), anatomy principles, proper portal selection, and adequate patient positioning are key to reduce further complications.^47,97 However, there are still some concerns regarding the potential complications of elbow arthroscopic surgery, especially regarding nerve injuries and elbow stiffness.

Because the indications and utilization of elbow arthroscopic surgery have increased dramatically, the purpose of this study was to collect all the reported complications of elbow arthroscopic surgery. We hypothesized that elbow arthroscopic surgery would be a relatively safe procedure with low complication rates.

Methods

This review was conducted with adherence to the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).⁶¹

Eligibility Criteria

The inclusion criteria comprised clinical studies that reported complications of elbow arthroscopic surgery. The exclusion criteria were abstracts, case reports, reviews, nonclinical studies, imaging studies, technique studies, and those not reporting postoperative complications.

Information Sources and Search Strategy

PubMed, Web of Science, and Embase were searched up to July 2021. The search keywords used in each database were (“Elbow”) AND (“Arthroscopy”) NOT (“Shoulder”) NOT (“Wrist”) NOT (“Hip”) NOT (“Knee”) NOT (“Ankle”). Studies were screened by titles and abstracts. A full-text review was performed if a study matched the eligibility criteria. Overall, 2 authors (A.F.A. and O.Z.A.) performed the search independently, and the senior author (B.A.Z.) resolved any disagreement.

Data Collection Process and Data Items

The baseline data items that were collected included author(s), study year, level of evidence, age, patient position (prone, lateral, or supine), number of elbow arthroscopic procedures, and elbow complications. The elbow complications were infections, wound-healing complications, nerve injuries, subsequent procedures, instability, and stiffness. Infections were either superficial or deep infections. Wound complications entailed wound dehiscence or drainage. Nerve complications were injuries to the ulnar nerve, radial nerve, posterior interosseous nerve, median nerve, medial antebrachial cutaneous nerve, and lateral antebrachial cutaneous nerve (LABCN) as well as total nerve injuries and unspecific nerve injuries. Again, 2 authors (A.T.H. and A.T.) performed data extraction independently.

Statistical Analysis

A quantitative synthesis was performed using Stata/IC (StataCorp). The continuous variables of baseline patient demographics were reported as means or ranges, whereas categorical variables were reported as unweighted proportions. Complications were expressed as weighted proportions for total complications and for each individual complication with 95% CIs. An arcsine transformation was implemented to compute weighted proportions, which managed variance instability; it is one of the preferred transformation methods in meta-analyses of prevalence.⁸

Results

Study Selection

The search strategy resulted in 1208 articles, of which 310 duplicates were removed, thus leaving 898 articles for searching by titles and abstracts. A total of 767 articles were excluded, resulting in 131 articles eligible for full-text reviews. Of the 131 articles, 36 articles were excluded, leaving 95 eligible articles. The exclusions were because of articles being a narrative review (n = 1) or about a surgical technique (n = 35). All 95 eligible studies were included in the quantitative analysis. Overall, 17 studies were level 3 comparative cohort studies, and 78 were level 4 case series. The PRISMA flowchart is displayed in Figure 1.

Figure 1.

Search strategy flowchart.

Study Characteristics

A summary of the included studies is provided in Appendix Table A1. A total of 14,289 elbow arthroscopic procedures were included in this review. In 78 studies, elbow arthroscopic surgery was performed in an adult population, with mean ages ranging from 21.6 to 80 years. Pediatric populations were reported in 14 studies, with mean ages ranging from 4 to 16 years. One study involved patients <20 years and >60 years, and 1 study did not report patient age. Of the studies that reported patient position, the most common patient position was lateral in 65.1% (2959/4547 procedures), followed by prone in 20.8% (945/4547 procedures) and supine in 15.6% (719/4623 procedures). The mean follow-up was variable across studies, ranging from 1 month to up to 13 years. The main diagnoses for elbow arthroscopic surgery were osteochondritis dissecans, primary osteoarthritis, posttraumatic stiffness/arthritis, and loose bodies.

Complications

The total weighted complication rate was 11.0% (95% CI, 8.8%-13.5%; 1136/14,289 procedures). The overall nerve injury rate was reported with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). An ulnar nerve injury was the most common nerve injury with a weighted proportion of 2.6% (95% CI, 1.9%-3.4%; 123/6290 procedures). The second most injured nerve was the LABCN with a weighted proportion of 1.0% (95% CI, 0.6%-1.4%; 12/5178 procedures). The radial nerve was the third most injured nerve with a weighted proportion of 0.9% (95% CI, 0.6%-1.1%; 34/5666 procedures). Injuries to the posterior interosseous nerve had a weighted proportion of 0.6% (95% CI, 0.4%-0.8%; 8/4662 procedures). Both median nerve and medial antebrachial cutaneous nerve injuries had a similar weighted proportion of 0.5% (95% CI, 0.3%-0.7%; 8/5666 procedures). A nonspecific nerve injury was reported with a weighted proportion of 1.0% (95% CI, 0.7%-1.3%; 95/13,490 procedures).

In terms of soft tissue complications, a superficial wound infection was most commonly reported with a weighted proportion of 2.0% (95% CI, 1.5%-2.6%; 109/5805 procedures), whereas a deep wound infection had a weighted proportion of 0.7% (95% CI, 0.5%-0.9%; 21/5729 procedures). Wound-healing complications such as drainage or dehiscence were reported with a weighted proportion of 1.5% (95% CI, 1.0%-2.2%; 47/5718 procedures).

Regarding complications affecting elbow motion, elbow stiffness had a weighted proportion of 4.5% (95% CI, 2.1%-7.6%; 158/8818 procedures), whereas elbow instability had a weighted proportion of 2.6% (95% CI, 1.4%-4.3%; 6/442 procedures). The need for a subsequent surgical procedure after elbow arthroscopic surgery was reported with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures).

Discussion

The major finding in this meta-analysis of 95 studies with a total of 14,289 elbow arthroscopic procedures was the total complication rate of 11.0%, with the most common complication being elbow stiffness (4.5% [95% CI, 2.1%-7.6%]) and the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures), followed by nerve injuries (3.4% [95% CI, 2.6%-4.3%]). An ulnar nerve injury was the most common nerve injury (2.6% [95% CI, 1.9%-3.4%]), followed by an LABCN injury (1.0% [95% CI, 0.6%-1.4%]). To the best of our knowledge, this is the first meta-analysis that focused on pooling complication rates of elbow arthroscopic surgery, and no other analysis had 95 studies. The total complication rate reported in our meta-analysis seems to be similar to prior large case series that focused on complications after elbow arthroscopic surgery.^28,36,63 In a recent case series on 560 elbow arthroscopic procedures by Intravia et al²⁸ between 2006 and 2014, the overall complication rate was 9%, with a nerve injury being the most common complication with a rate of 3.5%. However, elbow stiffness was not reported because of the short follow-up period. In another series between 1999 and 2012, Nelson et al⁶³ reported a higher total complication rate of 14% in a case series of 417 procedures, with the most common complications being superficial and deep infections. In an earlier retrospective case series of 473 elbow arthroscopic procedures between 1980 and 1998, Kelly et al³⁶ reported a total complication rate of 11.7%, with a transient nerve injury being the most encountered complication with a rate of 2.5%.

Elbow stiffness after elbow arthroscopic surgery was the most common finding in this meta-analysis, with a weighted rate of 4.5%. Kelly et al³⁶ reported a postoperative stiffness rate of 1.5% with a follow-up period of ≥6 weeks in 87.5% of patients. Moreover, the authors attributed the loss of elbow motion to conditions that predispose to stiffness such as inflammatory arthritis, osteoarthritis, osteochondral defects, and osteochondritis dissecans. Nelson et al⁶³ reported a rate of 2.6% for postoperative elbow stiffness in 417 elbow arthroscopic procedures with a follow-up period of ≤6 weeks. The authors reported stiffness as heterotopic ossification requiring surgical excision and loss of elbow motion requiring manipulation under anesthesia. In a study using the PearlDiver patient record database, Leong et al⁵⁰ reported a reoperation rate of 0.63% within 90 days for stiffness among 4127 patients with 6268 elbow arthroscopic procedures. While conducting this meta-analysis, the rate of elbow stiffness was significantly variable in the literature. This is mainly attributed to the short-term follow-up, varying definitions of stiffness, and mixed patient populations such as different diagnoses and procedures.

Given the superficial position and proximity of neurovascular structures about the elbow joint, elbow arthroscopic surgery remains notorious for nerve injuries. This meta-analysis demonstrated that a nerve injury was the third most common complication in elbow arthroscopic surgery, with a weighted proportion of 3.4%. Moreover, an ulnar nerve injury was the most frequently reported of all nerve injuries, with a weighted proportion of 2.6%. Nerve injury rates after elbow arthroscopic surgery have been quite variable in the literature, with a rate ranging between 0% and 14%. In a retrospective review of 560 elbow arthroscopic procedures, Intravia et al²⁸ found that the nerve injury rate was 3.5%, which was significantly higher in female patients and patients with prior elbow surgery. In a case series on 200 elbow arthroscopic procedures by Elfeddali et al,²² a history of trauma and prior elbow surgery were predictors of an increased risk of nerve complications. In another study by Kelly et al³⁶ on 473 elbows, the rate of nerve injuries was 2.5%, with all being transient. Furthermore, the risk of nerve injuries was significantly associated with the diagnosis of rheumatoid arthritis and contracture. In contrast, other studies have found no association of diagnosis or prior surgery with nerve injuries. In a case series of 227 patients with a nerve injury rate of 6.6%, Jinnah et al³¹ did not find a significant association between nerve injuries and having prior elbow trauma or surgery. Nelson et al⁶³ reported a relatively lower nerve injury rate of 1.7% in 417 elbow arthroscopic procedures, with all nerve injuries being transient. Moreover, the authors did not report significant differences between increasing surgery complexity and the rate of nerve injuries.

An infection is a serious complication after elbow arthroscopic surgery. In a study on 2704 patients with Medicare, Camp et al¹³ reported a postoperative infection rate of 1.55%. In addition, several variables were identified as independent risk factors for infections such as age ≥65 years, body mass index >40, smoking, alcohol intake, diabetes mellitus, inflammatory arthritis, hypercoagulable disorders, and intra-articular corticosteroid injections at the time of surgery. Nelson et al⁶³ reported following 417 elbow arthroscopic procedures, with infection rates of 6.7% and 2.2% for superficial and deep infections, respectively. The higher infection rates were attributed to the frequent use of intra-articular corticosteroids at the time of surgery (P < .0001). In contrast, Intravia et al²⁸ did report a significant association between intra-articular corticosteroid use and infection rates; however, infection rates were significantly higher by 4-fold in patients with elevated blood sugar at the time of surgery.

Limitations

This study had several limitations that should be acknowledged. Most studies included in this meta-analysis were level 4 case series, with a minority being level 3 cohort studies; thus, the level of evidence in this meta-analysis was low. Although 2 authors independently performed the search, some studies could have been missed, leading to potential selection bias. Because of the complexity of elbow conditions, we found that studies’ demographics would be categorized by diagnoses (single diagnosis or a combination), case complexity codes, or procedure type. This led to significant limitations that prevented us from performing a metaregression and identifying risk factors that would predict specific complications such as diagnosis, case complexity, and procedure type. In addition, the definition of a complication was not uniform across studies, including specifying the severity and duration of certain complications. This could have led to the underestimation or overestimation of certain complication rates.

Conclusion

This study highlights that elbow arthroscopic surgery is a relatively safe procedure with low complication rates. This meta-analysis provides an overview of complication rates after elbow arthroscopic surgery, thus aiding surgeons in counseling patients. It should be emphasized to patients that the most common complications of elbow arthroscopic surgery are stiffness, the need for subsequent surgery and nerve injuries, especially ulnar nerve neuropathy. It is important to understand the anatomy of the elbow in 3 dimensions, learn the appropriate techniques, and comprehend the pathology before attempting elbow arthroscopic surgery. In addition, surgeons should be knowledgeable of the necessary measures to decrease nerve injuries such as joint distension and portal position. Experienced arthroscopic skills are necessary to prevent minor and major complications as the numbers of elbow arthroscopic procedures increase.

Footnotes

Final revision submitted August 8, 2022; accepted August 30, 2022.

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

This article does not contain any studies with human participants performed by any of the authors.

APPENDIX

APPENDIX TABLE A1

Characteristics of Included Studies ^a

Lead Author (Year)	Country	LOE	No. of Patients	Age, y	Surgical Position, n			Follow-up, mo
Lead Author (Year)	Country	LOE	No. of Patients	Age, y	Prone	Lateral	Supine	Follow-up, mo
Schreiner⁸⁰ (2020)	Germany	4	44	40.8	44	0	0	37.2
Kwak⁴⁶ (2020)	Republic of Korea	4	65	52	0	65	0	32.9
Intravia²⁸ (2020)	USA	4	556	38.6	367	178	11	12
Matsuura⁵⁵ (2020)	Japan	4	23	14.7	0	0	23	138
Bachman⁶ (2020)	USA	3	41	32	0	41	0	16
Temporin⁸⁶ (2020)	Japan	4	10	51.9	10	0	0	24
Yang⁹⁷ (2020)	China	4	101	38.6	0	101	0	21
Kwak⁴⁷ (2019)	Republic of Korea	3	13	39	0	13	0	26.5
Pederzini⁶⁹ (2019)	Italy	4	9	22.4	0	9	0	48
Rai⁷³ (2019)	China	4	143	33	0	0	143	44
Kwak⁴⁵ (2019)	Republic of Korea	3	52	52.4	0	52	0	35.4
Carlier¹⁴ (2019)	France	3	87	49.8	NR			6
Karelson³⁴ (2019)	Finland	4	63	44.6	NR			72
Jhan³⁰ (2018)	Taiwan	4	15	27	0	15	0	31.2
Andelman³ (2018)	USA	4	29	12.7	0	0	29	15.8
Zhu⁹⁹ (2018)	China	4	11	41.7	NR			65
Nowotny⁶⁶ (2018)	Germany	4	27	14	0	27	0	45.6
Lubiatowski⁵² (2018)	Poland	4	54	37	0	0	54	24
Kim³⁸ (2018)	Republic of Korea	3	34	49	34	0	0	24
Jinnah³¹ (2018)	USA	4	227	39	0	227	0	1
Noticewala⁶⁵ (2018)	USA	4	530	45.6	NR			NR
Mardani-Kivi⁵⁴ (2018)	Iran	4	18	36.1	0	18	0	12
Koh⁴² (2018)	USA	4	36	32	36	0	0	51
Willinger⁹⁴ (2018)	Germany	4	42	41	0	42	0	28.3
Matsuura⁵⁶ (2017)	Japan	4	15	15.7	0	15	0	26.7
Andelman² (2017)	USA	4	64	11.8	0	0	64	10.3
Kim⁴⁰ (2017)	Republic of Korea	4	43	37.6-42.5	0	43	0	55.4-62.2
Arrigoni⁴ (2017)	Italy	3	35	47.1	0	35	0	24
Chen¹⁶ (2017)	China	3	32	34.3	0	0	32	17.1
Kwon⁴⁸ (2017)	Republic of Korea	3	30	49.3	0	30	0	31
Werner⁹² (2016)	USA	3	1265	<65 y: 48.5%; 65-80 y: 47.8%-48.2%; >80 y: 3.3%-3.8%	NR			3
Vavken⁹⁰ (2016)	Switzerland	4	50	13.6	0	0	50	12
Soeur⁸² (2016)	France	4	35	48	0	35	0	48
van Rheenen⁸⁹ (2015)	Netherlands	4	1004	NR	NR			12
Dilokhuttakam²⁰ (2015)	Thailand	4	49	42	0	49	0	1.5
Leong⁵⁰ (2015)	USA	4	6268	<20 y: 25%; 20-39 y: 25%; 40-59 y: 47%; ≥60 y: 6%	NR			NR
Wu⁹⁵ (2015)	China	4	34	39.6	0	0	34	12
Yoon⁹⁸ (2015)	Republic of Korea	4	45	45.9	45	0	0	26.9
Rajeev⁷⁴ (2015)	UK	4	121	38	NR			12
Merolla⁵⁷ (2015)	Italy	3	48	48.1	0	48	0	44
Temporin⁸⁵ (2015)	Japan	4	9	6.6	0	9	0	14.7
Ertem²³ (2015)	Turkey	4	28	46	28	0	0	20.5
Uchida⁸⁸ (2015)	Japan	4	18	14.2	0	0	18	36
Oki⁶⁸ (2014)	Japan	4	23	49	0	23	0	24
Moon⁶² (2014)	Republic of Korea	4	11	45	0	11	0	30
Pederzini⁷⁰ (2014)	Italy	4	212	41-43	212	0	0	58
Nelson⁶³ (2014)	USA	4	417	43.4	0	417	0	0.5-1.5
Miyake⁶⁰ (2014)	Japan	4	20	38	20	0	0	25
Lim⁵¹ (2014)	Republic of Korea	4	43	51.4	0	43	0	38
Babaqi⁵ (2014)	Egypt	4	33	33.7	0	33	0	14.4
Kniesel⁴¹ (2014)	Germany	3	25	46	25	0	0	24
Blonna¹¹ (2014)	USA	3	235	41	0	235	0	NR
Rhyou⁷⁶ (2013)	Republic of Korea	3	39	46-47	NS (either prone or lateral)			46
Elfeddali²² (2013)	UK	4	200	37	0	200	0	2
MacLean⁵³ (2013)	UK	4	21	42	0	21	0	65.9
Wijeratna⁹³ (2012)	UK	4	15	49.6	0	15	0	20
Dzugan²¹ (2012)	USA	4	7	40.7	7	0	0	12-24
Wulf⁹⁶ (2012)	USA	4	10	13.9	10	0	0	42
Kovachevich⁴³ (2012)	USA	4	15	51	0	15	0	12
Cefo¹⁵ (2011)	Netherlands	4	27	42	0	27	0	24
Blonna¹² (2010)	USA	4	26	38	NR			33
Schoch⁷⁹ (2010)	USA	4	13	16	NS (either prone or supine)			43.2
Kang³³ (2010)	Republic of Korea	4	26	45.5	0	26	0	33.9
Rahusen⁷² (2009)	Netherlands	4	16	29	0	16	0	38
Grewal²⁴ (2009)	Canada	4	36	45.3	0	36	0	42
Hausman²⁵ (2008)	USA	4	4	42.8	0	0	4	12
Adams¹ (2008)	USA	4	42	52.8	0	42	0	24
Michels⁵⁹ (2007)	Belgium	4	14	37.5	14	0	0	67.2
Krishnan⁴⁴ (2007)	USA	4	11	36	11	0	0	26
Kelly³⁵ (2007)	USA	4	25	51	0	25	0	33.8
Hausman²⁶ (2007)	USA	4	6	4	0	0	6	52
Schubert⁸¹ (2007)	Belgium	4	24	38.4	0	24	0	24
Cummins¹⁹ (2006)	USA	4	18	43.2	0	18	0	21.6
Nguyen⁶⁴ (2006)	Canada	4	22	42	0	22	0	25
Spahn⁸³ (2006)	Germany	3	21	34	21	0	0	30
Tanaka⁸⁴ (2006)	Japan	3	11	51	0	11	0	156
Kim³⁷ (2006)	USA	4	12	21.6	0	0	12	33.8
Ball⁷ (2002)	USA	4	14	36.9	0	14	0	12-29
Horiuchi²⁷ (2002)	Japan	4	29	51.2	0	29	0	97
Micheli⁵⁸ (2001)	USA	4	49	14	0	0	49	56.4
Clasper¹⁷ (2001)	UK	4	57	41.4	0	57	0	27
Kelly³⁶ (2001)	USA	4	473	36	0	473	0	42
Cohen¹⁸ (2000)	USA	3	26	46	NR			35.3
Reddy⁷⁵ (2000)	USA	3	181	30	13	74	94	42.3
Savoie⁷⁸ (2009)	USA	4	24	59	24	0	0	32
Ruch⁷⁷ (1998)	USA	4	12	14.5	12	0	0	48
Baumgarten⁹ (1998)	USA	4	17	13.8	0	0	17	32.4
Jerosch²⁹ (1998)	Germany	4	103	29	NR			74.4
Phillips⁷¹ (1998)	USA	4	25	31.6	0	0	25	18
Lee⁴⁹ (1997)	USA	4	14	<65	NR			42
Kim³⁹ (1995)	Republic of Korea	4	26	34	NS (either prone or supine)			25
Timmerman⁸⁷ (1994)	USA	4	19	36	0	0	19	29
Ward⁹¹ (1993)	USA	4	35	29	0	0	35	24
Jones³² (1993)	USA	4	12	38	12	0	0	21.8
O’Driscoll⁶⁷ (1992)	USA	4	70	34	Initial cases were supine; later in the study, a lateral position was used			34

^a Data are reported as means or ranges. LOE, level of evidence; NR, not reported; NS, not specified.

References

Adams

Wolff

3rd Merten

Steinmann

. Osteoarthritis of the elbow: results of arthroscopic osteophyte resection and capsulectomy. J Shoulder Elbow Surg. 2008;17(1):126–131.

Andelman

Meier

Walsh

Kim

Hausman

. Pediatric elbow arthroscopy: indications and safety. J Shoulder Elbow Surg. 2017;26(10):1862–1866.

Andelman

Walsh

Sochol

Rubenstein

Hausman

. Arthroscopic elbow contracture release in the pediatric patient. J Pediatr Orthop. 2018;38(9):e507–e513.

Arrigoni

Cucchi

D’Ambrosi

, et al. Intraarticular findings in symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2255–2263.

Babaqi

Kotb

Said

AbdelHamid

ElKady

ElAssal

. Short-term evaluation of arthroscopic management of tennis elbow, including resection of radiocapitellar capsular complex. J Orthop. 2014;11(2):82–86.

Bachman

Fitzsimmons

O’Driscoll

. Safety of arthroscopic versus open or combined heterotopic ossification removal around the elbow. Arthroscopy. 2020;36(2):422–430.

Ball

Meunier

Galatz

Calfee

Yamaguchi

. Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg. 2002;11(6):624–629.

Barendregt

Doi

Lee

Norman

Vos

. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67(11):974–978.

Baumgarten

Andrews

Satterwhite

. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med. 1998;26(4):520–523.

10.

Blonna

Bellato

Marini

Scelsi

Castoldi

. Arthroscopic treatment of stiff elbow. ISRN Surg. 2011;2011:378135.

11.

Blonna

Huffmann

O’Driscoll

. Delayed-onset ulnar neuritis after release of elbow contractures: clinical presentation, pathological findings, and treatment. Am J Sports Med. 2014;42(9):2113–2121.

12.

Blonna

Lee

O’Driscoll

. Arthroscopic restoration of terminal elbow extension in high-level athletes. Am J Sports Med. 2010;38(12):2509–2515.

13.

Camp

Cancienne

Degen

Dines

Altchek

Werner

. Factors that increase the risk of infection after elbow arthroscopy: analysis of patient demographics, medical comorbidities, and steroid injections in 2,704 Medicare patients. Arthroscopy. 2017;33(6):1175–1179.

14.

Carlier

Lenoir

Rouleau

, et al. Arthroscopic debridement for osteoarthritis of the elbow: results and analysis of predictive factors. Orthop Traumatol Surg Res. 2019;105(8)(suppl):S221–S227.

15.

Cefo

Eygendaal

. Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg. 2011;20(3):434–439.

16.

Chen

Weng

Chiu

Chang

Cheng

Chan

. A modified approach for elbow arthroscopy using an adjustable arm holder. J Orthop Surg Res. 2017;12(1):20.

17.

Clasper

Carr

. Arthroscopy of the elbow for loose bodies. Ann R Coll Surg Engl. 2001;83(1):34–36.

18.

Cohen

Redden

Stanley

. Treatment of osteoarthritis of the elbow: a comparison of open and arthroscopic debridement. Arthroscopy. 2000;16(7):701–706.

19.

Cummins

. Lateral epicondylitis: in vivo assessment of arthroscopic debridement and correlation with patient outcomes. Am J Sports Med. 2006;34(9):1486–1491.

20.

Dilokhuttakam

Phorkhar

. Neurovascular complications in forty-nine cases: elbow arthroscopy and review literatures. J Med Assoc Thai. 2015;98(suppl 10):S102–S106.

21.

Dzugan

Savoie

3rd Field

O’Brien

You

. Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report. J Shoulder Elbow Surg. 2012;21(12):1651–1655.

22.

Elfeddali

Schreuder

Eygendaal

. Arthroscopic elbow surgery: is it safe? J Shoulder Elbow Surg. 2013;22(5):647–652.

23.

Ertem

Ergen

Yoloğlu

. Functional outcomes of arthroscopic treatment of lateral epicondylitis. Acta Orthop Traumatol Turc. 2015;49(5):471–477.

24.

Grewal

MacDermid

Shah

King

GJW

. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg. 2009;34(5):849–857.

25.

Hausman

Klug

Qureshi

Goldstein

Parsons

. Arthroscopically assisted coronoid fracture fixation: a preliminary report. Clin Orthop Relat Res. 2008;466(12):3147–3152.

26.

Hausman

Qureshi

Goldstein

, et al. Arthroscopically-assisted treatment of pediatric lateral humeral condyle fractures. J Pediatr Orthop. 2007;27(7):739–742.

27.

Horiuchi

Momohara

Tomatsu

Inoue

Toyama

. Arthroscopic synovectomy of the elbow in rheumatoid arthritis. J Bone Joint Surg Am. 2002;84(3):342–347.

28.

Intravia

Acevedo

Chung

Mirzayan

. Complications of elbow arthroscopy in a community-based practice. Arthroscopy. 2020;36(5):1283–1290.

29.

Jerosch

Schröder

Schneider

. Good and relative indications for elbow arthroscopy: a retrospective study on 103 patients. Arch Orthop Trauma Surg. 1998;117(4-5):246–249.

30.

Jhan

Chou

Wang

Yang

. Outcomes and factors of elbow arthroscopy upon returning to sports for throwing athletes with osteoarthritis. J Orthop Surg Res. 2018;13(1):280.

31.

Jinnah

Luo

Wiesler

, et al. Peripheral nerve injury after elbow arthroscopy: an analysis of risk factors. Arthroscopy. 2018;34(5):1447–1452.

32.

Jones

Savoie

3rd . Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow. Arthroscopy. 1993;9(3):277–283.

33.

Kang

Park

Ahn

Lee

. Arthroscopic synovectomy for the rheumatoid elbow. Arthroscopy. 2010;26(9):1195–1202.

34.

Karelson

Launonen

Jokihaara

Havulinna

Mattila

. Pain, function, and patient satisfaction after arthroscopic treatment of elbow in a retrospective series with minimum of 5-year follow-up. J Orthop Surg (Hong Kong). 2019;27(1):2309499019832808.

35.

Kelly

Bryce

Coghlan

Bell

. Arthroscopic debridement without radial head excision of the osteoarthritic elbow. Arthroscopy. 2007;23(2):151–156.

36.

Kelly

Morrey

O’Driscoll

. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001;83(1):25–34.

37.

Kim

Gambardella

Elattrache

Yocum

Jobe

. Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers. Am J Sports Med. 2006;34(3):438–444.

38.

Kim

Chung

Kim

. Comparison of the clinical outcomes of open surgery versus arthroscopic surgery for chronic refractory lateral epicondylitis of the elbow. Orthopedics. 2018;41(4):237–247.

39.

Kim

Lee

. Arthroscopy for limitation of motion of the elbow. Arthroscopy. 1995;11(6):680–683.

40.

Kim

Lee

Choi

. Retrospective comparative analysis of elbow arthroscopy used to treat primary osteoarthritis with and without release of the posterior band of the medial collateral ligament. Arthroscopy. 2017;33(8):1506–1511.

41.

Kniesel

Huth

Bauer

Mauch

. Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability. Arch Orthop Trauma Surg. 2014;134(12):1641–1647.

42.

Koh

Zwahlen

Altchek

Zimmerman

. Arthroscopic treatment successfully treats posterior elbow impingement in an athletic population. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):306–311.

43.

Kovachevich

Steinmann

. Arthroscopic ulnar nerve decompression in the setting of elbow osteoarthritis. J Hand Surg Am. 2012;37(4):663–668.

44.

Krishnan

Harkins

Pennington

Harrison

Burkhead

. Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age. J Shoulder Elbow Surg. 2007;16(4):443–448.

45.

Kwak

Kholinne

Sun

Lim

Koh

Jeon

. Clinical outcome of osteocapsular arthroplasty for primary osteoarthritis of the elbow: comparison of arthroscopic and open procedure. Arthroscopy. 2019;35(4):1083–1089.

46.

Kwak

Kim

Sun

Kholinne

Koh

Jeon

. Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification. J Shoulder Elbow Surg. 2020;29(5):989–995.

47.

Kwak

Sun

Kholinne

Koh

Jeon

. Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra- and extra-articular elbow fractures. J Shoulder Elbow Surg. 2019;28(10):1998–2006.

48.

Kwon

Kim

Park

. The Nirschl procedure versus arthroscopic extensor carpi radialis brevis débridement for lateral epicondylitis. J Shoulder Elbow Surg. 2017;26(1):118–124.

49.

Lee

Morrey

. Arthroscopic synovectomy of the elbow for rheumatoid arthritis: a prospective study. J Bone Joint Surg Br. 1997;79(5):770–772.

50.

Leong

Cohen

Lord

Wang

McAllister

Petrigliano

. Demographic trends and complication rates in arthroscopic elbow surgery. Arthroscopy. 2015;31(10):1928–1932.

51.

Lim

Koh

Lee

Shim

Park

. Arthroscopic débridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome. J Shoulder Elbow Surg. 2014;23(9):1381–1387.

52.

Lubiatowski

Ślęzak

Wałecka

Bręborowicz

Romanowski

. Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture. J Shoulder Elbow Surg. 2018;27(9):e269–e278.

53.

MacLean

Oni

Crawford

Deshmukh

. Medium-term results of arthroscopic debridement and capsulectomy for the treatment of elbow osteoarthritis. J Shoulder Elbow Surg. 2013;22(5):653–657.

54.

Mardani-Kivi

Kazemnejad

Hashemi-Motlagh

Saheb-Ekhtiari

. Indications, results and complications of elbow arthroscopy treatment in eighteen patients. Shiraz E Med J. 2018;19(6):e62606.

55.

Matsuura

Iwame

Suzue

, et al. Long-term outcomes of arthroscopic debridement with or without drilling for osteochondritis dissecans of the capitellum in adolescent baseball players: a ≥10-year follow-up study. Arthroscopy. 2020;36(5):1273–1280.

56.

Matsuura

Wada

Suzue

Iwame

Fukuta

Sairyo

. Bilateral osteochondritis dissecans of the capitellum in fraternal twins: a case report. JBJS Case Connect. 2017;7(3):e44.

57.

Merolla

Buononato

Chillemi

Paladini

Porcellini

. Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up. Musculoskelet Surg. 2015;99(suppl 1):S83–S90.

58.

Micheli

Luke

Mintzer

Waters

. Elbow arthroscopy in the pediatric and adolescent population. Arthroscopy. 2001;17(7):694–699.

59.

Michels

Pouliart

Handelberg

. Arthroscopic management of Mason type 2 radial head fractures. Knee Surg Sports Traumatol Arthrosc. 2007;15(10):1244–1250.

60.

Miyake

Shimada

Oka

, et al. Arthroscopic debridement in the treatment of patients with osteoarthritis of the elbow, based on computer simulation. Bone Joint J. 2014;96-B(2):237–241.

61.

Moher

Liberati

Tetzlaff

Altman

; the PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–341.

62.

Moon

Biraris

Jeong

Kim

. Clinical results after arthroscopic treatment for septic arthritis of the elbow joint. Arthroscopy. 2014;30(6):673–678.

63.

Nelson

Galatz

Yamaguchi

Keener

. Elbow arthroscopy: early complications and associated risk factors. J Shoulder Elbow Surg. 2014;23(2):273–278.

64.

Nguyen

Proper

MacDermid

King

Faber

. Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy. 2006;22(8):842–849.

65.

Noticewala

Trofa

Vance

Jobin

Levine

Ahmad

. Elbow arthroscopy: 30-day postoperative complication profile and associated risk factors. Arthroscopy. 2018;34(2):414–420.

66.

Nowotny

Löbstein

Biewener

Fitze

Kasten

. Elbow arthroscopy in children and adolescents: analysis of outcome and complications. Eur J Med Res. 2018;23(1):42.

67.

O’Driscoll

Morrey

. Arthroscopy of the elbow: diagnostic and therapeutic benefits and hazards. J Bone Joint Surg Am. 1992;74(1):84–94.

68.

Oki

Iba

Sasaki

Yamashita

Wada

. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014;23(10):1527–1531.

69.

Pederzini

Bartoli

Cheli

Nicoletta

Severini

. Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD). Knee Surg Sports Traumatol Arthrosc. 2019;27(10):3291–3296.

70.

Pederzini

Nicoletta

Tosi

Prandini

Tripoli

Cossio

. Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):467–473.

71.

Phillips

Strasburger

. Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy. 1998;14(1):38–44.

72.

Rahusen

Brinkman

Eygendaal

. Arthroscopic treatment of posterior impingement of the elbow in athletes: a medium-term follow-up in sixteen cases. J Shoulder Elbow Surg. 2009;18(2):279–282.

73.

Rai

Zhang

Tamang

Jin

Wang

Meng

. Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes. BMC Musculoskelet Disord. 2019;20(1):285.

74.

Rajeev

Pooley

. Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain. J Orthop Surg (Hong Kong). 2015;23(1):11–14.

75.

Reddy

Kvitne

Yocum

ElAttrache

Glousman

Jobe

. Arthroscopy of the elbow: a long-term clinical review. Arthroscopy. 2000;16(6):588–594.

76.

Rhyou

Kim

. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res. 2013;471(1):284–290.

77.

Ruch

Cory

Poehling

. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy. 1998;14(8):797–803.

78.

Savoie

3rd Field

Gurley

. Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Hand Clin. 2009;25(3):323–329.

79.

Schoch

Wolf

. Osteochondritis dissecans of the capitellum: minimum 1-year follow-up after arthroscopic debridement. Arthroscopy. 2010;26(11):1469–1473.

80.

Schreiner

Schweikardt

Gühring

, et al. Arthroscopic arthrolysis leads to improved range of motion and health-related quality of life in post-traumatic elbow stiffness. J Shoulder Elbow Surg. 2020;29(8):1538–1547.

81.

Schubert

Dubuc

Barbier

. A review of 24 cases of elbow arthroscopy using the DASH questionnaire. Acta Orthop Belg. 2007;73(6):700–703.

82.

Soeur

Desmoineaux

Devillier

Pujol

Beaufils

. Outcomes of arthroscopic lateral epicondylitis release: should we treat earlier? Orthop Traumatol Surg Res. 2016;102(6):775–780.

83.

Spahn

Kirschbaum

Klinger

Wittig

. Arthroscopic electrothermal shrinkage of chronic posterolateral elbow instability: good or moderate outcome in 21 patients followed for an average of 2.5 years. Acta Orthop. 2006;77(2):285–289.

84.

Tanaka

Sakahashi

Hirose

Ishima

Ishii

. Arthroscopic and open synovectomy of the elbow in rheumatoid arthritis. J Bone Joint Surg Am. 2006;88(3):521–525.

85.

Temporin

Namba

Okamoto

Yamamoto

. Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res. 2015;101(5):593–596.

86.

Temporin

Shimada

Oura

Owaki

. Arthroscopic release for the severely stiff elbow. Musculoskelet Surg. 2020;104(1):81–86.

87.

Timmerman

Andrews

. Arthroscopic treatment of posttraumatic elbow pain and stiffness. Am J Sports Med. 1994;22(2):230–235.

88.

Uchida

Utsunomiya

Taketa

, et al. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate acid thread pins for treating elbow osteochondritis dissecans. Am J Sports Med. 2015;43(5):1057–1065.

89.

van Rheenen

van den Bekerom

Eygendaal

. The incidence of neurologic complications and associated risk factors in elbow surgery: an analysis of 2759 cases. J Shoulder Elbow Surg. 2015;24(12):1991–1997.

90.

Vavken

Muller

Camathias

. First 50 pediatric and adolescent elbow arthroscopies: analysis of indications and complications. J Pediatr Orthop. 2016;36(4):400–404.

91.

Ward

Anderson

. Elbow arthroscopy in a mostly athletic population. J Hand Surg Am. 1993;18(2):220–224.

92.

Werner

Fashandi

Chhabra

Deal

. Effect of obesity on complication rate after elbow arthroscopy in a Medicare population. Arthroscopy. 2016;32(3):453–457.

93.

Wijeratna

Bailey

Pace

Tytherleigh-Strong

Van Rensburg

Kent

. Arthroscopic radial head excision in managing elbow trauma. Int Orthop. 2012;36(12):2507–2512.

94.

Willinger

Siebenlist

Lenich

Liska

Imhoff

Achtnich

. Arthroscopic arthrolysis provides good clinical outcome in post-traumatic and degenerative elbow stiffness. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):312–317.

95.

Wang

Meng

, et al. Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2715–2720.

96.

Wulf

Stone

Giveans

Lervick

. Magnetic resonance imaging after arthroscopic microfracture of capitellar osteochondritis dissecans. Am J Sports Med. 2012;40(11):2549–2556.

97.

Yang

. Heterotopic ossification after arthroscopic elbow release. Orthop Surg. 2020;12(5):1471–1477.

98.

Yoon

Chung

, et al. Prognostic factors of arthroscopic extensor carpi radialis brevis release for lateral epicondylitis. Arthroscopy. 2015;31(7):1232–1237.

99.

Zhu

Wang

Mao

Chen

. Arthroscopic management of elbow synovial chondromatosis. Medicine (Baltimore). 2018;97(40):e12402.

Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis

Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Methods

Eligibility Criteria

Information Sources and Search Strategy

Data Collection Process and Data Items

Statistical Analysis

Results

Study Selection

Study Characteristics

Complications

Discussion

Limitations

Conclusion

Footnotes

APPENDIX

References