Elbow joint arthroscopy

A small detachment of bone or cartilage can occur in all joints, just like in the elbow joint, which may become a mechanical obstacle during movement causing occasional obstructions, and joint swelling. The loose body that is present in the joint wears down the cartilage surfaces, causes injuries and cartilage damage as a consequence of obstruction, and friction. Cartilage damage may occur due to other causes as well, greater loads due to sport or physical activity, repeated smaller injuries, or previous fractures may lead to cartilage wear too, which may cause the above mentioned complaints.

What treatment options are available?

Non surgical treatment

A conservative treatment option is not available in case of loose bodies in the joints, which cause complaints, and obstructions. If no loose bodies are present within the joint, so only cartilage wear is present, then exercising the joint, and physiotherapy may be beneficial. Additionally, it is recommended to take oral chondroprotective (cartilage repair) drugs, and hyaluronic acid injection could be administered to the elbow joint. These treatments may lead to the reduction of complaints for a short or long period of time, or even to an asymptomatic state. These could be supplemented by the administration of anti-inflammatory drugs if joint swellings, and pain are present. Surgical treatment is recommended for non-responders.

Surgical treatment

The removal of the loose bodies from the joint is performed in most cases with a minimal invasive arthroscopy, which is performed through small incisions. The advantage of an arthroscopic intervention is that it is less demanding than an open surgery, so the pain after the surgery is less intense, and the duration of recovery is shorter. Rarely, especially in case of larger loose bodies, smaller additional incisions may be necessary, and if the loose body is located in a place which is difficult to reach by the arthroscope, then the small exploration of the joint may be necessary too.

The main goal of the arthroscopy is to remove loose bodies. In case of concurrent injuries or wear and tear of the cartilage, the further goal of arthroscopy is the removal of the detached cartilage pieces with sparing as much hyalin cartilage as possible. Following this, the remaining uneven cartilage surface is shaved down. After the damaged part is removed, the cartilage surface will be smaller, but it will still be able to perform its main functions given that the extent of the injury is not too large.

It could occur that a too large cartilage surface injury is revealed during surgery, which extends to the bone. Sometimes, this may justify further surgical treatments. In a case like this, small drillings, and microfractures are created on the bone surface that is under the cartilage. This may induce the development of fibrous cartilage in the areas lacking cartilage. This fibrous cartilage that is developed is neither histologically, nor biomechanically identical to the original hyaline cartilage; it has a lesser load capacity. However, it is suitable to fill up the areas which are lacking cartilage and provide some level of load bearing.

After surgery, only two to three small cuts will be visible above the elbow joint. If additional incisions, or joint exploration is necessary, then longer incisions will be needed. The recovery greatly depends on this, so on the type of the performed surgery, and the postoperative treatment which is supported by physiotherapists. It is recommended to regularly do the practiced physiotherapy exercises at home, and to reduce the load of the operated limb. A few weeks after the intervention, a normal lifestyle without limitations could be followed, doing sports can be started 6-8 weeks after the surgery, depending on the intervention.

What happens during the surgery?

During surgery, an incision of 2-3 cm is made on both sides of the elbow joint, so that the arthroscopic optics and devices could be inserted into the joint. Special manual devices are used during the intervention to remove the loose body, and the damaged cartilage pieces are removed, and the surfaces are smoothed out with other devices, potentially with a motor shaver. The joint is rinsed, so that the inflammatory fluid and residual cartilage debris are removed. If necessary, small additional incisions are made, or small surgical incisions are used to explore the posterior parts of the joint, mainly in those areas which are difficult to reach with the arthroscope. Following surgery, the layers are closed after surgical hemostasis in accordance with the protocol. If necessary, a small suction drain is placed into the wound, which drains the blood and serum after surgery. After the surgery, an elastic bandage is applied to the patient’s arm.

What happens if the justified surgical treatment is not performed?

If the joint wear of the elbow is very advanced, then arthroscopic surgery has a higher risk due to the joint deformation; so, it is contraindicated in this case. In cases like this, open surgery is usually selected. In addition, other, general risks may be present.

The mechanical problem caused by the loose body in the joint, and the obstructions will remain present. The destruction of the cartilage surfaces will increase, causing additional pain, or potential movement difficulty. This may lead to join wear (arthrosis) in the long term. This process is irreversible and may cause a very painful joint with limited range of motion that could only be treatment with a greater surgical intervention.