Arthroscopic and open options for surgical treatment of chondromatosis of the elbow.

PURPOSE

The purpose of this study was to evaluate the treatment-specific outcome of surgical therapy of chondromatosis of the elbow with special attention on the complication and recurrence rate as well as induction of secondary osteoarthritis.

METHODS

A consecutive patient group from 1989 to 2003 was evaluated retrospectively and followed up clinically and radiologically. Special attention was paid to locking and catching, swelling, pain, loose bodies, and signs of osteoarthritis. In the case of a causal pathology, mostly osteoarthritis, the condition was classified as secondary; otherwise, it was classified as primary. The following scores were calculated: modified American Shoulder and Elbow Surgeons questionnaire for elbows; Disabilities of the Arm, Shoulder and Hand questionnaire; and Short Form 36.

RESULTS

Of 24 patients operated on, 19 (79%) were followed up after 56 months (range, 11 to 177 months). Of these, 10 were primary types and 9 secondary types. The extension deficit of 12 degrees preoperatively decreased to -9 degrees , and pain was significantly (P = .001) reduced. Postoperatively, 1 patient still reported occasional locking and 1 patient had swelling. In both patients no loose bodies could be identified by radiography. Comparison of the arthroscopic and open techniques showed a trend toward a shorter rehabilitation time of 2.4 months after arthroscopic intervention, in contrast to 4.6 months for an open procedure, and a trend toward higher patient satisfaction after arthroscopy. Comparison of the primary and secondary forms showed significantly (P = .042) better pain reduction for primary chondromatosis. Of the patients with distinct preoperative osteoarthritis, 44% showed ongoing osteophytic growth; there were no cases of new osteoarthritis.

CONCLUSIONS

Both open and arthroscopic approaches give satisfactory results with a trend toward shorter rehabilitation and higher patient satisfaction for the arthroscopic approach. Osteoarthritis is not induced and there is no danger of recurrence in the medium term.

LEVEL OF EVIDENCE

Level III, therapeutic, retrospective comparative study.