A new pathologic classification for elbow stiffness based on our experience in 216 patients.

BACKGROUND

Elbow stiffness commonly causes functional impairment and upper-limb disability. This study aimed to develop a new pathologic classification to further understand and standardize elbow arthrolysis from a new perspective, as well as to determine clinical outcomes.

METHODS

Extension-flexion dysfunction was classified into 4 types: EF, tethers alone; EF, tethers with blocks; EF, articular malformation; and EF, bony ankylosis. Forearm rotation dysfunction was classified into 3 types: FR, contracture alone; FR, radial head malunion or nonunion; and FR, proximal radioulnar bony ankylosis. A total of 216 patients with elbow stiffness were prospectively included and categorized preoperatively. All surgical procedures were performed by the same chief surgeon; different types underwent specific procedures. Patient data, elbow motion, and functional scores were analyzed.

RESULTS

Mean range of motion (ROM) increased from 40° preoperatively to 118° at final follow-up; 88% of patients regained ROM of 100° or greater. The forearm rotation arc (FRA) with forearm rotation dysfunction increased from a preoperative mean of 76° to 128°; 82% of patients regained an FRA of 100° or greater. The mean Mayo Elbow Performance Index (MEPI) increased from 63 to 91 points; the proportion of patients with good or excellent results was 95%. EF patients had the best ROM (129°) and MEPI (93 points) and EF patients achieved the most-changed ROM (116°), whereas EF patients had the worst ROM (104°) and MEPI (84 points) and the least-changed ROM (64°). The FRA was best in FR patients (142°), followed by FR patients (118°), and worst in FR patients (82°); in contrast, the changed FRA was greatest in FR patients (82°), followed by FR patients (64°), and least in FR patients (37°).

CONCLUSION

This study suggests that the proposed pathologic classification provides a new perspective on the understanding and standardization of elbow arthrolysis, providing satisfactory clinical outcomes.