Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia.
Am J Sports Med. 2023 Nov;51(13):3401-3408. doi: 10.1177/03635465231198862. Epub 2023 Oct 7.
Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral epicondylitis, ligament reconstruction, and elbow trauma. However, data on the true prevalence and characteristics of heterotopic ossification (HO) formation after elbow arthroscopy are limited.
To investigate the prevalence, timing, locational distribution, and risk factors of HO after elbow arthroscopy.
Cohort study; Level of evidence, 4.
Data on 205 patients undergoing elbow arthroscopy by a single senior elbow surgeon at a single institution between May 2011 and January 2022 were retrospectively reviewed. The patients were evaluated at 2 weeks, 8 weeks, 6 months, and then annually after surgery or more frequently if HO developed, with a minimum of 1 year of postoperative follow-up. Postoperative anteroposterior and lateral elbow radiographs were taken at 2 weeks to rule out fracture and at 8 weeks to identify HO. The clinical outcomes were evaluated based on the pain visual analog scale; the shortened version of the Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and the Single Assessment Numeric Evaluation scores before and after surgery. Bivariate logistic regression analyses were used to determine factors affecting HO prevalence.
Thirteen (12 male, 1 female) of 205 (6.3%) patients developed HO, with 10 (76.9%) with HO that formed on the medial compartment of the elbow. Ten (76.9%) patients were diagnosed at 8 weeks after arthroscopic surgery, 1 (7.7%) at 6 months after surgery, and 2 (15.4%) at 12 months after surgery. HO was not found at 2 weeks after surgery in any patient. The mean follow-up time was 3.5 years (range, 1.0-11.8 years). Eleven asymptomatic patients were treated nonoperatively, and 2 symptomatic patients underwent HO excision arthroscopically or had a combination of open surgery and arthroscopy. Age was a protective factor for HO formation (odds ratio [OR], 0.953; 95% CI, 0.910-0.999; = .047). The risk factors for HO formation were tourniquet time (OR, 1.042; 95% CI, 1.019-1.065; < .001) and surgical time (OR, 1.026; 95% CI, 1.011-1.041; < .001).
Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. Although the presence of HO may not affect the clinical outcomes in most patients, it should be carefully monitored for a minimum of 8 weeks postoperatively. Younger age, longer tourniquet time, and longer surgical time contributed to HO formation after elbow arthroscopy.
关节镜技术旨在减少创伤后僵硬、关节炎疾病、外侧髁炎、韧带重建和肘部创伤等治疗后肘部并发症的发生，并加速肘部的恢复。然而，有关肘部关节镜检查后异位骨化（HO）形成的真实患病率和特征的数据有限。
调查肘部关节镜检查后 HO 的患病率、发生时间、位置分布和危险因素。
队列研究；证据水平，4 级。
对 205 例由一名高级肘部外科医生在一家机构进行的肘部关节镜检查的患者数据进行回顾性分析。在术后 2 周、8 周、6 个月以及之后每年进行评估，或在出现 HO 时更频繁地进行评估，术后随访至少 1 年。术后 2 周拍摄前后位和侧位肘部 X 线片以排除骨折，术后 8 周拍摄 X 线片以确定 HO。基于疼痛视觉模拟评分、上肢残疾评定量表简化版、 Mayo 肘部功能评分和单因素数字评估评分来评估临床结果。使用双变量逻辑回归分析确定影响 HO 患病率的因素。
205 例患者中，有 13 例（12 例男性，1 例女性）发生 HO，其中 10 例（76.9%）HO 位于肘部内侧。10 例（76.9%）患者在关节镜手术后 8 周时被诊断为 HO，1 例（7.7%）在手术后 6 个月时被诊断为 HO，2 例（15.4%）在手术后 12 个月时被诊断为 HO。任何患者在术后 2 周时均未发现 HO。平均随访时间为 3.5 年（范围，1.0-11.8 年）。11 例无症状患者接受非手术治疗，2 例有症状患者接受 HO 切除术关节镜治疗或联合开放手术和关节镜治疗。年龄是 HO 形成的保护因素（比值比[OR]，0.953；95%置信区间[CI]，0.910-0.999； =.047）。HO 形成的危险因素是止血带时间（OR，1.042；95% CI，1.019-1.065； <.001）和手术时间（OR，1.026；95% CI，1.011-1.041； <.001）。
在 205 例行肘部关节镜检查的患者中，HO 是肘部关节镜检查的一种轻微并发症，患病率为 6.3%，通常位于肘部内侧。尽管 HO 的存在可能不会影响大多数患者的临床结果，但应至少在术后 8 周内密切监测。年龄较小、止血带时间较长和手术时间较长与肘部关节镜检查后 HO 的形成有关。
