Arthroscopic surgery of the elbow

Many diseases of the elbow joint may be controlled in a minimally-invasive way using arthroscopic techniques. Here, surgery is performed under general anesthesia.

Indications:

• Loose joint bodies
• Osteochondrosis dissecans
• Beginning arthrosis of the elbow joint
• Movability restrictions

Technique

At first, two portals are established in the front part of the joint which are used to inspect the joint space. This way, inflammation of the joint mucosa may be identified and removed. Loose joint bodies may be removed as well. In case of movement restrictions, bony projections (osteophytes, exostoses) have to be removed and the bone has to be smoothed.
In the next step, the back part of the joint is inspected. Here, inflammations are common as well. As a particularity, a thickened mucosa fold (Plica humeroradialis) may be observed which gets stuck in the joint during movement and leads to complaints. Finally, the upper joint space in the back (Fossa olecrani) is examined and treated. Loose joint bodies, mucosa inflammation and bony projections are the most commonly observed alterations that have to be treated.

Follow-up treatment

As a rule, immobilization using a bandage is not necessary, and physiotherapy is started on the first day after surgery. The patient may return to work after 1 week in case of light work, and after 3 - 6 weeks in case of heavy physical work.

Special case Osteochondrosis disseccans (OD)

With an arthroscopic treatment of OD which mainly affects adolescents, the extent of the damage may be identified and first therapeutic measures may be performed. This includes the smoothing of small cartilage lesions and especially the drilling into the OD center in order to allow local biological healing.
Advanced therapies such as the grafting of osteochondral (cartilage/bone) cylinders are used in case of open surgery.
The follow-up treatment of OD and resumption of sports activities need to be determined depending on the findings and treatment type; the entire process may easily take 6 - 12 months.