Systematic Review
Evidence-Based Indications for Elbow Arthroscopy

https://doi.org/10.1016/j.arthro.2011.10.007Get rights and content

Purpose

The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions.

Methods

A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence.

Results

There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade Cf recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation).

Conclusions

The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor.

Level of Evidence

Level IV, systematic review of Level II-IV studies.

Section snippets

Methods

The methodology of this study was modeled on that described in Glazebrook et al.,3 where the concepts introduced by Wright et al.4, 5 were used to provide the evidence-based indications for ankle arthroscopy. A search of the PubMed database was performed in October 2010 for all published articles in the English language using the key words “elbow arthroscopy.” This returned 645 results. The abstracts of these articles were reviewed to identify those describing therapeutic studies reporting the

Results

There is fair-quality evidence for the recommendation for elbow arthroscopy in the treatment of rheumatoid arthritis and lateral epicondylitis (grade of recommendation, B). There is weak evidence for, rather than against, the use of elbow arthroscopy in the treatment of degenerative arthritis, OCD, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of plica, and fractures (grade Cf). There is insufficient evidence to make a recommendation for

Discussion

Like arthroscopy of other joints, elbow arthroscopy is an attractive way to access the joint without a larger incision and the perceived morbidity of an arthrotomy.18 The proximity of neurovascular structures makes elbow arthroscopy potentially more risky than arthroscopy of other joints.18 The literature is littered with reports of severe neurologic injuries as a result of elbow arthroscopy.46, 57, 75, 77, 82

It is only in the past few decades that elbow arthroscopy has become more commonly

Conclusions

The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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