0
Scientific Articles   |    
Osteocapsular Arthroplasty of the ElbowSurgical Technique
Shawn W. O’Driscoll, MD, PhD, FRCS(C)1; Davide Blonna, MD2
1 Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905. E-mail address: odriscoll.shawn@mayo.edu
2 Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Based on an original article: J Bone Joint Surg Am. 2013 Aug 7;95(15):1373-81.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Aug 14;3(3):e15 1-9. doi: 10.2106/JBJS.ST.M.00002
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

Overview
Introduction

Arthroscopic osteocapsular arthroplasty of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain.

Step 1: Get in and Establish a View

Visualize identifiable articular structures and confirm their anatomic orientation.

Step 2: Create a Space in Which to Work

Remove debris and loose bodies, as well as excise the fat pad and perform a synovectomy as necessary, so that you can see clearly.

Step 3: Bone Removal

Remove osteophytes and restore the olecranon to its normal shape.

Step 4: Capsulectomy

Release the capsule according to the severity of the flexion loss.

Step 1 (Anterior Compartment): Get in and Establish a View

As with the posterior compartment, the first step in the anterior compartment is to visualize the joint structures and to be sure of their anatomic orientation.

Step 2 (Anterior Compartment): Create a Space in Which to Work

The stripping of the capsule is usually extremely effective for improving or creating the space in which to work in the anterior joint compartment.

Step 3 (Anterior Compartment): Bone Removal

Remove osteophytes and reshape the coronoid and coronoid fossa to their normal shape.

Step 4 (Anterior Compartment): Capsulectomy

Meticulously excise the anterior aspect of the capsule following four consistent steps.

Closure

Close the wounds after drains have been placed anteriorly (through the arthroscope sheath into the proximal anterolateral portal) and posteriorly (through the posterolateral portal into the olecranon fossa, exiting proximally through a separate skin puncture).

Postoperative Regimen

Postoperatively, check the nerve function before performing a regional block and commencing continuous passive motion.

Results

A retrospective review of a consecutive series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) in 464 patients revealed twenty-four cases (4.8%) of transient nerve injury7.

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

Figures in this Article

    First Page Preview

    View Large
    />
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Essential Surgical Techniques?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    Video 1: Introduction. The surgical technique of arthroscopic osteocapsular arthroplasty of the elbow, which is also referred to as “OCA.” The video provides two specific surgical examples that are refered to as the “principal case” and the “secondary case.” The “principal case” is used to demonstrate the majority of the surgical technique. The “secondary case” is used to explain optional surgical steps or situations when these steps are better visualized in the “secondary case” than during the “principal case.”

    Running Time: 1:20

    Video 2: Preoperative planning. Use three-dimensional and two-dimensional imaging to review the pathology and plan the details of the surgical procedure.

    Running Time: 5:42

    Video 3: Setup and portals. Patient positioning, portal placement, and ulnar nerve decompression are discussed and demonstrated.

    Running Time: 7:40

    Video 4: Step 1: Get in and establish a view. Visualize identifiable articular structures and confirm their anatomic orientation.

    Running Time: 1:45

    Video 5: Step 2: Create a space in which to work. Remove debris and loose bodies as well as excise the fat pad and perform a synovectomy as necessary, so that you can see clearly.

    Running Time: 4:38

    Video 6: Step 3: Bone removal. Remove osteophytes and restore the olecranon and olecranon fossa to their normal shape. Also remove osteophytes in the medial and lateral gutters.

    Running Time: 2:42

    Video 7: Step 4: Capsulectomy. Release the capsule according to the severity of the flexion loss.

    Running Time: 2:32

    Video 8: Anterior joint compartment. After completing work in the posterior compartment and the medial and lateral gutters, enter the anterior compartment and follow the same four-step sequence.

    Running Time: 1:59

    Video 9: Step 1 (anterior joint compartment): Get in and establish a view.

    Running Time: 1:00

    Video 10: Step 2 (anterior joint compartment): Create a space in which to work.

    Running Time: 0:35

    Video 11: Step 3 (anterior joint compartment): Bone removal.

    Running Time: 3:56

    Video 12: Step 4 (anterior joint compartment): Capsulectomy.

    Running Time: 3:45

    Video 13: Take-home messages and top-ten tips. Arthroscopic contracture release of the elbow is not without risk of nerve injury even in the hands of expert surgeons. Surgeons must anticipate and try to prevent accidents that can happen due to unpredictable circumstances related to the patient, anatomy, procedure, instruments, or surgical team.

    Running Time: 3:40

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    Results
    Provided by:
    Essential Surgical Techniques
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Guidelines
    The treatment of glenohumeral joint osteoarthritis. -American Academy of Orthopaedic Surgeons (AAOS) | 9/11/2009
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/27/2014
    Massachusetts - Boston Medical Center and Boston University School of Medicine
    03/19/2014
    Virginia - OrthoVirginia
    04/02/2014
    IL - Hinsdale Orthopaedics
    11/15/2013
    LA - Ochsner Health System