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