A new pathologic classification for elbow stiffness based on our experience in 216 patients

Background: Elbow stiffness commonly causes functional impairment and upper-limb disability. This study aimed to develop a new pathologic classification to further understand and standardize elbow arthrolysis from a new perspective, as well as to determine clinical outcomes. Methods: Extension-flexion dysfunction was classified into 4 types: EFI, tethers alone; EFII. tethers with blocks; EFIII, articular malformation; and EFIV, bony ankylosis. Forearm rotation dysfunction was classified into 3 types: FRI, contracture alone; FRII, radial head malunion or nonunion; and FRIII, proximal radioulnar bony ankylosis. A total of 216 patients with elbow stiffness were prospectively included and categorized preoperatively. All surgical procedures were performed by the same chief surgeon; different types underwent specific procedures. Patient data, elbow motion, and functional scores were analyzed. Results: Mean range of motion (ROM) increased from 40 degrees preoperatively to 118 degrees at final follow-up; 88% of patients regained ROM of 100 degrees or greater. The forearm rotation arc (FRA) with forearm rotation dysfunction increased from a preoperative mean of 76 degrees to 128'; 82% of patients regained an FRA of 100 degrees or greater. The mean Mayo Elbow Performance Index (MEPI) increased from 63 to 91 points; the proportion of patients with good or excellent results was 95%. EFI patients had the best ROM (129 degrees) and MEPI (93 points) and EFIV patients achieved the most-changed ROM (116 degrees), whereas EF in patients had the worst ROM (104 degrees) and MEPI (84 points) and the least-changed ROM (64 degrees). The FRA was best in FRI patients (142 degrees), followed by FRII patients (118 degrees), and worst in FRIII patients (82 degrees): in contrast, the changed FRA was greatest in FRIII patients (82 degrees), followed by FRII patients (64 degrees), and least in FRI patients (37 degrees). Conclusion: This study suggests that the proposed pathologic classification provides a new perspective on the understanding and standardization of elbow arthrolysis, providing satisfactory clinical outcomes. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.