Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation.

BACKGROUND: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.

Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy.

OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of instability and tears of the proximal long head of biceps tendon (LHBT). To assess intraobserver and interobserver agreement. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of 100 consecutive shoulders who underwent non-contrast 1.5-T MRI prior to arthroscopic surgery due to rotator cuff injury. Images were independently analyzed by two musculoskeletal radiologists. LHBT was evaluated for presence of tearing (intact, longitudinal split, partial-thickness, or full-thickness) and position (normal, subluxated, and dislocated). Anterosuperior rotator cuff tears were also assessed. The reference standard was arthroscopic surgery. The ramp test was performed in order to evaluate LHBT stability. Diagnostic performance measures were determined and Kappa coefficients assessed agreement. RESULTS: Concerning the detection of overall tears, sensitivity ranged from 71 to 73% and specificity was 73%. The specificity for full-thickness tears ranged from 75 to 96%. Overall displacement showed sensitivity ranging from 51 to 58% and specificity ranging from 70 to 86%. The specificity of overall displacement combined with anterosuperior rotator cuff tears ranged from 73 to 91%. Interobserver Kappa values were between 0.59 and 0.69. Intraobserver Kappa values were between 0.74 and 0.82. CONCLUSIONS: MRI has moderate accuracy and good agreement for detection of LHBT tears and instability. There is a tendency for increased specificity for full-thickness tears and for instability in the coexistence of anterosuperior rotator cuff tears.

Matrix Metalloproteases 1 and 3 Promoter Gene Polymorphism Is Associated With Rotator Cuff Tear.

BACKGROUND: Studies suggest that the collagen degeneration and disordered arrangement of collagen fibers in rotator cuff tears are associated with an increase in activity of matrix metalloproteases 1 and 3 (MMP-1 and MMP-3), and that MMP activity may be in part genetically mediated. The degree to which this might be clinically relevant in patients with rotator cuff tears has not been well characterized. QUESTIONS/PURPOSES: (1) Is genetic polymorphism of MMP-1 and MMP-3 associated with rotator cuff tears? (2) Are there haplotypes of MMP-1 and MMP-3 correlated with rotator cuff tears? (3) Compared with control subjects, do patients with rotator cuff tears have a higher proportion of relatives with the same disease? METHODS: We evaluated 64 patients with full-thickness rotator cuff tears and 64 asymptomatic control subjects. Patients younger 65 years, with nontraumatic tears, were included. The tear or integrity of the rotator cuff tear was evaluated by MRI or ultrasonography in all individuals. The patients and control subjects were paired by age. MMP-1 and MMP-3 genotypes were determined using the PCR-restriction fragment length polymorphism assays. RESULTS: Genetic polymorphisms in MMP-1 and MMP-3 are associated with rotator cuff tear, in which individuals with rotator cuff tears have associated genotypes 1G/2G (patients, 32 of 64 [50%], control subjects, 16 of 64 [25%]; odds ratio [OR], 4.8; 95% CI, 2.1-11.0; p < 0.001) and 2G/2G were at great risk (patients, 15 of 64 [23%], control subjects, seven of 64 [11%]; OR, 5.2; 95% CI,1.8-14.9; p < 0.001), and patients with rotator cuff tears were associated with a higher proportion of 2G allele distribution (62 of 128 [48%] versus 30 of 128 [23%]; p < 0.001). Patients with the 5A/5A genotype are at greater risk of rotator cuff tear (patients, 15 of 64 [23%]; control subjects, four of 64 [6%]; OR, 5.5; 95% CI, 1.4-20.9; p = 0.021), and there was higher 5A allele distribution in patients with rotator cuff tears (patients, 68 of 128 [53%]; control subjects, 52 of 128 [41%]; p = 0.045). Individuals with the haplotype 2G/5A were more likely to have rotator cuff tears develop (patients, 42 of 64 [66%]; control subjects, 17 of 64 [27%]; OR, 5.3; 95% CI, 2.5-11.3; p < 0.001). Patients with rotator cuff tears reported, in higher number, the existence of relatives who previously had treatment for rotator cuff tears (19 of 64 [30%] versus four of 64 [6%]; OR, 6.3; 95% CI, 2.0-19.9; p = 0.001). CONCLUSIONS: The genetic polymorphism of MMP-1 and MMP-3 is associated with rotator cuff tear. Individuals with haplotype 2G/5A were more susceptible to rotator cuff tears in the population studied. CLINICAL RELEVANCE: Knowledge of the genetic markers related to rotator cuff tears can enable identification of susceptible individuals and increase understanding of the pathogenesis of tendon degeneration.

Intraobserver and interobserver agreement in the classification and treatment of proximal humeral fractures.

BACKGROUND: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. METHODS: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. RESULTS: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (κ = 0.749) and medial metaphyseal comminution (κ = 0.627) and moderate for the pathomorphologic classification (κ = 0.504), displacement of the greater tuberosity (κ = 0.422), and treatment decision (κ = 0.565). Intraobserver reliability was substantial for treatment indication (κ = 0.620) and presence of displacement of the fracture of the greater tuberosity (κ = 0.627 and 0.611) and moderate for the Neer (κ = 0.490) and pathomorphologic (κ = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). CONCLUSION: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience.

Clinical outcomes of arthroscopic rotator cuff repair: correlation between the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores.

BACKGROUND: There are more than 40 outcome scores for evaluating shoulder pain and function. Some studies have correlated the results obtained using different scales, but none has compared the results obtained by the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores. METHODS: We performed a retrospective study to evaluate patients who underwent arthroscopic rotator cuff repair with 2 years' follow-up. The patients were evaluated by the UCLA and ASES scores preoperatively and at 6, 12, and 24 months after surgery. The Pearson correlation coefficient (r) was calculated to measure the degree of correlation between the 2 outcome scores. RESULTS: We evaluated 143 patients. At 24 months postoperatively, the UCLA and ASES scores were 30.4 ± 5.8 and 81.2 ± 20.8, respectively (P < .001). The UCLA and ASES scores showed a very high correlation (r = 0.91, P < .001). In all the postoperative clinical evaluations, the scores obtained from the 2 scales were highly or very highly correlated (r = 0.87-0.92, P < .001). For the preoperative scores, the correlation was moderate (r = 0.67, P < .001). CONCLUSION: The UCLA and ASES scores presented a very high correlation in the evaluation of surgical treatment of rotator cuff tear. In the preoperative period, the correlation was moderate.

The rotation of the humeral head does not alter radiographic evaluation of the head-shaft angle.

BACKGROUND: The head-shaft angle is used to plan osteotomies and arthroplasties and to assess the radiographic outcomes of surgical treatment for proximal humerus fractures. There are no published data showing whether different degrees of arm rotation interfere with the evaluation of this angle. METHODS: Eighteen humeri from adult cadavers were used. Radiographs were taken with the specimens initially placed in a true anteroposterior position and then subsequently positioned with internal and external rotations of 10°, 20°, and 30°. All radiographs were evaluated by 3 shoulder and elbow surgeons at 2 different times 3 months apart. The head-shaft angle was measured using a picture archiving and communication system. RESULTS: For the humerus in the neutral position, the head-shaft angle was 137° ± 4°. With the anatomic specimen positioned with increasing external and internal rotations, there was a maximum difference of 2° compared with the value observed in the neutral position, which was not a significant difference (P = .911). Measurements of the head-shaft angle showed a good interobserver correlation coefficient, with a value of 0.788 (0.728-0.839) for all measurements. The intraobserver correlation coefficient ranged from moderate to excellent (0.536-0.938). CONCLUSION: The head-shaft angle did not change significantly with varying degrees of humeral rotation. The interobserver correlation coefficient showed good reliability, and the intraobserver correlation was moderate to excellent.

Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial.

BACKGROUND: Previous studies have shown good clinical results in patients with proximal humeral fractures (PHFs) treated with locking intramedullary nails or locking plates. Our study compared the clinical and radiographic outcomes in patients with 2- and 3-part surgical neck fractures. METHODS: In this prospective, randomized controlled trial, 72 patients with 2- or 3-part surgical neck PHFs were randomly assigned to receive fixation with locking intramedullary nails (nail group) or locking plates (plate group). The primary outcome was the 12-month Constant-Murley score. The secondary outcomes included the Disabilities of the Arm, Shoulder and Hand score, the visual analog scale pain score, the shoulder passive range of motion, the neck-shaft angle, and complication rates. RESULTS: There was no significant mean treatment group difference in the Constant-Murley score at 12 months (70.3 points for the nail group vs. 71.5 points for the plate group; P = .750) or at individual follow-up assessments. There were no differences in the 3-, 6- and 12-month Disabilities of the Arm, Shoulder and Hand scores, visual analog scale scores, and range of motion, except for the medial rotation at 6 months. The neck-shaft angle was equivalent between the groups at 12 months. There were significant differences over 12 months in total complication rates (P = .002) and reoperation rates (P = .041). There were no significant differences for the rotator cuff tear rate (P = .672). CONCLUSION: Fixation of PHFs with locking plates or locking intramedullary nails produces similar clinical and radiologic results. Nevertheless, the complication and reoperation rates were higher in the nail group.

Accuracy of preoperative MRI in the diagnosis of subscapularis tears.

INTRODUCTION: The subscapularis has received little attention in the orthopedic literature, although such lesions are evident in up to 40 % of arthroscopies. An accurate diagnosis is important in clinical practice, as it affects both patient prognosis and surgical planning. The aim of this study was to evaluate the accuracy of preoperative MRI for the identification of subscapularis tears. Our secondary aim involved the identification of factors that may be predictive for the presence of subscapularis tears. MATERIALS AND METHODS: This retrospective case series included patients undergoing shoulder arthroscopy due to rotator cuff injury. MRI was performed using a 1.5 T unit, and the results were assessed by a musculoskeletal radiologist. The findings were compared to those of arthroscopic inspection. RESULTS: A total of 93 shoulders were analyzed. The overall accuracy was 82 %, with values of 79 % for partial tears and 89 % for full-thickness tears. Tears requiring repair demonstrated an accuracy of 88 %. Infraspinatus tears, fatty degeneration of the subscapularis, biceps instability and age were identified as predictive factors for the presence of injury. CONCLUSIONS: MRI of the shoulder demonstrated an accuracy of 82 % for the diagnosis of subscapularis tears. The accuracy values for partial and full-thickness tears were 79 and 89 %, respectively. LEVEL DE EVIDENCE: III, development of diagnostic criteria with universally applied reference-nonconsecutive patients.

Serial structural MRI evaluation of arthroscopy rotator cuff repair: does Sugaya's classification correlate with the postoperative clinical outcomes?

INTRODUCTION: Sugaya's classification is the most commonly used for postoperative evaluation of rotator cuff repairs. However, the correlation between this classification and clinical outcomes after supraspinatus tendon repair were not performed with serial MRI examinations in standardized time intervals. MATERIALS AND METHODS: This prospective case series involved 54 patients undergoing repair of the supraspinatus tendon tear. Magnetic resonance imaging (MRI, 1.5 T) was used to determine the Sugaya's classifications at 3, 6, and 12 months, and these data were correlated with the visual analog scale for pain (VAS), Constant and University of California at Los Angeles (UCLA) assessments. RESULTS: Patients with types I, II, and ≥III of Sugaya's classification experienced pain of 1.27 ± 1.95, 1.00 ± 1.40, and 3.43 ± 3.36, respectively (p = 0.010), according to the VAS. The Constant and UCLA scales did not differ significantly. Type II predominated, though their percentage decreased over time (from 77.8 to 66.7 %), whereas type I became more frequent (from 1.9 to 20.4 %). CONCLUSIONS: The pain was more intense in patients classified as types III, IV, or V of Sugaya's classification. The postoperative appearance of the supraspinatus tendon was not correlated with the Constant and UCLA scales. The occurrence of type II, the most prevalent, decreased over time, whereas the occurrence of type I increased; these differences were not significant. Level de evidence: prospective cohort evaluation-level III.

Predictive Factors for the Healing of Rotator Cuff Repairs.

INTRODUCTION: Rotator cuff tears (RCTs) are a significant cause of shoulder pain. Rotator cuff repair is common, but healing failure is frequent and the reasons for the retear are still unclear. OBJECTIVE: This study aimed to determine if specific preoperative factors related to patients and tears affect the structural outcome after rotator cuff repair. METHODS: This is a multivariate prognostic model study, based on prospectively collected data from a retrospective cohort. We included individuals who received arthroscopic RCT repair from January 2013 to April 2022. Evaluations were performed using magnetic resonance imaging (MRI) at 12 months postoperatively, and clinical outcomes were measured using the American Shoulder and Elbow Surgeons (ASES) scale. Statistical analysis was conducted using multivariate logistic regression. RESULTS: The sample included 176 patients, with a retear rate of 35.2%. Male (p=0.029), smoking (p=0.026), full-thickness infraspinatus tears (p=0.007), and instability of the long head of the biceps (p=0.046) were identified as predictive factors for non-healing. Traumatic lesions (p=0.017) favored healing. All patients showed significant clinical improvement. At 24 months, patients with healed tendons had better clinical outcomes. CONCLUSION: Male sex, smoking, full-thickness infraspinatus tears, and instability of the long head of the biceps are predictive factors for retear after rotator cuff repair. Traumatic lesions favor tendon healing.

Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair.

BACKGROUND/HYPOTHESIS: Minimal clinically important difference (MCID) is a vital tool in the analysis of clinical results. It allows the determination of clinical relevance of statistical data. Our hypothesis was that specific differences between preoperative and postoperative scores would be able to accurately predict patient perception of improvement and satisfaction as reflected by anchor and distribution-based questions. METHODS: Retrospective cohort with patients that underwent rotator cuff repair. We evaluated the University of California at Los Angeles Shoulder Rating Scale (UCLA) and the American Shoulder and Elbow Surgeons Assessment Form (ASES) before and 12-months after surgery. Anchor-based, distribution-based and minimum detectable change (MDC) approaches were utilized. RESULTS: We evaluated 289 shoulders. The MCID for the UCLA scale was 4.5 points using the anchor method, 2.5 by the distribution method and 3.6 by MDC. Patients with a baseline score>20 presented a lower MCID (1.5, 1.1 and 1.7, respectively). For the ASES score, the MCID was 6.1 by the anchor method, 10.5 based on the distribution method and 26.3 by MDC. In the group of patients above the 60 point cutoff, the obtained values were 2.4, 4.9 and 13.6, respectively. CONCLUSION: The mean MCID value for the UCLA shoulder score is 3.5 points, ranging from 2.5 points (distribution method) to 4.5 points (anchor method). The mean MCID value for the ASES score was 15.2 points, ranging from 6.1 (anchor method) to 26.3 (MDC). Patients groups presenting with higher preoperative scores showed lower MCID values. This fact needs to be considered in postoperative comparisons between treatment groups. LEVEL OF EVIDENCE: Basic Science Study, Validation of Outcomes Instruments/Classification Systems.

Isokinetic evaluation of the shoulder and elbow after Latarjet procedure.

BACKGROUND/HYPOTHESIS: The Latarjet procedure changes the anatomy of the shoulder, moving the coracoid process distally through an incision in the subscapularis muscle. Some authors have studied the effect of this surgery on shoulder rotator strength. Our hypothesis is that the Latarjet procedure decreases elbow supination and flexion strength. METHODS: A retrospective case series, evaluating patients submitted to the Latarjet procedure between May 2013 and June 2017. Movements of the elbow (supination, pronation, flexion and extension) and shoulder (internal and external rotation) were evaluated bilaterally using a Biodex System 3 isokinetic dynamometer (Biodex Medical Systems, New York) in concentric/concentric mode. RESULTS: We evaluated 20 patients with an average follow-up of 36 months. In the elbow, we observed a 9.1% decrease in supination strength at a speed of 60°/s (p=0.044), without statistical difference at 120°/s (p=0.570). In the shoulder, there was a 13.5% decrease in external rotation strength at 60°/s and 4.5% at 180°/s (p=0.009 and p=0.040, respectively). The other movements did not demonstrate any statistically significant differences. CONCLUSION: After the Latarjet procedure, the supination strength at 60°/s was decreased, as was the external rotation strength of the shoulder at 60°/s and 180°/s. We did not observe any reduction in strength for shoulder flexion or internal shoulder rotation. LEVEL OF EVIDENCE: IV, case series.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach.

Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period ( p < 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% ( p < 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° ( p < 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively ( p < 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively ( p < 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period ( p = 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Surgical treatment of varus malunion of the proximal humerus with valgus osteotomy.

Among the complications of 2-part fractures of the upper end of the humerus, little attention has been paid to the treatment of the varus malunion. However, this deformity frequently causes pain and disability of the shoulder. To improve this condition, we treated this malunion with a valgus wedge osteotomy. From August 1995 to January 1999, 5 patients with this deformity, all complaining about pain or unsatisfactory function of the shoulder (University of California, Los Angeles score <13), underwent osteotomy and internal fixation with a plate and screws. The mean age was 53 years (range, 25-73 years), there were 4 male patients, and the left side was involved in 4 cases. The mean follow-up was 34 months (range, 22-63 months). Union occurred in all cases by 6 weeks. Three of the results were excellent, and two were good (University of California, Los Angeles score >30). All patients were satisfied with the treatment.

Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures.

INTRODUCTION: Proximal humerus fractures (PHF) are common fractures and are the third most common type of fractures among older adults. The most commonly used implants include the locking plate and the locking intramedullary nail. Areas covered: The aim of this study is to perform a literature review of biomechanical and clinical studies that compare the locking plate and intramedullary nail for PHF osteosynthesis. Expert commentary: Twelve clinical studies and seven biomechanical studies were identified that met this criterion. The findings of this review showed that intramedullary nailing and locking plate fixation yielded similar functional results, but with contrasting complication rates. The biomechanical studies showed controversial results, with most of the studies demonstrating better biomechanical properties for the intramedullary nail. Different types of intramedullary nail for PHF have different characteristics, with curvilinear nails presenting a higher risk of complications.

Fracture of the clavicle and second rib: an indirect injury from tricep dips.

Due to the recent rise in the interest in strength training, an increment in the number of lesions is expected, whether of the tendons, muscles, or bones. We describe a case of fracture involving the middle third of the clavicle and the second rib in a low-demand weightlifter. The fractures occurred suddenly while performing a triceps dips exercise, and the patient had no previous symptoms. He was treated conservatively and was able to return to sports six months later. To our knowledge, this is the first study describing the association of these fractures triggered by a single event of muscle contraction.

Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon.

OBJETIVES: To evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of disorders of the long head of the biceps tendon (LHBT). The secondary objective was to investigate predictive factors for tears and instability. METHODS: This retrospective case series involved patients undergoing shoulder arthroscopy due to rotator cuff injury. MRI was performed in a 1.5T scanner and was evaluated by a musculoskeletal radiologist. The findings were compared with those of arthroscopic inspection. RESULTS: A total of 90 shoulders were analyzed. Regarding tears, there was 67% sensitivity and 98% specificity. Regarding instabilities, the values were 53% and 72%, respectively. Tears and fatty degeneration of the infraspinatus are predictive factors for tears of the LHBT. Tears of the subscapularis and infraspinatus, retraction of the supraspinatus and infraspinatus equal to or greater than 30mm, and fatty degeneration of the infraspinatus and subscapularis are predictive factors for instability. CONCLUSION: Compared to arthroscopy, the shoulder MRI has a sensitivity of 67% and a specificity of 98% for the detection of complete tears of the LHBT. For instability, the values are 53% and 72%, respectively.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach / Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.