E. Edward Khalfayan, M.D.
Arthroscopic surgery of the elbow is similar to arthroscopy of other joints. It allows the use of small incisions and small instruments to perform the surgery. The most common indications for elbow arthroscopy in sports medicine are to remove loose bodies and bone spurs. Other procedures such as microfracture or tennis elbow surgery can be done arthroscopically.
Loose bodies are fragments of bone and/or cartilage that become free floating. They may cause catching or locking of the elbow. They should be removed if they cause the elbow to catch or lock as this can result in further damage to the joint surface or articular cartilage and lead to arthritis. Arthritis results from the degeneration of articular cartilage. Articular cartilage is the cartilage that covers bone and provides the smooth surface of joints. Arthritis leads to the development of bone spurs that result in a loss of range of motion.
Elbow arthritis and loose bodies often occur together.
The bone spurs due to arthritis can cause elbow pain and nonoperative treatment like rest, ice, anti-inflammatory medicine, and occasional cortisone injections are usually the initial treatment. If nonoperative treatment is not successful, arthroscopic surgery can be done to remove the bone spurs, shave rough areas of articular cartilage damage, and sometimes improve range of motion by cutting the joint capsule.
X-Ray of Elbow with Loose Body and Arthritis
Loose Body Being Removed from the Back of the Elbow
Bone Spur in Back of the Elbow at the Olecranon
Bone Spur Removed
In adult pitchers, bone spurs are very common. They don’t always cause elbow pain. When they do cause problems, the pain is usually in the back of the elbow and occurs at ball release. The bone spurs can fragment and become loosely attached or may break off completely and become loose bodies. Arthroscopic surgery is done to remove the loose bodies or spurs when they cause pain with pitching.
The surgery is an outpatient procedure with patients going home the same day. A sling is used for a short period of time, usually a few days. Elbow physical therapy is started immediately to work on range of motion and to decrease swelling. Sometimes a CPM (Continuous Passive Motion) machine is used to help with range of motion.
Rehabilitation for removal of a loose body or bone spur usually takes several weeks to return to most activities. It can take 2-3 months to return to pitching.
Arthroscopy for microfracture of the Capitellum is sometimes done for Osteochondritis Dissecans lesions (see section on Elbow Throwing Injuries). These lesions sometimes leave a crater in the joint surface cartilage and bone directly underneath it. Microfracture involves using a small pick to puncture holes in the bone to create bleeding from it. This also allows the release of mesenchymal stem cells (MSCs) that can create scar cartilage (fibrocartilage) to cover the crater.
Arthroscopic View of Loose Body in Elbow and Osteochondritis Dissecans of Capitellum
Loose Body Being Removed
Loose Body Removed - a Fragment of Cartilage and Bone from Osteochondritis Dissecans lesion of the Capitellum
Osteochondritis Dissecans Lesion of Capitellum
Osteochondritis Dissecans lesion Prepared for Microfracture
Microfracture of Capitellum Osteochondritis Dissecans Lesion
Bleeding from Microfracture Site of Capitellum
Rehabilitation for a microfracture of the Capitellum takes months and depends on the size of the lesion. A sling is usually used for 3-6 weeks and physical therapy is started shortly after the surgery. A throwing program may be started 4 months after surgery. It may take 6 months to 1 year to recover enough to return to sports and as long as 12 to 18 months to return to pitching following microfracture surgery.