Introduction
Elbow arthroscopy has been popularized during the past 3 decades. It was initially utilized as a diagnostic tool and later on, it became an effective tool for the treatment of elbow pathologies. However, elbow arthroscopy is technically demanding, therefore it is liable to complications even when implemented by experienced surgeons. Therefore, the objective of this meta-analysis was to evaluate the rate of complications of elbow arthroscopy in the literature.
Methods
PubMed, Web of Science, and Embase were searched in February 2021. Eligibility criteria included clinical studies reporting postoperative complications following elbow arthroscopy. Excluded articles were abstracts, case reports, reviews, non-clinical studies, imaging studies, technique studies, and those not reporting postoperative complications.
The baseline data items that were collected included: the authors’ surnames, study year, level of evidence, age, number of elbows operated, diagnosis, procedure position, and follow-up time points. The primary outcome was the total complication rate for all studies. We further subdivided complications to entail all potential complication rates individually.
The statistical analysis entailed pooling the total complication rates by dividing the total complications by the overall sample size. Each individual complication was calculated by dividing the number of events of an individual complication divided by the number of patients at risk. For each individual complication, we only pooled patients in studies that reported that specific complication to avoid underestimating or overestimating individual complications.
Results
A total of 95 studies were included with 14,213 patients. The majority were case series with a level of evidence of IV. The age was variable across studies. Twelve studies reported complications in pediatric patients with a mean age ranging from 4-16 years. Whereas the rest of the studies reported outcomes on patients' mean ages 20-80. The main diagnoses for elbow arthroscopy were osteochondritis dissecans, primary osteoarthritis, post-traumatic stiffness/arthritis, and loose bodies. Not all studies reported patient position during the procedure, however, the most common position reported was the lateral position. The mean follow-up was variable across studies ranging from 1 month and up to 13 years.
The total complication rate was 8% (1136/14,213). Nerve injury was the most common complication with a rate of 1.95% of which most were transient. Ulnar nerve dysfunction was the most common nerve injury, with a rate of 1.95%. The second most injured nerve was the radial nerve (0.73%) followed by the lateral antebrachial cutaneous nerve (0.26%). The posterior interosseous and the median nerves had a similar injury rate of 0.17%. The least injured nerve was the medial antebrachial cutaneous nerve (0.09%).
In terms of infection, the superficial infection rate was 1.89% and the deep infection rate was 0.36%. Wound healing complications such as drainage or dehiscence were reported in 0.81%. Stiffness was found to be prevalent in 1.79% of patients, and instability in 1.36%. Complex regional pain syndrome was reported in five patients. The all-cause revision rate due to failure of arthroscopy was 1.9%.
Conclusion
This study highlights that elbow arthroscopy is a relatively safe procedure with low complication rates. However, surgeons must be conscious of its complications, and counsel patients accordingly.