Comparative Study of Arthroscopic and Open Surgery for Elbow Joint Stiffness: A Prospective Cohort Study

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The formation of heterotopic ossification (HO), contracture, and soft tissue adhesion are some of the main reasons behind the development of this disability. The aim of this study is to compare the efficiency of arthroscopic and open surgical management in elbow stiffness. Aims and Objectives: To compare the outcome of open and Arthroscopic surgery in the management of stiffness of the elbow joint. Methods: A prospective cohort study included Ninety patients with elbow-stiffness received open or arthroscopic arthrolysis. 55.5% of the women in Group 1 (arthroscopic) had an average age of 45.67 years, while 33.3% of the women in Group 2 (open) had an average age of 38.90 years. Functional outcomes were examined using Disability of the Arm, Shoulder, and Hand (DASH) scores, range of motion (ROM), and Numerical Rating Scale (NRS) pain ratings at 6 weeks, 3 months, and 6 months postoperatively. Results: The demographic comparison between arthroscopic and open surgery groups shows no significant differences in age (p = 0.0698), gender (p = 0.0644 for women and p = 0.0866 for men), or previous surgery (p = 0.0958). However, the ROM was significantly better in the arthroscopic group (103.5° vs. 64.8°) with a highly significant p-value of 0.001. Pain and disability scores were not significantly different between the groups. Conclusion: The study concluded that while both arthroscopic and open surgery groups showed improvements, the only statistically significant difference between the groups was in ROM, where the arthroscopic group demonstrated superior outcomes. arthroscopic open surgery joint stiffness elbow pain Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Elbow joint stiffness is a common complication that particularly develops following trauma. The formation of HO, contracture, and soft tissue adhesion are some of the main reasons behind the development of this disability. The intricate anatomy of the joint consists of three interlinking articulations; the humeroulnar, humeroradial, and proximal radioulnar joints. This intricate design creates a vulnerability in the elbow that makes them susceptible to reduced function [ 1 ]. For daily activities to function properly it is important to have sufficient ROM in the elbow joint. Typically for common daily activities a range between 30° and 130° flexion-extension arc is considered functional along with 50° of rotation of the forearm in both supination and pronation as shown by Morrey et al [ 2 ]. Diminishing this ROM can result in considerable disability that may disable a person's skill to carry out basic tasks such as operating a mobile phone and most importantly, can deteriorate their quality of life [ 3 ]. A stiff elbow typically has a flexion–extension range of under 100 degrees and a flexion contracture higher than 30 degrees. For serious problems, even a 50 degree decrease in flexibility can bring about an 80% loss of elbow functionality during normal activities [ 2 ]. The cause of elbow stiffness can be intrinsic or extrinsic or both at once. Soft tissue scarring and heterotopic ossification usually cause extrinsic contractures that stem from extra-articular sources [ 4 – 5 ]. 12 percent of traumatic injuries to the elbow result in stiffness needing surgical intervention [ 6 ]. For elbow stiffness treatment generally begins with conservative approaches including physiotherapy combined with static or dynamic progressive splinting. Restoration of a practical range of motion within six months is the goal of recommended conservative treatment. If the patient's functional requirements are higher than the achieved range of motion or if there is no significant improvement seen with conservative methods, then, surgical options can be explored [ 7 ]. Multiple factors influence the decision to undergo surgery including the ulnar nerve's condition and location of ossifications as well as the level of stiffness and articular involvement. Surgical management of elbow stiffness can be approached in two principal ways. One may choose between open arthrolysis surgery or arthroscopic arthrolysis surgery. Open arthrolysis, a more established procedure of the two, offers a direct view of the joint and includes several methods like lateral, medial, posterior, and combined techniques which can be bolstered with a hinged external fixator when required [ 8 – 11 ]. Even though open surgery provides good exposure and ease of access, arthroscopic arthrolysis has increased in popularity in recent times owing to its non-invasive method and fast recovery. Arthroscopic surgeries are becoming the procedure to opt for when there is mild contracture or region-specific symptoms. This approach makes it possible to remove adhesions as well as address surrounding osteophytes and capsular release while avoiding significant damage to neighboring structures [ 12 ]. The rising use of arthroscopic methods has not settled the debate over selecting between standard and open arthrolysis. Both strategies intend to address stiff elbow-related pain, recover functional motion, and improve quality of life; nonetheless, there is a shortage of studies that compare their outcomes. Even though studies show positive outcomes for both methods, there is a crucial need for direct, prospective comparisons between these two procedures to help make informed clinical decisions. So far, many articles have reported that the minimally invasive arthroscopic technique for treating elbow stiffness is advancing with better outcomes. It is important to close the current literature gap through a prospective comparison of functional outcomes for patients having open or arthroscopic surgery on their elbow due to stiffness. Evaluation of functional outcome scores can lead to a meaningful understanding of the advantages and disadvantages of these techniques. 2. Methods 2.1 Study design A total of 90 patients treated with elbow arthrolysis were enrolled in this prospective trial. Elbow stiffness that did not respond to conservative medical treatment for at least three months was the rationale for surgery. Group 1 included patients receiving arthroscopic arthrolysis with 55.5% women and 44.4% men with mean age of 45.67 years. Group 2 included patients receiving open arthrolysis with mean age of 38.90 years and 33.3% women and 66.6% men. Table 1 presents the demographic data of patients. Table 2 compares the delta values of DASH, ROM, and VAS with preoperative values. Six weeks, three months, and six months following surgery, the patients underwent a standardized clinical examination that included an assessment of their clinical outcomes using the DASH score, NRS, and ROM (extension/flexion). 2.2 Inclusion and exclusion criteria Patients with elbow arthrolysis where they are resistant to conservative management for 3 months and need surgery are included in the study. Patients with written informed consent and willing to participate in the study were included. Patients with incomplete postoperative evaluation forms completed within the designated follow-up times, patients who underwent further hardware removal during surgery, and patients undergoing other surgical procedures (e.g., ligament restoration due to inherent instability) were excluded. 2.3 Statistical analysis The statistical analysis was carried out using SPSS 27 for efficient analysis. The continuous data was expressed as mean±standard deviation. The discrete data was expressed as frequency and their percentages. The scores were analyzed using independent t-test while other parameters were analyzed using ANOVA. The level of significance was considered to be P<0.05. 2.4 Ethical approval The patients were given a thorough explanation of the study by the authors. The patients' permissions have been gotten. The concerned hospital's ethical committee has accepted the study's methodology. 3. Results 3.1 Participant Demographics and Baseline Characteristics In Table 1, the demographic data of participants in both the arthroscopic and open surgery groups are compared. The mean age of participants in the arthroscopic group is 45.67 years, while in the open group, it is 38.90 years. The p-value for the age comparison is 0.0698, which suggests no statistically significant difference in age between the two groups, though it approaches the threshold of significance. Regarding gender distribution, 55.5% of participants in the arthroscopic group are women compared to 33.3% in the open group, with a p-value of 0.0644. This difference is not statistically significant but indicates a trend toward significance. Similarly, the proportion of men in the open group (66.6%) is higher than in the arthroscopic group (44.4%), with a p-value of 0.0866, which is not significant. In terms of prior surgeries, 44.4% of participants in the arthroscopic group had undergone previous surgery compared to 64.4% in the open group, with a p-value of 0.0958, showing no significant difference. A major finding in this table is the ROM in extension and flexion, where the arthroscopic group shows significantly better outcomes (103.5° ± 23.9°) than the open group (64.8° ± 31.6°), with a highly significant p-value of 0.001. Regarding pain, the NRS scores are 5.8 (± 2.9) in the arthroscopic group and 4.9 (± 3.1) in the open group, with a p-value of 0.39, indicating no significant difference in pain levels between the two groups. The DASH scores are also similar between the two groups, with no significant differences. Overall, this table suggests that, except for the ROM, there are no statistically significant differences between the two groups in the analyzed demographic variables. Open surgery generally yields a more improved ROM, but comes with a higher rate of revision surgery, more ulnar nerve complications, and less improvement in DASH scores. It's more invasive but more beneficial in severe cases. Conversely, arthroscopic surgery is less invasive, leading to a lower rate of revision surgery, fewer ulnar nerve complications, and better DASH scores. While it offers less improved ROM, it's less often used in severe cases (Figure 2). Table 1 Demographic data of the participants in each group Arthroscopic Open p-value Age (years) 45.67 (± 14.89) 38.90 (± 15.67) 0.0698 Gender 25 (55.5%) women 15 (33.3%) women 0.0644 20 (44.4%) men 30 (66.6%) men 0.0866 Previous surgery 20 (44.4%) 29 (64.4%) 0.0958 ROM (extension/flexion) 103.5° (± 23.9°) 64.8° (± 31.6°) 0.001 NRS 5.8 (± 2.9) 4.9 (± 3.1) 0.39 DASH 37.8 (± 23.8) 38.7 (± 24.7) 0.29 Dominant limb 38 (84.4%) 25 (55.5%) 0.12 ROM: range of motion in extension and flexion, NRS: numerical rating scale, DASH: disability of the arm, shoulder and hand 3.2 Postoperative Outcomes: Range of Motion, Pain, and Disability Scores Table 3 provides an outcome assessment for participants in both the arthroscopic and open surgery groups, focusing on ROM, Visual Analogue Scale (VAS), and DASH scores at different postoperative time points (6 weeks, 3 months, and 6 months). For ROM , at 6 weeks, the arthroscopic group shows a mean improvement of 13.2° (± 22.4°) compared to 29.2° (± 23.9°) in the open group, with a p-value of 0.15, indicating no statistically significant difference between the two groups. At 3 months, the arthroscopic group improves by 19.4° (± 21.4°) compared to 33.9° (± 18.2°) in the open group, with a p-value of 0.71, again showing no significant difference. At 6 months, the arthroscopic group shows a mean improvement of 21.8° (± 21.9°) versus 37.2° (± 30.2°) in the open group, with a p-value of 0.99, indicating no statistically significant difference between the two groups across time points. For VAS (pain scores) , the arthroscopic group demonstrates a reduction of 2.8 points (± 2.5) at 6 weeks, compared to a reduction of 0.91 points (± 3.8) in the open group, with a p-value of 0.26, indicating no significant difference. At 3 months, the arthroscopic group shows a mean pain reduction of 3.2 points (± 2.9), while the open group shows a reduction of 1.71 points (± 3.7), with a p-value of 0.34, again showing no significant difference. By 6 months, the arthroscopic group has a pain reduction of 3.4 points (± 3.4) compared to 2.5 points (± 3.1) in the open group, with a p-value of 0.36, indicating no statistically significant difference in pain reduction. For DASH scores , which measure disability, at 6 weeks, the arthroscopic group shows a reduction of 4.3 points (± 27.8), compared to a reduction of 3.1 points (± 21.4) in the open group, with a p-value of 0.86, indicating no significant difference. At 3 months, the arthroscopic group sees a reduction of 16.9 points (± 26.5), compared to a reduction of 14.7 points (± 31.3) in the open group, with a p-value of 0.68, again showing no significant difference. At 6 months, the arthroscopic group demonstrates a reduction of 22.7 points (± 21.8), compared to 21.4 points (± 27.2) in the open group, with a p-value of 0.7, showing no significant difference in DASH scores between the groups over time. Table 3 Outcome assessment using ROM, VAS and DASH in the patients of each group Outcome assessment parameter Arthroscopic Open p-value ROM 6 weeks 13.2 (± 22.4) 29.2 (±23.9) 0.15 3 months 19.4 (± 21.4) 33.9 (± 18.2) 0.71 6 months 21.8 (± 21.9) 37.2 (± 30.2) 0.99 VAS 6 weeks -2.8 (± 2.5) -0.91 (± 3.8) 0.26 3 months -3.2 (± 2.9) -1.71 (± 3.7) 0.34 6 months -3.4 (±3.4) -2.5 (± 3.1) 0.36 DASH 6 weeks -4.3 (± 27.8) -3.1 (± 21.4) 0.86 3 months -16.9 (± 26.5) -14.7 (± 31.3) 0.68 6 months -22.7 (21.8) -21.4 (± 27.2) 0.7 ROM: range of motion in extension and flexion, VAS: Visual analogue scale, DASH: disability of the arm, shoulder and hand For the arthroscopic group, preoperative range of motion improved dramatically: at six weeks, it was 117.8° (±15.8°; p=0.01), up from 103.5° (±23.9) to 121.9° (±15.7°; p=0.001) after three months, and 124.7° (±12.8°; p=0.001) after six months. After six weeks, the mean ROM arc in the group getting open arthrolysis increased considerably to 94.5° (±22.1; p= 0.028), followed by 3 months to 99.7° (±22.6°, p= 0.015), and 6 months to 101.4° (±25.8°, p= 0.007) (Figure 3). When compared to preoperative values, there were no significant variations in the two groups' gains in elbow motion. Before surgery, the mean DASH score for the arthroscopic group was 37.8 points (±23.8 points). After six weeks, it improved to 30.1 points (±23.5 points, p = 0.16), after three months to 21.7 points (±21.1 points; p = 0.005), and after six months to 16.8 points (±16.7 points, p = 0.001). The DASH score in the open arthrolysis group increased by 38.7 points (±24.6 points) after surgery in comparison to its preoperative value. After six weeks, the score was 35.8 (±16.5, p = 0.76), after three months it was 29.2 (±24.7, p = 0.52), and after six months it was 19.8 (±17.8, p = 0.02) (Figure 4). In both groups, the NRS decreased following surgery. Nevertheless, the pain decreases only reached statistical significance in the arthroscopic group. After six weeks, the NRS in the arthroscopic group dropped from 5.8 points (±2.7 points) preoperatively to 3.5 points (±2.9, p=0.002), and after three months, it dropped from 3 points (±2.8 points, p=0.001) to 2.5 points (±2.7 points, p=0.001) six months later. In contrast, after 6 weeks postoperatively, the NRS in the open group decreased from 4.9 points (±2.9 points) to 4 points (±2.1 points; p= 0.34), 3.3 points (±2.6 points, p= 0.30) after 3 months, and 2.7 points (±2.6 points; p= 0.15) after 6 months (Figure 5). 4. Discussion Numerous studies conducted to analyze the functional outcomes of arthroscopic and open surgeries for elbow stiffness have reported improved range of motion (ROM) and Performance Scores for both procedures although significant variations are observed in specific aspects of recovery, complication rates, and need for revision surgery. A recent work by Lanzerath et al. involving 1666 patients from 27 studies found that the preoperative Mayo Elbow Performance Score significantly improved after both surgeries with a mean improvement of 28.9 for the open surgery group and 25.7 in the arthroscopically treated group. Both treatments restore function and mitigate the effects of elbow stiffness as demonstrated by postoperative MEPS scores of 89.7 and 88.8 after open and arthroscopic surgeries [13]. Although both methods provide similar functional results, studies show a notable difference in complication rates. In contrast to the arthroscopic group's 1.6% revision surgery rate, 6.3% of the open surgery group had revision surgery [13-21]. Complications that did not involve revision surgery occurred more often in the open group (18.1%) than in the arthroscopic group (9.1%). This variation is due to low-tissue-injury, and rapid recovery after arthroscopic surgery [9, 16, 19, 22-30]. Complications related to the ulnar nerve were common in the open surgeries. Doctors report a higher rate of transient and persistent nerve issues due to the exposure and dissection required in open procedures. This result indicates the complexities of protecting nerve function during open procedures. By contrast, the use of arthroscopies with smaller cuts and precise interventions seems to cut down the risk of nerve damage leading to lower complication levels [9,16-18, 23-30]. An important difference between the two groups lies in the degree of improvement in ROM. Lanzerath et al. reported that patients undergoing open surgery started with a much lower preoperative angle (42.7°) than those receiving arthroscopic treatment (68.1°). The open group achieved more significant improvement in ROM (70.4°) than the arthroscopic group (39.2°) [9, 13-39]. Similar data was reported by Leschinger et. al. as they studied 126 patients with stiff elbows and found that the ROM in the arthroscopic group improved from 103.3° to 123.5° over 6 months, representing a 20.2° increase. The open arthrolysis patients had a lower average ROM of 64.5° and improved from 36.4° to 100.9° at 6 months [40]. Kwak et al. also noted the same pattern in results and found that open procedures achieved more ROM but also experienced higher revision and complication rates [28]. Kodde et al. demonstrated that arthroscopic methods were more secure and had a complication rate of 5%, higher than the rates seen in open surgery [41]. The outcomes are reflective of the greater severity of contractures in the open group requiring a more invasive operation. Better ROM improvements after open surgery may be due to more comprehensive access that enables the removal of extensive heterotopic ossifications. Incorporating a hinged external fixator into the open group adds complexity to the analysis of both techniques. Those who received a hinged external fixator had improved MEPS scores and reduced revision rates after treatment. Treatment with a hinged fixator resulted in a complication rate that was 7.6 percentage higher (21.8%) than that seen in patients treated without it (14.2%) [13, 41]. These findings show that employing a hinged external fixator could increase joint stability and enhance functional results in more extreme situations while simultaneously raising the risk of non-revision issues possibly related to added hardware and complications from infection or mechanical problems. Work done by Leschinger et. al. reported improved DASH scores in both groups however the arthroscopic group achieved better reduction in disability over time. At the outset of treatment in the arthroscopic group, the mean DASH score was 37.3 points which reduced to 16.1 points six months into recovery. Six months after surgery, the DASH score of the open group fell from 38.2 points to 19.45 points [40]. The NRS indicated that pain levels in the arthroscopic surgery group decreased from 5.5 to 2.3 points after 6 months while it declined from 4.6 to 2.6 in the open group. However, no statistically significant differences were found. That variation may point to the less invasive approach of arthroscopy that might decrease pain post-operatively and boost patient comfort and contentment throughout recovery [40]. The findings reveal open and arthroscopic interventions can provide good recovery in patients suffering from elbow stiffness. More improvement of ROM for the open group might be due to a wider release of contractures that included structures like the medial collateral ligament (MCL). Patients experiencing severe stiffness or extensive physical restrictions may benefit from this method. Effective release of capsular contractures, osteophytes, and low soft tissue disruption, fewer complications, better pain relief, and a lower chance for revision surgery, emerge as major perks of arthroscopic surgery. If possible, arthroscopic methods should be chosen due to their less invasive nature and lower risk profile while open surgeries remain the preferred option for serious conditions. Table 4 Functional outcomes of open and arthroscopic surgeries of the published studies as reviewed Study Type of surgery Mean MEPS preop Mean MEPS postop Flexion arc preop, ° Flexion arc postop, ° Forearm rotation preop, ° Forearm rotation postop, ° Cohen et. al. Open 50 89 74 129 135 159 Mansat et. al. Open 62 81 49 94 128 138 Ring et. al. Open - 81 45 103 94 141 Sharma et. al. Open 65 85 55 110 - - Kulkarni et. al. Open 45 89 16 102 - - Park et. al. Open 73 94 55 115 - - Ayadi et. al. Open - 76 45 95 142 151 Ouyang et. al. Open 59 87 41 114 - - Koh et. al. Open 69 87 60 105 - - Koh et. al. Open - 92 45 112 - - Wang et. al. Open 62 97 43 130 139 146 Kruse et. al. Open 44 91 52 109 - - Chen et. al. Open 58 94 40 133 121 152 Zhou et. al. Open 68 96 27 126 148 154 Zheng et. al. Open 60 93 43 111 104 138 Gundes et. al. Open 60 85 45 110 170 180 Kwak et. al. Open 49 80 52 96 - - Sun et. al. Open 54 95 27 131 115 145 Sun et. al. Open 63 91 40 118 76 128 Xiong et. al. Open 69 91 38 114 110 141 Lapner et. al. Arthroscopic 64 90 108 126 - - Nguyen et. al. Arthroscopic 57 88 84 122 150 148 Kim et. al. Arthroscopic 60 87 77 117 - - Pederzini et. al. Arthroscopic 63 88 74 98 140 157 Wu et. al. Arthroscopic 68 92 49 115 - - Lubiatowski et. al. Arthroscopic 73 93 - - - - Rai et. al. Arthroscopic 63 90 50 110 - - Kwak et. al. Arthroscopic 52 81 72 107 - - 5. Conclusion The study concluded that while both arthroscopic and open surgery groups showed improvements, the only statistically significant difference between the groups was in ROM, where the arthroscopic group demonstrated superior outcomes. No significant differences were observed in age, gender, prior surgery, pain levels (NRS), or disability scores (DASH), indicating that aside from ROM, the two surgical approaches had comparable outcomes in most assessed parameters. In conclusion, individuals experiencing elbow stiffness that does not respond to conservative treatment have access to both arthroscopic and open arthrolysis as viable treatment choices. The arthroscopic group exhibited benefits in terms of decreased complication rates, faster recovery, and less postoperative discomfort, while the open surgery group showed higher improvements in ROM, particularly in patients with more severe stiffness. Even though the two groups' gains in pain and disability scores were comparable, the arthroscopic method might have a better risk profile, especially for those with mild stiffness. Open arthrolysis is still the preferable treatment for severe contractures requiring extensive release. However, where possible, arthroscopic procedures should be chosen due to their minimally invasive nature and reduced risks. The clinical contribution of this study lies in demonstrating that arthroscopic surgery offers superior outcomes in terms of ROM compared to open surgery, which may guide clinicians in selecting treatment options for patients requiring improved joint mobility. However, with no significant differences in pain reduction (NRS) or disability scores (DASH), the overall benefits of arthroscopy should be weighed against other factors like patient preference and recovery times. For future prospects, further studies could focus on long-term functional outcomes, patient satisfaction, and cost-effectiveness to better understand the broader implications of both surgical techniques. Additionally, exploring larger sample sizes or different patient populations could provide more definitive evidence and help refine surgical decision-making. Abbreviations ROM – Range of Motion DASH – Disability of the Arm, Shoulder, and Hand NRS – Numerical Rating Scale VAS – Visual Analogue Scale HO – Heterotopic Ossification MEPS – Mayo Elbow Performance Score MCL – Medial Collateral Ligament SPSS – Statistical Package for the Social Sciences Declarations Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethical Statement This study was conducted in accordance with the ethical standards of the institutional and national research committees and the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Sixth Affiliated Hospital of Xinjiang Medical University (Approval No. HL2024-021). Informed consent was obtained from all participants prior to inclusion in the study. Data Availability All data are available on request from corresponding author. Author Contributions MNK: writing – original draft. MB: review & editing. HJ review & editing. SM: review & editing. WS: review & editing. AUR: review & editing. XL: Writing – review & editing, Funding acquisition, Supervision. Funding This research was financially supported by the Sixth Affiliated Hospital of Xinjiang Medical University. 11. Acknowledgements The authors would like to express their sincere gratitude to the Sixth Affiliated Hospital of Xinjiang Medical University for providing institutional and financial support to this research. Special thanks are extended to all patients who participated in this study for their cooperation and trust. The authors also acknowledge the contributions of the hospital’s ethics committee for their guidance and approval of the study protocol. The authors further extend their appreciation to the research and medical staff involved in data collection, statistical analysis, and clinical follow-up, whose dedication and assistance made this study possible. Ethics Approval Not applicable. Consent to Participate Not applicable. Consent to Publication Not applicable. Conflict of Interest Not applicable. References Modabber, M. Ramin, and Jesse B. Jupiter. "Reconstruction for post-traumatic conditions of the elbow joint." JBJS 77.9 (1995): 1431-1446. Morrey, B. F., L. J. Askew, and E. Y. 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"Arthroscopic treatment for limitation of motion of the elbow: the learning curve." Knee Surgery, Sports Traumatology, Arthroscopy 19 (2011): 1013-1018. Pederzini, Luigi, et al. "Elbow arthroscopy in stiff elbow." Elbow Arthroscopy. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. 43-56. Wu, Xinghuo, et al. "Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness." Knee Surgery, Sports Traumatology, Arthroscopy 23 (2015): 2715-2720. Lubiatowski, Przemysław, et al. "Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture." Journal of shoulder and elbow surgery 27.9 (2018): e269-e278. Rai, Saroj, et al. "Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes." BMC musculoskeletal disorders 20 (2019): 1-8. Leschinger, Tim, et al. "A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness." Obere Extremitaet-Schulter-Ellenbogen-Hand 14.4 (2019): 263-269. Kodde, Izaäk F., et al. "Surgical treatment of post-traumatic elbow stiffness: a systematic review." Journal of shoulder and elbow surgery 22.4 (2013): 574-580. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 17 Dec, 2025 Editor assigned by journal 31 Oct, 2025 Submission checks completed at journal 30 Oct, 2025 First submitted to journal 30 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7893211","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571046746,"identity":"5524bf9f-9916-4562-9902-54e21235adff","order_by":0,"name":"Kaishaer Baihetiyaer","email":"","orcid":"","institution":"the Sixth Affiliated Hospital of Xinjiang Medical University，","correspondingAuthor":false,"prefix":"","firstName":"Kaishaer","middleName":"","lastName":"Baihetiyaer","suffix":""},{"id":571046754,"identity":"096f709d-eaa2-4095-bdc9-f474834bfcd0","order_by":1,"name":"Mayila Maimaiti","email":"","orcid":"","institution":"the Fourth 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1","display":"","copyAsset":false,"role":"figure","size":486970,"visible":true,"origin":"","legend":"\u003cp\u003eshows the operative techniques for open and arthroscopic procedures.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/bcddd6b090eeec7bca686807.png"},{"id":100362388,"identity":"5f4d81b0-04a3-42e0-a98d-c2d551251ce2","added_by":"auto","created_at":"2026-01-16 07:46:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":247776,"visible":true,"origin":"","legend":"\u003cp\u003eshows the key distinctions between open and arthroscopic surgical approaches.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/184df620598687d31660a641.png"},{"id":100361587,"identity":"c71c2ab9-a5df-415f-bab3-f43bf5378045","added_by":"auto","created_at":"2026-01-16 07:45:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28313,"visible":true,"origin":"","legend":"\u003cp\u003ePre and postoperative range of motion in patients of each group\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/25811748a5e22f6ca1f1e34a.png"},{"id":100361479,"identity":"755ee312-d0bf-43d9-9521-a8e7512a0f14","added_by":"auto","created_at":"2026-01-16 07:45:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24692,"visible":true,"origin":"","legend":"\u003cp\u003ePre and postoperative DASH in patients of each group\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/dce78c0f3e96bfdb90ae1912.png"},{"id":100361561,"identity":"fe90dd2a-d346-48ac-974e-2a263c35850c","added_by":"auto","created_at":"2026-01-16 07:45:16","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":22921,"visible":true,"origin":"","legend":"\u003cp\u003ePre and postoperative NRS in patients of each group\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/0fdc7330de64945e367731db.png"},{"id":100406152,"identity":"b4a96a62-52f3-40f4-a101-fb0ec68df125","added_by":"auto","created_at":"2026-01-16 12:45:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1726061,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7893211/v1/6ccff564-5006-4f26-8968-dbea9aa1805d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Study of Arthroscopic and Open Surgery for Elbow Joint Stiffness: A Prospective Cohort Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eElbow joint stiffness is a common complication that particularly develops following trauma. The formation of HO, contracture, and soft tissue adhesion are some of the main reasons behind the development of this disability. The intricate anatomy of the joint consists of three interlinking articulations; the humeroulnar, humeroradial, and proximal radioulnar joints. This intricate design creates a vulnerability in the elbow that makes them susceptible to reduced function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For daily activities to function properly it is important to have sufficient ROM in the elbow joint. Typically for common daily activities a range between 30\u0026deg; and 130\u0026deg; flexion-extension arc is considered functional along with 50\u0026deg; of rotation of the forearm in both supination and pronation as shown by Morrey et al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Diminishing this ROM can result in considerable disability that may disable a person's skill to carry out basic tasks such as operating a mobile phone and most importantly, can deteriorate their quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA stiff elbow typically has a flexion\u0026ndash;extension range of under 100 degrees and a flexion contracture higher than 30 degrees. For serious problems, even a 50 degree decrease in flexibility can bring about an 80% loss of elbow functionality during normal activities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The cause of elbow stiffness can be intrinsic or extrinsic or both at once. Soft tissue scarring and heterotopic ossification usually cause extrinsic contractures that stem from extra-articular sources [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. 12 percent of traumatic injuries to the elbow result in stiffness needing surgical intervention [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor elbow stiffness treatment generally begins with conservative approaches including physiotherapy combined with static or dynamic progressive splinting. Restoration of a practical range of motion within six months is the goal of recommended conservative treatment. If the patient's functional requirements are higher than the achieved range of motion or if there is no significant improvement seen with conservative methods, then, surgical options can be explored [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Multiple factors influence the decision to undergo surgery including the ulnar nerve's condition and location of ossifications as well as the level of stiffness and articular involvement.\u003c/p\u003e \u003cp\u003eSurgical management of elbow stiffness can be approached in two principal ways. One may choose between open arthrolysis surgery or arthroscopic arthrolysis surgery. Open arthrolysis, a more established procedure of the two, offers a direct view of the joint and includes several methods like lateral, medial, posterior, and combined techniques which can be bolstered with a hinged external fixator when required [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Even though open surgery provides good exposure and ease of access, arthroscopic arthrolysis has increased in popularity in recent times owing to its non-invasive method and fast recovery.\u003c/p\u003e \u003cp\u003eArthroscopic surgeries are becoming the procedure to opt for when there is mild contracture or region-specific symptoms. This approach makes it possible to remove adhesions as well as address surrounding osteophytes and capsular release while avoiding significant damage to neighboring structures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The rising use of arthroscopic methods has not settled the debate over selecting between standard and open arthrolysis. Both strategies intend to address stiff elbow-related pain, recover functional motion, and improve quality of life; nonetheless, there is a shortage of studies that compare their outcomes.\u003c/p\u003e \u003cp\u003eEven though studies show positive outcomes for both methods, there is a crucial need for direct, prospective comparisons between these two procedures to help make informed clinical decisions. So far, many articles have reported that the minimally invasive arthroscopic technique for treating elbow stiffness is advancing with better outcomes. It is important to close the current literature gap through a prospective comparison of functional outcomes for patients having open or arthroscopic surgery on their elbow due to stiffness. Evaluation of functional outcome scores can lead to a meaningful understanding of the advantages and disadvantages of these techniques.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 90 patients treated with elbow arthrolysis were enrolled in this prospective trial. Elbow stiffness that did not respond to conservative medical treatment for at least three months was the rationale for surgery. Group 1 included patients receiving arthroscopic arthrolysis with 55.5% women and 44.4% men with mean age of 45.67 years. Group 2 included patients receiving open arthrolysis with mean age of 38.90 years and 33.3% women and 66.6% men. Table 1 presents the demographic data of patients. Table 2 compares the delta values of DASH, ROM, and VAS with preoperative values. Six weeks, three months, and six months following surgery, the patients underwent a standardized clinical examination that included an assessment of their clinical outcomes using the DASH score, NRS, and ROM (extension/flexion).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with elbow arthrolysis where they are resistant to conservative management for 3 months and need surgery are included in the study. Patients with written informed consent and willing to participate in the study were included. Patients with incomplete postoperative evaluation forms completed within the designated follow-up times, patients who underwent further hardware removal during surgery, and patients undergoing other surgical procedures (e.g., ligament restoration due to inherent instability) were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statistical analysis was carried out using SPSS 27 for efficient analysis. The continuous data was expressed as mean\u0026plusmn;standard deviation. The discrete data was expressed as frequency and their percentages. The scores were analyzed using independent t-test while other parameters were analyzed using ANOVA. The level of significance was considered to be P\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Ethical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients were given a thorough explanation of the study by the authors. The patients\u0026apos; permissions have been gotten. The concerned hospital\u0026apos;s ethical committee has accepted the study\u0026apos;s methodology.\u003c/p\u003e"},{"header":"3.\tResults","content":"\u003cp\u003e\u003cstrong\u003e3.1 Participant Demographics and Baseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Table 1, the demographic data of participants in both the arthroscopic and open surgery groups are compared. The mean age of participants in the arthroscopic group is 45.67 years, while in the open group, it is 38.90 years. The p-value for the age comparison is 0.0698, which suggests no statistically significant difference in age between the two groups, though it approaches the threshold of significance. Regarding gender distribution, 55.5% of participants in the arthroscopic group are women compared to 33.3% in the open group, with a p-value of 0.0644. This difference is not statistically significant but indicates a trend toward significance. Similarly, the proportion of men in the open group (66.6%) is higher than in the arthroscopic group (44.4%), with a p-value of 0.0866, which is not significant.\u003c/p\u003e\n\u003cp\u003eIn terms of prior surgeries, 44.4% of participants in the arthroscopic group had undergone previous surgery compared to 64.4% in the open group, with a p-value of 0.0958, showing no significant difference. A major finding in this table is the ROM in extension and flexion, where the arthroscopic group shows significantly better outcomes (103.5\u0026deg; \u0026plusmn; 23.9\u0026deg;) than the open group (64.8\u0026deg; \u0026plusmn; 31.6\u0026deg;), with a highly significant p-value of 0.001. Regarding pain, the NRS scores are 5.8 (\u0026plusmn; 2.9) in the arthroscopic group and 4.9 (\u0026plusmn; 3.1) in the open group, with a p-value of 0.39, indicating no significant difference in pain levels between the two groups. The DASH scores are also similar between the two groups, with no significant differences. Overall, this table suggests that, except for the ROM, there are no statistically significant differences between the two groups in the analyzed demographic variables.\u003c/p\u003e\n\u003cp\u003eOpen surgery generally yields a more improved ROM, but comes with a higher rate of revision surgery, more ulnar nerve complications, and less improvement in DASH scores. It\u0026apos;s more invasive but more beneficial in severe cases. Conversely, arthroscopic surgery is less invasive, leading to a lower rate of revision surgery, fewer ulnar nerve complications, and better DASH scores. While it offers less improved ROM, it\u0026apos;s less often used in severe cases (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic data of the participants in each group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArthroscopic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e45.67 (\u0026plusmn; 14.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38.90 (\u0026plusmn; 15.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25 (55.5%) women\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e15 (33.3%) women\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e20 (44.4%) men\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e30 (66.6%) men\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePrevious surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e20 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eROM (extension/flexion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e103.5\u0026deg; (\u0026plusmn; 23.9\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e64.8\u0026deg; (\u0026plusmn; 31.6\u0026deg;)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eNRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e5.8 (\u0026plusmn; 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.9 (\u0026plusmn; 3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDASH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e37.8 (\u0026plusmn; 23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38.7 (\u0026plusmn; 24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDominant limb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38 (84.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eROM: range of motion in extension and flexion, NRS: numerical rating scale, DASH: disability of the arm, shoulder and hand\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Postoperative Outcomes: Range of Motion, Pain, and Disability Scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 provides an outcome assessment for participants in both the arthroscopic and open surgery groups, focusing on ROM, Visual Analogue Scale (VAS), and DASH scores at different postoperative time points (6 weeks, 3 months, and 6 months).\u003c/p\u003e\n\u003cp\u003eFor \u003cstrong\u003eROM\u003c/strong\u003e, at 6 weeks, the arthroscopic group shows a mean improvement of 13.2\u0026deg; (\u0026plusmn; 22.4\u0026deg;) compared to 29.2\u0026deg; (\u0026plusmn; 23.9\u0026deg;) in the open group, with a p-value of 0.15, indicating no statistically significant difference between the two groups. At 3 months, the arthroscopic group improves by 19.4\u0026deg; (\u0026plusmn; 21.4\u0026deg;) compared to 33.9\u0026deg; (\u0026plusmn; 18.2\u0026deg;) in the open group, with a p-value of 0.71, again showing no significant difference. At 6 months, the arthroscopic group shows a mean improvement of 21.8\u0026deg; (\u0026plusmn; 21.9\u0026deg;) versus 37.2\u0026deg; (\u0026plusmn; 30.2\u0026deg;) in the open group, with a p-value of 0.99, indicating no statistically significant difference between the two groups across time points.\u003c/p\u003e\n\u003cp\u003eFor \u003cstrong\u003eVAS (pain scores)\u003c/strong\u003e, the arthroscopic group demonstrates a reduction of 2.8 points (\u0026plusmn; 2.5) at 6 weeks, compared to a reduction of 0.91 points (\u0026plusmn; 3.8) in the open group, with a p-value of 0.26, indicating no significant difference. At 3 months, the arthroscopic group shows a mean pain reduction of 3.2 points (\u0026plusmn; 2.9), while the open group shows a reduction of 1.71 points (\u0026plusmn; 3.7), with a p-value of 0.34, again showing no significant difference. By 6 months, the arthroscopic group has a pain reduction of 3.4 points (\u0026plusmn; 3.4) compared to 2.5 points (\u0026plusmn; 3.1) in the open group, with a p-value of 0.36, indicating no statistically significant difference in pain reduction.\u003c/p\u003e\n\u003cp\u003eFor \u003cstrong\u003eDASH scores\u003c/strong\u003e, which measure disability, at 6 weeks, the arthroscopic group shows a reduction of 4.3 points (\u0026plusmn; 27.8), compared to a reduction of 3.1 points (\u0026plusmn; 21.4) in the open group, with a p-value of 0.86, indicating no significant difference. At 3 months, the arthroscopic group sees a reduction of 16.9 points (\u0026plusmn; 26.5), compared to a reduction of 14.7 points (\u0026plusmn; 31.3) in the open group, with a p-value of 0.68, again showing no significant difference. At 6 months, the arthroscopic group demonstrates a reduction of 22.7 points (\u0026plusmn; 21.8), compared to 21.4 points (\u0026plusmn; 27.2) in the open group, with a p-value of 0.7, showing no significant difference in DASH scores between the groups over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eOutcome assessment using ROM, VAS and DASH in the patients of each group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome assessment parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArthroscopic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13.2 (\u0026plusmn; 22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29.2 (\u0026plusmn;23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e19.4 (\u0026plusmn; 21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e33.9 (\u0026plusmn; 18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e21.8 (\u0026plusmn; 21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e37.2 (\u0026plusmn; 30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-2.8 (\u0026plusmn; 2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-0.91 (\u0026plusmn; 3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-3.2 (\u0026plusmn; 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-1.71 (\u0026plusmn; 3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-3.4 (\u0026plusmn;3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-2.5 (\u0026plusmn; 3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDASH\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-4.3 (\u0026plusmn; 27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-3.1 (\u0026plusmn; 21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-16.9 (\u0026plusmn; 26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-14.7 (\u0026plusmn; 31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e6 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-22.7 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e-21.4 (\u0026plusmn; 27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eROM: range of motion in extension and flexion, VAS: Visual analogue scale, DASH: disability of the arm, shoulder and hand\u003c/p\u003e\n\u003cp\u003eFor the arthroscopic group, preoperative range of motion improved dramatically: at six weeks, it was 117.8\u0026deg; (\u0026plusmn;15.8\u0026deg;; p=0.01), up from 103.5\u0026deg; (\u0026plusmn;23.9) to 121.9\u0026deg; (\u0026plusmn;15.7\u0026deg;; p=0.001) after three months, and 124.7\u0026deg; (\u0026plusmn;12.8\u0026deg;; p=0.001) after six months. After six weeks, the mean ROM arc in the group getting open arthrolysis increased considerably to 94.5\u0026deg; (\u0026plusmn;22.1; p= 0.028), followed by 3 months to 99.7\u0026deg; (\u0026plusmn;22.6\u0026deg;, p= 0.015), and 6 months to 101.4\u0026deg; (\u0026plusmn;25.8\u0026deg;, p= 0.007) (Figure 3). When compared to preoperative values, there were no significant variations in the two groups\u0026apos; gains in elbow motion.\u003c/p\u003e\n\u003cp\u003eBefore surgery, the mean DASH score for the arthroscopic group was 37.8 points (\u0026plusmn;23.8 points). After six weeks, it improved to 30.1 points (\u0026plusmn;23.5 points, p = 0.16), after three months to 21.7 points (\u0026plusmn;21.1 points; p = 0.005), and after six months to 16.8 points (\u0026plusmn;16.7 points, p = 0.001). The DASH score in the open arthrolysis group increased by 38.7 points (\u0026plusmn;24.6 points) after surgery in comparison to its preoperative value. After six weeks, the score was 35.8 (\u0026plusmn;16.5, p = 0.76), after three months it was 29.2 (\u0026plusmn;24.7, p = 0.52), and after six months it was 19.8 (\u0026plusmn;17.8, p = 0.02) (Figure 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn both groups, the NRS decreased following surgery. Nevertheless, the pain decreases only reached statistical significance in the arthroscopic group. After six weeks, the NRS in the arthroscopic group dropped from 5.8 points (\u0026plusmn;2.7 points) preoperatively to 3.5 points (\u0026plusmn;2.9, p=0.002), and after three months, it dropped from 3 points (\u0026plusmn;2.8 points, p=0.001) to 2.5 points (\u0026plusmn;2.7 points, p=0.001) six months later. In contrast, after 6 weeks postoperatively, the NRS in the open group decreased from 4.9 points (\u0026plusmn;2.9 points) to 4 points (\u0026plusmn;2.1 points; p= 0.34), 3.3 points (\u0026plusmn;2.6 points, p= 0.30) after 3 months, and 2.7 points (\u0026plusmn;2.6 points; p= 0.15) after 6 months (Figure 5).\u003c/p\u003e"},{"header":"4.\tDiscussion ","content":"\u003cp\u003eNumerous studies conducted to analyze the functional outcomes of arthroscopic and open surgeries for elbow stiffness have reported improved range of motion (ROM) and Performance Scores for both procedures although significant variations are observed in specific aspects of recovery, complication rates, and need for revision surgery. A recent work by Lanzerath et al. involving 1666 patients from 27 studies found that the preoperative Mayo Elbow Performance Score significantly improved after both surgeries with a mean improvement of 28.9 for the open surgery group and 25.7 in the arthroscopically treated group. Both treatments restore function and mitigate the effects of elbow stiffness as demonstrated by postoperative MEPS scores of 89.7 and 88.8 after open and arthroscopic surgeries [13].\u003c/p\u003e\n\u003cp\u003eAlthough both methods provide similar functional results, studies show a notable difference in complication rates. In contrast to the arthroscopic group\u0026apos;s 1.6% revision surgery rate, 6.3% of the open surgery group had revision surgery [13-21]. Complications that did not involve revision surgery occurred more often in the open group (18.1%) than in the arthroscopic group (9.1%). This variation is due to low-tissue-injury, and rapid recovery after arthroscopic surgery [9, 16, 19, 22-30].\u003c/p\u003e\n\u003cp\u003eComplications related to the ulnar nerve were common in the open surgeries. Doctors report a higher rate of transient and persistent nerve issues due to the exposure and dissection required in open procedures. This result indicates the complexities of protecting nerve function during open procedures. By contrast, the use of arthroscopies with smaller cuts and precise interventions seems to cut down the risk of nerve damage leading to lower complication levels [9,16-18, 23-30].\u003c/p\u003e\n\u003cp\u003eAn important difference between the two groups lies in the degree of improvement in ROM. \u0026nbsp;Lanzerath et al. reported that patients undergoing open surgery started with a much lower preoperative angle (42.7\u0026deg;) than those receiving arthroscopic treatment (68.1\u0026deg;). The open group achieved more significant improvement in ROM (70.4\u0026deg;) than the arthroscopic group (39.2\u0026deg;) [9, 13-39]. Similar data was reported by Leschinger et. al. as they studied 126 patients with stiff elbows and found that the ROM in the arthroscopic group improved from 103.3\u0026deg; to 123.5\u0026deg; over 6 months, representing a 20.2\u0026deg; increase. The open arthrolysis patients had a lower average ROM of 64.5\u0026deg; and improved from 36.4\u0026deg; to 100.9\u0026deg; at 6 months [40]. Kwak et al. also noted the same pattern in results and found that open procedures achieved more ROM but also experienced higher revision and complication rates [28]. Kodde et al. demonstrated that arthroscopic methods were more secure and had a complication rate of 5%, higher than the rates seen in open surgery [41]. The outcomes are reflective of the greater severity of contractures in the open group requiring a more invasive operation. Better ROM improvements after open surgery may be due to more comprehensive access that enables the removal of extensive heterotopic ossifications.\u003c/p\u003e\n\u003cp\u003eIncorporating a hinged external fixator into the open group adds complexity to the analysis of both techniques. Those who received a hinged external fixator had improved MEPS scores and reduced revision rates after treatment. Treatment with a hinged fixator resulted in a complication rate that was 7.6 percentage higher (21.8%) than that seen in patients treated without it (14.2%) [13, 41]. These findings show that employing a hinged external fixator could increase joint stability and enhance functional results in more extreme situations while simultaneously raising the risk of non-revision issues possibly related to added hardware and complications from infection or mechanical problems.\u003c/p\u003e\n\u003cp\u003eWork done by Leschinger et. al. reported improved DASH scores in both groups however the arthroscopic group achieved better reduction in disability over time. At the outset of treatment in the arthroscopic group, the mean DASH score was 37.3 points which reduced to 16.1 points six months into recovery. Six months after surgery, the DASH score of the open group fell from 38.2 points to 19.45 points [40]. The NRS indicated that pain levels in the arthroscopic surgery group decreased from 5.5 to 2.3 points after 6 months while it declined from 4.6 to 2.6 in the open group. However, no statistically significant differences were found. That variation may point to the less invasive approach of arthroscopy that might decrease pain post-operatively and boost patient comfort and contentment throughout recovery [40].\u003c/p\u003e\n\u003cp\u003eThe findings reveal open and arthroscopic interventions can provide good recovery in patients suffering from elbow stiffness. More improvement of ROM for the open group might be due to a wider release of contractures that included structures like the medial collateral ligament (MCL). Patients experiencing severe stiffness or extensive physical restrictions may benefit from this method. Effective release of capsular contractures, osteophytes, and low soft tissue disruption, fewer complications, better pain relief, and a lower chance for revision surgery, emerge as major perks of arthroscopic surgery. \u0026nbsp;If possible, arthroscopic methods should be chosen due to their less invasive nature and lower risk profile while open surgeries remain the preferred option for serious conditions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4\u003c/strong\u003e Functional outcomes of open and arthroscopic surgeries of the published studies as reviewed\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eType of surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean MEPS preop\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean MEPS postop\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFlexion arc preop, \u0026deg;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFlexion arc postop, \u0026deg;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eForearm rotation preop, \u0026deg;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eForearm rotation postop, \u0026deg;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCohen et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMansat et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRing et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSharma et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKulkarni et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePark et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAyadi et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOuyang et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKoh et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKoh et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWang et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKruse et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChen et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eZhou et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eZheng et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGundes et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKwak et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSun et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSun et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eXiong et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLapner et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNguyen et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKim et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePederzini et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWu et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLubiatowski et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRai et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKwak et. al.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArthroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"5.\tConclusion","content":"\u003cp\u003eThe study concluded that while both arthroscopic and open surgery groups showed improvements, the only statistically significant difference between the groups was in ROM, where the arthroscopic group demonstrated superior outcomes. No significant differences were observed in age, gender, prior surgery, pain levels (NRS), or disability scores (DASH), indicating that aside from ROM, the two surgical approaches had comparable outcomes in most assessed parameters.\u003c/p\u003e\n\u003cp\u003eIn conclusion, individuals experiencing elbow stiffness that does not respond to conservative treatment have access to both arthroscopic and open arthrolysis as viable treatment choices. The arthroscopic group exhibited benefits in terms of decreased complication rates, faster recovery, and less postoperative discomfort, while the open surgery group showed higher improvements in ROM, particularly in patients with more severe stiffness. Even though the two groups' gains in pain and disability scores were comparable, the arthroscopic method might have a better risk profile, especially for those with mild stiffness. Open arthrolysis is still the preferable treatment for severe contractures requiring extensive release. However, where possible, arthroscopic procedures should be chosen due to their minimally invasive nature and reduced risks.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe clinical contribution of this study lies in demonstrating that arthroscopic surgery offers superior outcomes in terms of ROM compared to open surgery, which may guide clinicians in selecting treatment options for patients requiring improved joint mobility. However, with no significant differences in pain reduction (NRS) or disability scores (DASH), the overall benefits of arthroscopy should be weighed against other factors like patient preference and recovery times.\u003c/p\u003e\n\u003cp\u003eFor future prospects, further studies could focus on long-term functional outcomes, patient satisfaction, and cost-effectiveness to better understand the broader implications of both surgical techniques. Additionally, exploring larger sample sizes or different patient populations could provide more definitive evidence and help refine surgical decision-making.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eROM – Range of Motion\u003cbr\u003e\u0026nbsp;DASH – Disability of the Arm, Shoulder, and Hand\u003cbr\u003e\u0026nbsp;NRS – Numerical Rating Scale\u003cbr\u003e\u0026nbsp;VAS – Visual Analogue Scale\u003cbr\u003e\u0026nbsp;HO – Heterotopic Ossification\u003cbr\u003e\u0026nbsp;MEPS – Mayo Elbow Performance Score\u003cbr\u003e\u0026nbsp;MCL – Medial Collateral Ligament\u003cbr\u003e\u0026nbsp;SPSS – Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the institutional and national research committees and the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of\u0026nbsp;the Sixth Affiliated Hospital of Xinjiang Medical University\u0026nbsp;(Approval No. HL2024-021). Informed consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data are available on request from corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMNK: writing \u0026ndash; original draft. MB: review \u0026amp; editing. HJ review \u0026amp; editing. SM: review \u0026amp; editing. WS: review \u0026amp; editing. AUR: review \u0026amp; editing. XL: Writing \u0026ndash; review \u0026amp; editing, Funding acquisition, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was financially supported by the\u0026nbsp;Sixth Affiliated Hospital of Xinjiang Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11. Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the Sixth Affiliated Hospital of Xinjiang Medical University for providing institutional and financial support to this research. Special thanks are extended to all patients who participated in this study for their cooperation and trust. The authors also acknowledge the contributions of the hospital\u0026rsquo;s ethics committee for their guidance and approval of the study protocol.\u003c/p\u003e\n\u003cp\u003eThe authors further extend their appreciation to the research and medical staff involved in data collection, statistical analysis, and clinical follow-up, whose dedication and assistance made this study possible.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eModabber, M. Ramin, and Jesse B. 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F. Morrey. \u0026quot;The column procedure: a limited lateral approach for extrinsic contracture of the elbow.\u0026quot; JBJS 80.11 (1998): 1603-15.\u003c/li\u003e\n\u003cli\u003eAyADi, Djamila, et al. \u0026quot;Results of open arthrolysis for elbow stiffness. A series of 22 cases.\u0026quot; Acta Orthop Belg 77.4 (2011): 453-7.\u003c/li\u003e\n\u003cli\u003eOuyang, Yuanming, et al. \u0026quot;Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion.\u0026quot; Orthopedics 36.2 (2013): e186-e192.\u003c/li\u003e\n\u003cli\u003eKruse, Kevin K., et al. \u0026quot;Release of the stiff elbow with mini-open technique.\u0026quot; Journal of Shoulder and Elbow Surgery 25.3 (2016): 355-361.\u003c/li\u003e\n\u003cli\u003eChen, Shuai, et al. \u0026quot;Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows.\u0026quot; Journal of Shoulder and Elbow Surgery 26.1 (2017): 133-139.\u003c/li\u003e\n\u003cli\u003eZheng, Wei, et al. \u0026quot;The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness.\u0026quot; Journal of Shoulder and Elbow Surgery 26.5 (2017): 809-814.\u003c/li\u003e\n\u003cli\u003eKwak, Jae-Man, et al. \u0026quot;Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra-and extra-articular elbow fractures.\u0026quot; Journal of shoulder and elbow surgery 28.10 (2019): 1998-2006.\u003c/li\u003e\n\u003cli\u003eSun, Ziyang, et al. \u0026quot;What range of motion and functional results can be expected after open arthrolysis with hinged external fixation for severe posttraumatic elbow stiffness?.\u0026quot; Clinical Orthopaedics and Related Research\u0026reg; 477.10 (2019): 2319-2328.\u003c/li\u003e\n\u003cli\u003eXiong, Hao, et al. \u0026quot;Effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open arthrolysis combined with hinged external fixation: a retrospective study.\u0026quot; Journal of Shoulder and Elbow Surgery 29.7 (2020): 1387-1393.\u003c/li\u003e\n\u003cli\u003eWang, Wei, et al. \u0026quot;Limited medial and lateral approaches to treat stiff elbows.\u0026quot; Orthopedics 38.6 (2015): e477-e484.\u003c/li\u003e\n\u003cli\u003eSun, Ziyang, et al. \u0026quot;A new pathologic classification for elbow stiffness based on our experience in 216 patients.\u0026quot; Journal of Shoulder and Elbow Surgery 29.3 (2020): e75-e86.\u003c/li\u003e\n\u003cli\u003eLapner, Peter C., Jordan M. Leith, and William D. Regan. \u0026quot;Arthroscopic debridement of the elbow for arthrofibrosis resulting from nondisplaced fracture of the radial head.\u0026quot; Arthroscopy: The Journal of Arthroscopic \u0026amp; Related Surgery 21.12 (2005): 1492-e1.\u003c/li\u003e\n\u003cli\u003eNguyen, Duong, et al. \u0026quot;Functional outcomes of arthroscopic capsular release of the elbow.\u0026quot; Arthroscopy: The Journal of Arthroscopic \u0026amp; Related Surgery 22.8 (2006): 842-849.\u003c/li\u003e\n\u003cli\u003eKim, Sung-Jae, et al. \u0026quot;Arthroscopic treatment for limitation of motion of the elbow: the learning curve.\u0026quot; Knee Surgery, Sports Traumatology, Arthroscopy 19 (2011): 1013-1018.\u003c/li\u003e\n\u003cli\u003ePederzini, Luigi, et al. \u0026quot;Elbow arthroscopy in stiff elbow.\u0026quot; Elbow Arthroscopy. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. 43-56.\u003c/li\u003e\n\u003cli\u003eWu, Xinghuo, et al. \u0026quot;Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness.\u0026quot; Knee Surgery, Sports Traumatology, Arthroscopy 23 (2015): 2715-2720.\u003c/li\u003e\n\u003cli\u003eLubiatowski, Przemysław, et al. \u0026quot;Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture.\u0026quot; Journal of shoulder and elbow surgery 27.9 (2018): e269-e278.\u003c/li\u003e\n\u003cli\u003eRai, Saroj, et al. \u0026quot;Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes.\u0026quot; BMC musculoskeletal disorders 20 (2019): 1-8.\u003c/li\u003e\n\u003cli\u003eLeschinger, Tim, et al. \u0026quot;A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness.\u0026quot; Obere Extremitaet-Schulter-Ellenbogen-Hand 14.4 (2019): 263-269.\u003c/li\u003e\n\u003cli\u003eKodde, Iza\u0026auml;k F., et al. \u0026quot;Surgical treatment of post-traumatic elbow stiffness: a systematic review.\u0026quot; Journal of shoulder and elbow surgery 22.4 (2013): 574-580.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"arthroscopic, open surgery, joint stiffness, elbow pain","lastPublishedDoi":"10.21203/rs.3.rs-7893211/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7893211/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eElbow joint stiffness is a common complication that particularly develops following trauma. The formation of heterotopic ossification (HO), contracture, and soft tissue adhesion are some of the main reasons behind the development of this disability. The aim of this study is to compare the efficiency of arthroscopic and open surgical management in elbow stiffness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and Objectives: \u003c/strong\u003eTo compare the outcome of open and Arthroscopic surgery in the management of stiffness of the elbow joint.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA prospective cohort study included Ninety patients with elbow-stiffness received open or arthroscopic arthrolysis. 55.5% of the women in Group 1 (arthroscopic) had an average age of 45.67 years, while 33.3% of the women in Group 2 (open) had an average age of 38.90 years. Functional outcomes were examined using Disability of the Arm, Shoulder, and Hand (DASH) scores, range of motion (ROM), and Numerical Rating Scale (NRS) pain ratings at 6 weeks, 3 months, and 6 months postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe demographic comparison between arthroscopic and open surgery groups shows no significant differences in age (p = 0.0698), gender (p = 0.0644 for women and p = 0.0866 for men), or previous surgery (p = 0.0958). However, the ROM was significantly better in the arthroscopic group (103.5° vs. 64.8°) with a highly significant p-value of 0.001. Pain and disability scores were not significantly different between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study concluded that while both arthroscopic and open surgery groups showed improvements, the only statistically significant difference between the groups was in ROM, where the arthroscopic group demonstrated superior outcomes.\u003c/p\u003e","manuscriptTitle":"Comparative Study of Arthroscopic and Open Surgery for Elbow Joint Stiffness: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:20:53","doi":"10.21203/rs.3.rs-7893211/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"218550749215664655093771792289189017593","date":"2026-01-13T23:06:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T15:22:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-17T06:08:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-31T09:59:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-30T14:40:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-10-30T14:37:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7083216a-d7bc-4ff3-9e9b-ec456458b509","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T06:20:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:20:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7893211","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7893211","identity":"rs-7893211","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}