Management of Post-Traumatic Elbow Stiffness: A Systematic Review of Randomized Controlled Trials with Meta-Analysis

Introduction. This systematic review (SR) and meta-analysis aimed to assess the effectiveness of surgical and conservative treatments for post-traumatic elbow stiffness in improving pain, functionality, and quality of life. Methods. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted for English-language studies up to April 2024. Randomized clinical trials (RCTs) focusing on surgical or conservative interventions for post-traumatic elbow stiffness were included. Primary outcomes were pain, functionality, and quality of life. Study quality and risk of bias were assessed using the Cochrane Risk of Bias 2 tool, while evidence certainty was evaluated with GRADE methodology. Results. Twelve RCTs met the inclusion criteria. Surgical interventions, particularly open arthrolysis combined with early structured rehabilitation and intraoperative pain modulation, significantly improved long-term range of motion (ROM) compared to standard postoperative care, though evidence quality was low due to methodological limitations. Conservative treatments, such as muscle energy techniques (MET), provided short-term improvements in pain and functionality but lacked consistent long-term data. Conclusions. Conservative treatments like MET are recommended for mild to moderate post-traumatic elbow stiffness. Severe cases or those unresponsive to conservative care benefit more from open arthrolysis followed by early rehabilitation and adjunct therapies. Further high-quality RCTs are needed to confirm these findings and refine treatment protocols.