Preoperative risk factors associated with patient outcomes following arthroscopic elbow contracture release

<h2>Abstract</h2><h3>Background</h3> Elbow contractures can occur due to several causes including age-related degenerative disease, inflammatory conditions, and post-traumatic injury. The resulting pain and reduced range of motion can significantly interfere with activities of daily living and impede patient functionality. One treatment option for elbow contractures is arthroscopic contracture release. The purpose of this study is to evaluate the preoperative risk factors associated with inferior clinical outcomes following arthroscopic elbow contracture release. <h3>Methods</h3> This retrospective cohort study included patients ≥18 years old who underwent arthroscopic elbow contracture release at a single institution between January 2015 and November 2024. Patients were included if they had pre- and postoperative Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Function (P-UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) scores collected at ≥6 months follow-up. Postoperative PROMIS scores were stratified into tertiles to identify patients with inferior clinical outcomes, defined as the lowest tertile for function and highest tertile for pain-related measures. Multivariate logistic regression analyses were performed to evaluate the association between preoperative patient factors and inferior postoperative outcomes. <i>P</i>-values were adjusted for multiple comparisons using the Bonferroni correction. Postoperative complications, including recurrent contracture, neurological symptoms, and reoperations, were also recorded. <h3>Result</h3> A total of 65 patients (47 male, 18 female) with a mean age of 52.2 years (range: 19 - 77) were followed for a mean of 18 months postoperatively for in-person assessments. Mean flexion improved from 122° (range, 80–145°) to 127° (90–150°) (p = 0.02), extension from 20° (0–50°) to 14° (–5–45°) (p < .001), and the flexion-extension arc from 103° (30–140°) to 113° (45–145°) (p < .001). Supination and pronation remained stable (79° to 81° and 85° to 85°, respectively). PROMIS scores were collected at a mean follow-up of 51.6 (range: 7 – 131) months. Function (p = 0.01) and pain intensity scores (p = 0.01) both improved significantly following surgery. Female sex (odds ratio [OR]: 10.7; p=0.02) was associated with low postoperative P-UE scores. <h3>Conclusions</h3> Arthroscopic elbow contracture release can improve function and range of motion; however, outcomes may vary based on preoperative patient characteristics. Female sex may be associated with lower postoperative PROMIS function scores.