Rapid recovery with continuous passive motion after arthroscopic elbow contracture release
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Continuous passive motion may result in a greater range of motion and faster recovery compared with physical therapy for some patients after arthroscopic release of elbow contractures, according to a presented study.
“[Continuous passive motion] CPM is indicated for patients with moderate to severe contractures, who need rapid recovery following surgery, for whom a small difference in range of motion would be important if it is just a mild contracture to begin with. Based on the results of this randomized controlled trial, my partners and I use CPM for these three indications, but we have changed our practice so that we offer, but no longer recommend, CPM for mild contractures,” Shawn W. O’Driscoll, MD, PhD, said at the virtual American Shoulder and Elbow Surgeons Annual Meeting.
In the prospective randomized controlled trial, O’Driscoll and colleagues studied if rehabilitation with CPM compared with PT after arthroscopic release of elbow contracture was linked to better range of motion and faster recovery. Inclusion criteria were patients who had contracture of at least 6 months and failed nonoperative treatment and who had arthroscopic capsulectomy or osteocapsular arthroplasty performed by a single surgeon. Overall, 60 patients were randomized 1:1 to either the CPM or PT group. Nine patients were excluded after randomization due to withdrawal of consent or intraoperative exclusion criteria. There were 24 patients in the CPM group and 27 patients in the PT group, with 100% follow-up obtained. Patients in both groups had no significant differences in baseline variables.
Primary outcome measures were arc of elbow motion at 1 year. Secondary outcomes were patient-reported outcomes, speed of recovery and functional testing of strength and endurance. Speed of recovery was assessed by measuring range of motion at 3 days and 6 and 12 weeks, and patients’ completion of a daily diary and weekly phone calls.
Patients in the CPM group had a faster and greater arc of motion than patients in the PT group, which was greater at all time points, O’Driscoll said. Patients in the CPM group also recovered a greater percentage of lost motion at all time points. The percentage of patients who achieved functional extension was similar, but the percentage of patients who achieved functional flexion, defined as flexion to at least 130°, was greater in the CPM group than the PT group.
A higher percentage of CPM patients achieved a functional arc of motion, defined as extension to at least 30° and flexion to at least 130°. Patients in the CPM group had an increased percentage of patients with a functional arc and ASES-e functional score at 6 weeks. There were no significant differences at any point in ASES-e pain score, as well as DASH summary outcome determination scores. Isometric and dynamic strength were better at 3 days with CPM. Elbow endurance was greater at 3 days and 1 year with CPM, O’Driscoll said.
Median times to normal elbow was perceived as normal and almost normal and to get their first goal after surgery were decreased for patients in the CPM group. Both groups showed no significant differences in pain and opioid consumption, he said.
“The benefits of CPM were a greater range of motion, greater percentage recovery of loss motion, faster recovery as evidenced by swelling and strength at 3 days; function and range of motion at 6 weeks; the time taken to get normal or almost normal; and how long to achieve number one goal of surgery, which was typically to get back to work; but the results were dependent on the severity of the contracture. The effect of CPM will be greater for moderate to severe contractures than it would be for mild contractures,” he said.
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O’Driscoll SW, et al. Paper 2. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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