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Elbow Osteoarthritis

Osteoarthritis of the elbow — primary and post-traumatic, conservative and surgical options.

Overview

Nonoperative treatment is the first step in the early management of elbow osteoarthritis [2]. For patients with mild to moderate disease, elbow arthroscopic osteocapsular arthroplasty is a safe and efficacious treatment [1]. This procedure is recommended in the surgical management of elbow osteoarthritis [5] and can be recommended for its favorable overall treatment outcomes [29]. Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates [16]. Both open and arthroscopic debridement procedures are safe and effective in the treatment of elbow osteoarthritis [27]. Additionally, capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective [3].

Elbow arthroplasty remains a poor option for active patients due to high rates of complications and limited durability [7]. However, the range of indications for total elbow arthroplasty is broadening, with use for acute trauma and osteoarthritis becoming increasingly more common [14]. Total elbow replacement is a viable option for severe arthropathy in patients with congenital afibrinogenemia [11]. Shoulder arthroplasty is a reasonable option for select patients with osteoarthritis [7].

Elbow hemiarthroplasty is an option for young or active patients with end-stage posttraumatic arthritis who are unwilling to accept activity limitations, though high rates of revision surgery and revision to total elbow arthroplasty occur [22]. Interposition elbow arthroplasty using fascia lata graft for post-traumatic elbow osteoarthritis without ligament reconstruction provides favorable surgical outcomes with high satisfaction rates among young patients [26].

Anatomy & Pathophysiology

Osseous

In primary osteoarthritis, osteophytic change occurs predominantly in the ulnohumeral compartment [33], while joint space narrowing more frequently affects the radiocapitellar articulation [33]. Three-dimensional computational models have identified unique regions of bony impingement in patients with osteoarthritis of the elbow, such as between the radial head and a posterior capitellar osteophyte in extension [34]. An increase in carrying angle is associated with radial deviation of stress in the distal humerus between early and advanced stages of osteoarthritis [23].

Ligamentous

Deficiency of the ulnar collateral ligament (UCL) increased contact pressure within the posteromedial compartment of the elbow with an associated decrease in contact area [46]. Elbow ligament reconstruction effectively restores stability and limits progression to osteoarthritis in the long term [32]. Both posterolateral and posteromedial rotatory instability must be addressed surgically to restore elbow stability [40].

Kinematics & Functional Implications

Normal kinematics was preserved in the osteoarthritic elbow with a normal radiocapitellar joint [13]. Heterotopic ossification should be considered in patients with a mechanical block to function after injury to the elbow or surgery [39]. Flexion contracture is not primarily related to bony changes of the elbow in patients with obstetric brachial plexus injury [44].

Classification

Elbow osteoarthritis affects 55.0% of respondents aged 40 years or older, with a symptomatic prevalence of 22.6% [8]. Older age, male sex, and a history of elbow trauma are significant risk factors for the condition [8]. Primary osteoarthritis is characterized by relative preservation of articular cartilage, maintenance of joint space, and hypertrophic osteophyte formation [10]. In patients with a normal radiocapitellar joint (OAN group), normal kinematics are preserved in the osteoarthritic elbow [13].

BM Classification: Demonstrates substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [25].

HR Classification: Demonstrates substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [25].

Bony Landmarks Classification: Effectively delineates osteophyte distribution in elbow patients [36].

Clinical Presentation

Elbow osteoarthritis is a prevalent condition, with a general prevalence of 55.0% in respondents aged 40 years or older and a symptomatic prevalence of 22.6% [8]. Older age, male sex, and a history of elbow trauma are significant risk factors for the disease [8]. Primary osteoarthritis predominantly affects middle-aged men undertaking heavy manual work [28]. Pathologically, primary elbow osteoarthritis is characterized by relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation [10].

Clinically, primary elbow osteoarthritis presents with pain, limited movement, and potential ulnar nerve symptoms [28]. Nonoperative treatment remains the first step in the early management of elbow osteoarthritis [2]. Nonsurgical management may provide relief in early stages of elbow arthritis [15].

Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands [15]. The appropriate treatment depends on these same factors [4], with surgical treatment based on disease etiology, severity of degeneration, and patient age [6]. Arthroscopic treatment of elbow osteoarthritis is indicated for pain at motion extremes [15]. Total elbow arthroplasty is indicated for pain throughout the arc of motion in elbow arthritis [15].

Investigations

Nonoperative treatment remains the first step in the early management of elbow osteoarthritis [2]. Primary osteoarthritis of the elbow is characterized by relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation [10]. Osteophytic change occurs predominantly in the ulnohumeral compartment of the elbow [33], whereas joint space narrowing more frequently affects the radiocapitellar articulation in primary osteoarthritis [33]. An increase in carrying angle is associated with radial deviation of stress in the distal humerus subchondral bone density distribution between early and advanced stages of osteoarthritis [23].

Plain radiography: Normal kinematics was preserved in the osteoarthritic elbow with a normal radiocapitellar joint [13]. Both the BM and HR classification systems demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [25].

CT: CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis [51]. Three-dimensional computational models identified unique regions of bony impingement, such as between the radial head and a posterior capitellar osteophyte in extension [34].

MRI: MRI should be performed if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage in cases of osteochondritis dissecans of the capitellum [50].

Treatment

Non-Operative Management

Nonoperative treatment remains the first step in the early management of elbow osteoarthritis [2]. Nonsurgical management may provide relief in early stages of elbow arthritis [15].

Operative

Indications: The appropriate treatment for elbow arthritis depends on the etiology, severity, patient age, and functional demands [4]. Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age [6]. Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands [15]. Primary elbow osteoarthritis predominantly affects middle-aged men undertaking heavy manual work, presenting with pain, limited movement, and potential ulnar nerve symptoms [28].

Surgical Approach / Technique: Elbow arthroscopic osteocapsular arthroplasty (AOA) is a safe, efficacious treatment for patients with mild to moderate osteoarthritis [1]. Capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective [3]. Arthroscopic debridement is recommended in the surgical management of patients with osteoarthritis of the elbow based on computer simulation [5]. Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates [16]. Open and arthroscopic debridement procedures are safe and effective in the treatment of elbow osteoarthritis [27]. Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis, including advanced-stage primary disease [29]. Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management [30]. Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management [31]. Surgical debridement is an effective treatment for the disabling symptoms of primary elbow osteoarthritis with an acceptable complication rate [37]. Arthroscopic debridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome [38]. Osteocapsular debridement, a non-arthroplasty option, is safe and effective in treating patients with elbow arthritis [47].

Implant Selection: Total elbow arthroplasty is a surgical option for pain throughout the arc of motion in elbow arthritis [15]. Shoulder arthroplasty is a reasonable option for select patients with osteoarthritis, whereas elbow arthroplasty remains a poor option for active patients due to high rates of complications and limited durability [7]. The range of indications for total elbow arthroplasty is broadening, with use for acute trauma and osteoarthritis becoming increasingly common [14]. Total elbow replacement is a viable option for severe arthropathy in patients with congenital afibrinogenemia, achieving satisfactory results with no complications [11].

Other Considerations: Interposition elbow arthroplasty using fascia lata graft for post-traumatic elbow osteoarthritis without ligament reconstruction provides favorable surgical outcomes with high satisfaction rates among young patients [26].

Complications

General Arthroplasty Outcomes: Total elbow arthroplasty remains a poor option for active patients due to high rates of complications and limited durability [7]. However, total elbow arthroplasty has an acceptable complication rate [42].

Arthroscopic and Open Debridement Outcomes: Elbow arthroscopic osteocapsular arthroplasty is a safe treatment for patients with mild to moderate osteoarthritis [1]. Elbow arthroscopic debridement for primary degenerative osteoarthritis results in low complication and reoperation rates [16]. Arthroscopic osteophyte resection and capsulectomy was safe in the studied series [20]. Capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach is associated with a low rate of complications [3].

Other Considerations: Osteoarthritis is not induced and there is no danger of recurrence in the medium term following surgical treatment for chondromatosis of the elbow [41].

Recovery

Nonoperative treatment is the first step in the early management of elbow osteoarthritis [2]. Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands [15]. Nonsurgical management may provide relief in early stages of elbow arthritis [15]. Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age [6].

Surgical Options: Arthroscopic osteocapsular arthroplasty (AOA): A safe and efficacious treatment for patients with mild to moderate osteoarthritis [1]. Clinical outcomes for primary elbow OA patients undergoing arthroscopic OCA improve from preoperative assessment to short- and medium-term follow-up, although range of motion decreases between short- and medium-term follow-up [18]. Arthroscopic elbow debridement provides satisfactory elbow function and improvement in pain with little chance of reoperation at midterm follow-up for both posttraumatic and primary degenerative osteoarthritis [9].

Open Debridement and Resection: Capsulectomy and debridement through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective for primary osteoarthritis of the elbow [3]. Most patients undergoing open debridement and radiocapitellar replacement have an uneventful postoperative course with a painless elbow joint and satisfactory functional recovery at short-term follow-up [19]. Open and arthroscopic treatment yields similar results in experienced hands, though patients may experience some degree of recurrence or motion loss [56].

Arthroplasty: Elbow arthroplasty remains a poor option for active patients due to high rates of complications and limited durability [7]. Elbow arthroplasty is a reasonable option for select patients with osteoarthritis [7]. Surgical options for elbow arthritis range from arthroscopic debridement for pain at motion extremes to total elbow arthroplasty for pain throughout the arc of motion [15]. Radiocapitellar prosthetic arthroplasty largely preserves elbow kinematics and stability [24]. Revision radiocapitellar arthroplasty by mismatched implant components is a salvage option that improved Mayo elbow performance scores from poor to good/excellent with no signs of implant failure at a minimum three-year follow-up [12]. Elbow hemiarthroplasty is an option for young or active patients with end-stage posttraumatic arthritis who are unwilling to accept activity limitations, though it is associated with high rates of revision surgery and revision to total elbow arthroplasty [22].

Other Considerations: Elbow ligament reconstruction effectively restores stability and limits progression to osteoarthritis in the long term [32].

Key Evidence

  • [L4] Elbow AOA is a safe, efficacious treatment for patients with mild to moderate osteoarthritis. (10.1016/j.jhsa.2015.11.018)
  • [L5] Nonoperative treatment remains the first step in the early management of elbow osteoarthritis. (10.2106/jbjs.e.00568)
  • [L4] This approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow. (10.1016/j.jhsa.2011.07.018)
  • [L5] The appropriate treatment for elbow arthritis depends on the etiology, severity, patient age, and functional demands. (10.1016/j.jhsa.2009.02.019)
  • [L4] The study recommends this technique in the surgical management of patients with osteoarthritis of the elbow. (10.1302/0301-620x.96b2.30714)
  • [L5] Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age. (10.1016/j.jhsa.2007.12.022)
  • [L5] Shoulder arthroplasty is a reasonable option for select patients with osteoarthritis, whereas elbow arthroplasty remains a poor option for active patients due to high rates of complications and limited durability. (10.1016/j.jht.2022.02.002)
  • [L3] The prevalence of elbow OA was 55.0% in respondents aged 40 years or older, with a symptomatic prevalence of 22.6%; older age, male sex, and a history of elbow trauma were identified as significant risk factors. (10.1016/j.jse.2018.02.049)
  • [L3] Patients with either pathology can expect satisfactory elbow function and an improvement in pain with little chance of reoperation at the midterm of the follow-up duration. (10.1016/j.jseint.2021.07.018)
  • [L4] Primary osteoarthritis of the elbow is unique due to relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation. (10.5435/00124635-200802000-00005)
  • [L4] The patient achieved satisfactory results with no complications, demonstrating that total elbow replacement is a viable option for severe arthropathy in this rare condition. (10.2106/jbjs.i.00149)
  • [L4] At a minimum of three-year follow-up, both cases improved from poor to good and excellent Mayo elbow performance scores with no signs of implant failure on standard radiographs. (10.1177/17585732241297152)
  • [L4] Normal kinematics was preserved in the osteoarthritic elbow with a normal radiocapitellar joint (OAN group). (10.1016/j.jhsa.2013.02.006)
  • [L2] The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. (10.1302/2058-5241.5.190036)
  • [L5] Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands; nonsurgical management may provide relief in early stages, while surgical options range from arthroscopic debridement for pain at motion extremes to total elbow arthroplasty for pain throughout the arc of motion. (10.1016/j.jhsa.2012.12.037)
  • [L1] Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. (10.1016/j.arthro.2017.08.247)
  • [L4] Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA showed that the clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although ROM decreased between short- and medium-term follow-up. (10.1177/23259671231162398)
  • [L4] Most patients had an uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional recovery at short-term follow-up. (10.1016/j.jse.2011.08.071)
  • [L4] This procedure addresses the pathologic processes associated with arthritis of the elbow and was safe and effective in this series. (10.1016/j.jse.2007.04.005)
  • [L4] Elbow hemiarthroplasty is an option for young or active patients with end-stage posttraumatic arthritis who are unwilling to accept activity limitations, though high rates of revision surgery and revision to total elbow arthroplasty occur. (10.5435/jaaos-d-18-00055)
  • [L3] An increase in carrying angle is associated with radial deviation of stress. (10.1097/corr.0000000000002921)
  • [L4] The procedure largely preserves elbow kinematics and stability. (10.1016/j.jse.2014.01.042)
  • [L3] Both the BM and HR classification systems demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow. (10.1016/j.jse.2014.10.015)
  • [L4] It provides favorable surgical outcomes with high satisfaction rates among young patients with elbow osteoarthritis. (10.1016/j.jhsg.2024.05.002)
  • [L5] However, from the data we obtained the open and arthroscopic debridement procedures seem to be safe and effective in the treatment of elbow OA. (10.1186/s12891-018-2318-x)
  • [L4] Primary elbow osteoarthritis predominantly affects middle-aged men undertaking heavy manual work, presenting with pain, limited movement, and potential ulnar nerve symptoms. (10.1111/j.1758-5740.2010.00089.x)
  • [L4] Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. (10.1016/j.jse.2019.09.036)
  • [L1] Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management. (10.1016/j.jse.2020.01.061)
  • [L2] Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management. (10.1016/j.jse.2020.01.060)
  • [L4] Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term. (10.1016/j.jseint.2022.12.009)
  • [L3] Osteophytic change occurs predominantly in the ulnohumeral compartment of the elbow, whereas joint space narrowing more frequently affects the radiocapitellar articulation. (10.1016/j.jse.2006.08.005)
  • [L4] Three-dimensional computational models identified the locations and volumes of bony impingement in patients with osteoarthritis of the elbow and highlighted unique regions of impingement, such as between the radial head and a posterior capitellar osteophyte in extension. (10.1016/j.jhsa.2013.03.035)
  • [L3] The bony landmarks classification system effectively delineated osteophyte distribution in elbow patients. (10.1186/s13018-025-06145-9)
  • [L1] Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate. (10.1302/2058-5241.5.190095)
  • [L4] Arthroscopic debridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. (10.1016/j.jse.2014.01.009)
  • [L4] Its presence should be considered in patients in whom there is a mechanical block to function after injury to the elbow or surgery. (10.1016/j.jse.2007.06.018)
  • [L4] Both directions of instability must be addressed surgically to restore elbow stability. (10.1016/j.injury.2007.01.039)
  • [L3] Osteoarthritis is not induced and there is no danger of recurrence in the medium term. (10.1016/j.arthro.2007.12.002)
  • [L5] Total elbow arthroplasty has become a successful reconstruction for painful destructive arthritis about the elbow with an acceptable complication rate. (10.1016/j.jhsa.2009.02.021)
  • [L4] This indicates that flexion contracture is not primarily related to bony changes of the elbow. (10.5435/jaaos-d-17-00110)
  • [L5] Under the conditions tested, deficiency of the UCL increased contact pressure within the posteromedial compartment of the elbow with associated decrease in the contact area. (10.1016/j.arthro.2013.03.046)
  • [Commentary] Osteocapsular debridement, a non-arthroplasty option, proves to be safe and effective in treating patients with elbow arthritis, making the elbow more forgiving than previously thought. (10.1016/j.arthro.2020.10.029)
  • [Case_report] The authors recommend performing an MRI if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage. (10.1007/s00402-005-0018-0)
  • [L1] CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. (10.1016/j.jse.2021.04.001)
  • [Commentary] Open and arthroscopic treatment yields similar results in experienced hands, but patients may have some degree of recurrence or motion loss. (10.1016/j.arthro.2019.02.004)

See Also

References

[1] Outcomes of Elbow Arthroscopic Osteocapsular Arthroplasty. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.018

[2] Management of Elbow Osteoarthritis. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00568

[3] Capsulectomy and Debridement for Primary Osteoarthritis of the Elbow Through a Medial Trans-Flexor Approach. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.07.018

[4] Elbow Arthritis: Current Concepts. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.019

[5] Arthroscopic debridement in the treatment of patients with osteoarthritis of the elbow, based on computer simulation. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b2.30714

[6] Surgical Options for the Arthritic Elbow. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.12.022

[7] Surgical management of osteoarthritis in the shoulder and elbow. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2022.02.002

[8] The prevalence of elbow osteoarthritis in Japanese middle-aged and elderly populations: the relationship between risk factors and function. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.049

[9] Midterm outcomes and survivorship of arthroscopic elbow debridement: a comparison of posttraumatic versus primary degenerative osteoarthritis. JSES International. 2022. DOI: 10.1016/j.jseint.2021.07.018

[10] Primary Osteoarthritis of the Elbow: Current Treatment Options. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200802000-00005

[11] Severe Elbow Arthropathy in a Patient with Congenital Afibrinogenemia. The Journal of Bone & Joint Surgery. 2010. DOI: 10.2106/jbjs.i.00149

[12] Revision radiocapitellar arthroplasty by mismatched implant components – A salvage option: A report of two cases with a minimum three-year follow-up. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241297152

[13] Kinematic Changes in Elbow Osteoarthritis: In Vivo and 3-Dimensional Analysis Using Computed Tomographic Data. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.006

[14] Global trends in indications for total elbow arthroplasty: a systematic review of national registries. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.190036

[15] Elbow Arthritis: Current Concepts. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.12.037

[16] Arthroscopic Debridement for Primary Degenerative Osteoarthritis of the Elbow Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.247

[18] Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231162398

[19] Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow: a multicenter study. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.08.071

[20] Osteoarthritis of the elbow: Results of arthroscopic osteophyte resection and capsulectomy. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.04.005

[22] Outcomes After Hemiarthroplasty of the Elbow for the Management of Posttraumatic Arthritis: Minimum 2-Year Follow-up. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00055

[23] How Does the Subchondral Bone Density Distribution of the Distal Humerus Change Between Early and Advanced Stages of Osteoarthritis?. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002921

[24] Radiocapitellar prosthetic arthroplasty: a report of 6 cases and review of the literature. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.042

[25] Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.015

[26] Functional Outcomes Following Interposition Elbow Arthroplasty Using Fascia Lata Graft for Post-Traumatic Elbow Osteoarthritis Without Ligament Reconstruction: A Minimum 3-Year Follow-Up Study. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.05.002

[27] Treatment of osteoarthritis of the elbow with open or arthroscopic debridement: a narrative review. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2318-x

[28] Primary Elbow Osteoarthritis: An Updated Review. Shoulder & Elbow. 2011. DOI: 10.1111/j.1758-5740.2010.00089.x

[29] Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography–based classification. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.036

[30] Patient and Procedure Specific Variables Associated with Revision or Removal of Radial Head Arthroplasty. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.061

[31] The Clinical Impact of Different Approaches to Osteocapsular Debridement for Primary Osteoarthritis of the Elbow: A Systematic Review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.060

[32] Lateral elbow ligament reconstruction for posterolateral rotatory instability: 10 years follow-up in 32 patients. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.009

[33] Radiographic changes at the elbow in primary osteoarthritis: A comparison with normal aging of the elbow joint. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.08.005

[34] Identifying the Location and Volume of Bony Impingement in Elbow Osteoarthritis by 3-Dimensional Computational Modeling. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.035

[36] Bony landmarks guided mapping of the osteophytes of the elbow osteoarthritis patients: a three dimensional computed tomograph based study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06145-9

[37] Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.190095

[38] Arthroscopic débridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.009

[39] Heterotopic ossification after the Outerbridge-Kashiwagi procedure in the elbow. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.06.018

[40] Combined posterolateral and posteromedial rotatory instability of the elbow. Injury Extra. 2007. DOI: 10.1016/j.injury.2007.01.039

[41] Arthroscopic and Open Options for Surgical Treatment of Chondromatosis of the Elbow. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2007.12.002

[42] Total Elbow Arthroplasty: Surgical Technique. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.021

[44] Natural History of the Elbow Bony Architecture in Patients With Obstetric Brachial Plexus Injury and the Association With Flexion Contractures. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00110

[46] Impact of Ulnar Collateral Ligament Tear on Contact Pressure and Contact Area in the Posteromedial Compartment of the Elbow (SS‐39). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.046

[47] Editorial Commentary: Arthroscopic Elbow Arthritis Treatment With Osteocapsular Debridement Yields Favorable Results: On Second Thought, the Elbow Isn’t That Unforgiving. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.10.029

[50] Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s00402-005-0018-0

[51] Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.04.001

[56] Editorial Commentary: Open Versus Arthroscopic Elbow Osteocapsular Arthroplasty. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2019.02.004

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.