During the last two decades, we have made tremendous progress in orthopaedic surgery in terms of limiting the negative impact of surgical dissection on patient functional outcomes. The expanding use of the arthroscope has been at the forefront of these advances. Limiting the breadth, depth, and imprecision of surgical dissection has obvious benefits that have been well documented in hundreds of musculoskeletal procedures.
In the August 3, 2016 issue of The Journal, Kim et al. demonstrate arthroscopic repair of elbow instability following elbow dislocations with injury to the lateral ulnar collateral ligament. Despite the notable success reported by the authors in 13 patients, arthroscopic elbow ligament repair is obviously a technique that requires careful preparation, and patients should be advised to work with a surgeon who is experienced in this specific application of arthroscopy.
This study does not address the question of whether or not surgery is indicated for an individual patient with post-dislocation elbow instability. Comparing outcomes among surgically managed and non-surgically managed patients would be the mode of addressing that important question. Nevertheless, we should continue efforts to advance “limited surgical damage” approaches by applying appropriate clinical research designs to clarify the reward /risk tradeoffs related to patient outcomes.
Marc Swiontkowski, MD