一般 16「拘縮・関節鏡」

2月4日（土）15:25～16:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 16 "Contracture/ Arthroscopy"

Feb. 4th（Sat）15:25～16:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O16-1

Development and validation of a prognostic nomogram for open elbow
arthrolysis: the Shanghai Prediction model for Elbow Stiffness Surgical
Outcome (SPESSO)

Weixuan Liu 1, 2, Ziyang Sun 1, 2, Hao Xiong 1, 2, Junjian Liu 3, Jiuzhou Lu 4, Bin Cai 5, Wei Wang 1, 2,Cunyi Fan 1, 21

Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, P. R. China,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, P. R. China,
3
Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, P. R. China,
4
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China,
5Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai, P. R. China
2Take home message-- We developed and validated a nomogram（SPESSO）that would predict the probability of gaining afunctional ROM in posttraumatic elbow stiffness patients undergoing open elbow arthrolysis.
--BMI, disease duration, preoperative ROM, preoperative pain intensity, and grade of posttraumatic
elbow arthritis are independent predictors for open elbow arthrolysis outcome.
--SPESSO could assist clinicians in counselling patients regarding treatment expectations and taking
medical interventions to optimize care for posttraumatic elbow stiffness patients.
S229

一般AimsThis study aimed to develop and internally validate a prognostic nomogram to predict the probabilityof gaining a functional range of motion（ROM ≥120°）after open elbow arthrolysis for posttraumaticelbow stiffness.
Methods
We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome（SPESSO）
basing on a training dataset of 551 patients who underwent open elbow arthrolysis in 4 collaborative
institutions. Demographic and clinical characteristics were collected through medical records. The least
absolute shrinkage and selection operator（LASSO）regression model was used to optimize featureselection. Multivariable logistic regression analysis was applied to build SPESSO. The prediction
performance of SPESSO was evaluated using the concordance index（C-index）and calibration plot.
Internal validation was conducted using bootstrapping validation.
Results
Body mass index, disease duration, preoperative range of motion, preoperative pain intensity, andgrade of posttraumatic elbow arthritis were identified as outcome predictors and incorporated toconstruct the nomogram. SPESSO displayed good discrimination with a C-index of 0.73（95% CI 0.64 to0.81）. A high C-index value of 0.70 could still be reached in the interval validation. The calibration plot
showed good agreement between nomogram prediction and observed outcomes.
Conclusion
The newly developed SPESSO is a valid and convenient model to predict the clinical outcome ofopen elbow arthrolysis. SPESSO could assist clinicians in counselling patients regarding treatment
expectations and therapeutic choices.

一般 16「拘縮・関節鏡」

2月4日（土）15:25～16:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 16 "Contracture/ Arthroscopy"

Feb. 4th（Sat）15:25～16:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O16-2

Locational Distribution Characteristics and Risk Factors of Heterotopic
Ossification in Post-traumatic Elbow Stiffness
Kehan Hua, Chen Chen, Yejun Zha, Maoqi Gong, Weitong Sun, Dan Xiao, Shangwei Ji,
Xigong Zhang, Xieyuan Jiang
Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China

一般Objective
This study intends to evaluate the characteristics of locational distribution of heterotopic ossification（HO）in patients with post-traumatic elbow stiffness based on elbow 3DCT, and to analyze andexplore the risk factors for the development of HO in different locations.
Methods
Patients with post-traumatic elbow stiffness due to HO development who were admitted to ourdepartment from January 2018 to December 2018 were consecutively enrolled. The baseline data andCT data were collected and processed using Mimics 20.0. The locational distribution of HO for eachpatient were determined based on 8 regions including anteromedial, anterolateral, posteromedial,posterolateral, posterior, medial, lateral, and proximal radioulnar area. For the initial trauma, inaddition to specific diagnosis, the injury patterns of each patient was further divided according towhether or not these five types of injuries existed: distal humerus fractures, olecranon fractures, radialhead fractures, coronoid fractures and elbow dislocations. Taking the occurrence of HO in a certain
location as the dependent variable and the initial trauma and baseline data as independent variables,logistic regression analyses were used to evaluate the risk factors of HO in each location.
Results
A total of 91 patients were enrolled in this study. For the occurrence rate of HO, 88 cases had
posteromedial HO（96.7%）, 62 cases had posterior HO（68.1%）, 60 cases had posterolateral HO（65.9%）, 41 cases had anteromedial HO（45.1%）, 26 cases had anterolateral HO（28.6%））, 13 cases
had proximal radioulnar HO（14.3%）, 8 cases had lateral HO（8.8%）, and 7 cases had medial HO（7.7%）.
Logistic regression analysis showed that the presence of ulnar nerve symptoms（OR=4.354, P=0.017）,
the presence of elbow dislocation in the initial trauma（OR=2.927, P=0.042）were the independentrisk factors for the development of anteromedial HO, and the presence of olecranon fracture in theinitial trauma（OR=0.277, P=0.023）was the protective factor for the development of anteromedial
HO. The presence of radial head fracture in the initial trauma was the independent risk factor forthe development of anterolateral HO（OR=2.891, P=0.033）, posterolateral HO（OR=3.467, P=0.025）
and proximal radioulnar HO（OR=6.525, P=0.004）, respectively. Age was a protective factor for thedevelopment of medial HO（OR=0.899, P=0.028）.
Conclusion
HO development in patients with post-traumatic elbow stiffness has unique locational distributioncharacteristics and is closely related to the initial trauma. These results have important reference
value for the clinical evaluation of HO in patients with post-traumatic elbow stiffness.
S230

2022年10月22日（土）～10月23日（日）一般 16「拘縮・関節鏡」

2月4日（土）15:25～16:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 16 "Contracture/ Arthroscopy"

Feb. 4th（Sat）15:25～16:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O16-3

Serial changes in clinical outcomes of arthroscopic osteocapsulararthroplasty for primary elbow osteoarthritis: A medium-term followup study
Sang-Pil So 1, Jae-Man Kwak 2, Jun-Bum Lee 1, Hui Ben 3, Kyoung-Hwan Koh 1, In-Ho Jeon 1
1

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si,
Gyeonggi-do, Republic of Korea,
3Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2S231

一般

Background: Arthroscopic osteocapsular arthroplasty（OCA）shows promising short-term outcomesfor primary elbow osteoarthritis（OA）. This study was to evaluate the serial clinical outcomes ofprimary elbow OA after arthroscopic OCA.
Methods: Patients with primary elbow OA who were treated with arthroscopic OCA between January2010 and April 2020 were included. The elbow range of motion（ROM）, visual analog scale（VAS）
pain score, and Mayo elbow performance score（MEPS）were assessed preoperatively, at short-（3–12months）, and medium-term follow-up（≥ 2 years）.
Results: A total of 56 patients who underwent short-term follow-up（mean［range］, 5.9 months［3–9］）
and medium-term follow-up（62.2 months［24–129］）after arthroscopic OCA were analyzed. Comparedwith preoperative assessment, ROM arc（89.4°to 111.7°, P < .001）, VAS pain score（4.9 to 2.0, P <.001）and MEPS（62.3 to 83.7, P < .001）significantly improved at short-term follow-up. At mediumterm follow-up, ROM arc（111.7°to 105.4°, P < .001）decreased while VAS pain score（2.0 to 1.4, P =.010）and MEPS（83.7 to 87.8, P = .005）improved from short-term period. The time interval between
short-term and medium-term follow-up showed significant positive correlations with the aggravationof ROM in terms of both ROM subtraction（correlation coefficient: 0.290, P = .030）and ROM ratio（correlation coefficient: 0.302, P = .024）, and a significant negative correlation with improvement ofMEPS（correlation coefficient: -0.274, P = .041）.
Conclusions: Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA
showed that the clinical outcomes were improved from preoperative assessment to short-term followup and medium-term follow-up. Specifically, ROM had decreased over time while VAS pain score andMEPS showed serial improvement until medium-term follow-up.
Key terms: Elbow osteoarthritis; osteocapsular arthroplasty; arthroscopy; elbow arthrolysis

一般 16「拘縮・関節鏡」

2月4日（土）15:25～16:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 16 "Contracture/ Arthroscopy"

Feb. 4th（Sat）15:25～16:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O16-4

Clinical outcomes of revision arthroscopic osteocapsular arthroplasty
in primary elbow osteoarthritis: A retrospective cohort study

Sang-Pil So 1, Jae-Man Kwak 2, Jun-Bum Lee 1, Hui Ben 3, Keun Ho Kim 1, Kyoung-Hwan Koh 1,In-Ho Jeon 1
1

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si,Gyeonggi-do, Republic of Korea,
3Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2

一般Purpose: This study aimed to assess clinical outcomes after revision arthroscopic osteocapsulararthroplasty（OCA）in patients with primary elbow osteoarthritis（OA）.
Methods: Patients who underwent arthroscopic OCA due to primary elbow OA, from January 2010
to June 2021, were enrolled. We assessed range of motion（ROM）, visual analogue scale（VAS）
pain score, Mayo elbow performance score（MEPS）, preoperatively and at final follow-up. Patientsatisfaction with surgery was asked at the final follow-up.
Results: Data from 61 patients（PRIMARY: 53 patients, REVISION: 8 patients）were analyzed. Meanage was 56.3 ・ 8.5 years and 54.3 ・ 8.9 years in PRIMARY and REVISION groups, respectively（P =.684）. Mean interval from primary to revision surgery was 76.4（range, 26‒168）months. PRIMARY
group had significantly better preoperative（PRIMARY vs. REVISION, 89.9 ± 20.3°vs. 71.3 ± 22.3°,P = .021）and postoperative ROM arc（112.4 ± 17.1°vs. 96.9 ± 16.5°, P = .019）than that with theREVISION group; however, degree of improvement was comparable between groups（22.5 ± 13.4 °vs. 25.6 ± 11.5°, P = .445）. Both postoperative VAS pain score（2.0 ± 1.7 vs. 1.1 ± 1.0, P = .164）andMEPS（83.8 ± 12.8 vs. 88.1 ± 8.8, P = .581）were comparable between the groups, as were degreeof improvement in VAS pain score（2.8 ± 2.7 vs. 3.5 ± 3.2, P = .691）and MEPS（21.7 ± 15.7 vs. 25.6
± 15.2, P = .604）. All patients were very satisfied（n = 2, 25.0%）0 or satisfied（n = 6, 75.0%）withrevision surgery.
Conclusion: Revision arthroscopic OCA is a favorable treatment option in primary elbow OA patients,
who have recurrent symptoms. Compared to primary surgery, degree of ROM, VAS pain score,and MEPS were comparable after revision surgery, and all the patients were satisfied with revision
surgery.
Level of Evidence: Level III; Retrospective comparative study; Treatment Study

S232

2022年10月22日（土）～10月23日（日）一般 16「拘縮・関節鏡」

2月4日（土）15:25～16:15
第2会場（山形テルサ 1F テルサホール）

English & Japanese Oral Session 16 "Contracture/ Arthroscopy"

Feb. 4th（Sat）15:25～16:15
Room 2（Yamagata Terrsa 1F Terrsa Hall）

O16-5

Incidence of Heterotopic Ossification in Elbow Arthroscopy

Hyun June Lee 1, Ben Hui 1, Jae-Man Kwak 2, Jun-Bum Lee 1, Sang-Pil So 1, Kyoung-Hwan Koh 1,In-Ho Jeon 1
1

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea,
Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea

2S233

一般

Purpose: To assess the incidence of heterotopic ossification（HO）after elbow arthroscopy.
Methods: Data of consecutive patients receiving elbow arthroscopy from May 2011 to April 2022
at the authors’ center were retrospectively reviewed. HO identified on the radiograph and CT wasgraded using the Hasting & Graham classification. The clinical outcomes were assessed using thepain Visual Analogue Scale（VAS）, and the functional outcomes were evaluated using the Quick
Disabilities of the Arm Shoulder and Hand（QuickDASH）questionnaire, the Mayo Elbow Performance
Score（MEPS）, and the Single Assessment Numeric Evaluation（SANE）before and after surgery.
Results: Of the 253 patients enrolled, 13（5.1%）of them had HO confirmed with 10 formed on themedial side. The mean follow-up was 365.9 days（range, 37–1,166 days）. Eleven patients had Hasting& Graham grade 1 and 2 had grade 2. At the last follow-up, the functional outcomes of the 11
asymptomatic patients were all improved（QuickDASH, 33.1 ± 15.9 vs. 6.2 ± 5.4; MEPS, 73.9 ± 17.5
vs. 93.9 ± 8.2; SANE, 40.0 ± 17.3 vs. 79.3 ± 17.3; all P < 0.001）, but the clinical outcome was slightly
improved without statistical significance（VAS, 1.6 ± 1.4 vs. 0.4 ± 0.9; P = 0.064）. Two symptomaticpatients underwent repeated arthroscopy for HO excision, and their clinical and functional outcomes
were all improved at the last follow-up. HO appeared as early as 8 weeks after surgery, and younger
age and male gender were suggested as significant factors（odds ratio［age］, 0.948, P = 0.026; odds
ratio［sex］, 9.002, P = 0.038）.
Conclusions: HO is a younger age- and male gender-prone minor complication of elbow arthroscopy.
Although the presence of HO has minimal clinical or functional impact on most patients, it should beclosely monitored for a minimum of 8 weeks postoperatively.