title: Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: prospective study on 76 patients.
abstract: OBJECTIVE
  Complex elbow instability (CEI) is one of the most troublesome pathologies that orthopaedic surgeons have to face. One of the key requirements regarding the CEI surgical treatment is an early rehabilitation programme to avoid the elbow stiffness caused by a long period of immobilisation. Although this is well known, no study has ever examined how, and to what extent, the functional range of motion (ROM) is recovered during the various stages of a prompt rehabilitation. Our aims were: (1) to prospectively analyse the pattern of ROM recovery in a series of patients with CEI who underwent early rehabilitation and (2) to identify the period of time during rehabilitation in which the greatest degree of motion recovery is obtained.
  
  
  METHODS
  A total of 76 patients (78 elbows) with CEI were followed up for 2 years. All the patients underwent anatomical and stable ostheosynthesis of all the fractures, radial head replacement in Mason III fractures, ligament injuries reconstruction and early rehabilitation that started 2 days after surgery. Two surgeons evaluated the ROM with a hand-held goniometer every 3 weeks for the first 3 months, then at 6, 12 and 24 months after surgery.
  
  
  RESULTS
  At the 3-week follow-up, the mean flexion (F), extension (E), pronation (P) and supination (S) were 113°, 29°, 60° and 62°, respectively. At the 6-week and 9-week follow-up, F, E, P and S were 119°, 23°, 70° and 69° and 123°, 24°, 72° and 71°, respectively. At the 3-month follow-up, these values were 131°, 18°, 76° and 72°, while at the 6-month follow-up they were 136°, 15°, 79° and 77°, respectively. Thereafter, the ROM improvement was not significant.
  
  
  CONCLUSIONS
  This study shows that the first 6 months represent the critical rehabilitation period to obtain a functional elbow; indeed, 70% of the patients recovered functional ROM between the third and sixth month, though the recovery of flexion proved to be slower than that of the other elbow movements. Thereafter, improvement continued, though at a lower rate, until the end of the first year, when approximately 80% of the patients had recovered the functional ROM.
  
  
  CONCLUSIONS
  Following CEI surgical treatment, a rehabilitation programme needs to be started promptly and continued for at least 6 months because a significant improvement of ROM occurs prevalently in this period, which should be considered the critical time period to obtain a functional elbow in a majority of patients.
authors.affiliation: Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy. Electronic address: giannicola.giuseppe@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannicola
authors.affiliation: Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Polimanti
authors.affiliation: Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bullitta
authors.affiliation: Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Federico M
authors.initials: FM
authors.lastname: Sacchetti
authors.affiliation: Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cinotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D000092464:Elbow Injuries
keywords: Complex elbow instability; Elbow fracture–dislocation; Elbow outcomes; Elbow postoperative management; Elbow range of motion; Elbow rehabilitation; Functional elbow range of motion; Recovery of range of motion