Background: Loose body removal and debridement remain common indications for elbow arthroscopy. Purpose: To (1) identify trends in elbow arthroscopy versus open procedures for loose body removal and debridement among American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination candidates and (2) compare the use of elbow arthroscopy among candidates with different fellowship training backgrounds. Study Design: Cohort study; Level of evidence, 3. Methods: A search of the ABOS Part II Oral Examination case list database was performed for elbow arthroscopy and open debridement Current Procedural Terminology codes between 2011 and 2021. Cases were stratified according to fellowship training data found in the ABOS Part II case list database. Annual rates of elbow procedures, patient demographics, surgeon geographic location, and complications were collected. Statistically significance was determined using chi-square testing, Fisher exact test or 2-tailed t test ( P < .05). Results: A total of 1443 procedures, 1147 (79.5%) arthroscopic and 296 (20.5%) open, were identified and included. A decrease in arthroscopic cases was observed while open cases remained steady. Arthroscopic cases were performed in a younger patient population (39 ± 18.5 vs 41.7 ± 17.3 years respectively; P = .02). The plurality of cases were performed by sports medicine fellowship–trained surgeons (n = 506; 35.1%), followed by hand and upper extremity fellowship–trained surgeons (n = 440; 30.5%) and shoulder and elbow fellowship–trained surgeons (n = 365; 25.3%). Sports medicine fellowship–trained surgeons performed the greatest proportion of arthroscopic cases (n = 482/506; 95.3%). In general, complication rates were lower following arthroscopic versus open procedures (surgical complications: 8.6% vs 27.7%, P < .001; readmissions: 0.7% vs 2.0%, P = .04; reoperations: 1.6% vs 3.7%, P = .02). Specifically, commonly associated complications including arthrofibrosis and nerve injury were also lower following arthroscopic procedures (stiffness/arthrofibrosis: 29.3% vs 34.1%, P < .001; nerve injuries: 1.7% vs 5.1%, P < .001). Conclusion: In this study of patients treated by ABOS Part II Oral Examination candidates, with the largest population of patients undergoing elbow arthroscopy to date, rates of elbow arthroscopy have decreased over the past decade, although surgeons with sports medicine, hand and upper extremity, and/or shoulder and elbow fellowship training demonstrate a proclivity toward arthroscopic rather than open procedures. Overall rates of complication were lower following arthroscopic approaches in this cohort of surgeons.
Gavalas et al. (Wed,) studied this question.