Anatomic relationship between portals and nearby nerves at different positions in elbow arthroscopy

Abstract

Objective To evaluate the safety and value of standard portals used in elbow arthroscopy by comparing the anatomic relationships between the arthroscopic portals and nearby neurovascular structures at different positions. Methods The dissections were performed in 10 fresh cadaveric elbows. The minimum distances from the 9 standard paths of the arthroscopie sheath to nearby neurovascular structures were then measured and the value of each portal was assessed in terms of its effects on the elbow arthroscopy. Results The approach-to-nerve distance was affected by joint distention with fluid, elbow extension/flexion and forearm supination/pronation. The radial nerve showed significant proximity to the anterolateral portal in full elbow extension and forearm supination, the minimum distance from the anterolateral portal to radial nerve was （2.9 ± 1.1） mm, （4.5 ± 1.5） mm, （5.8 ± 1.7） mm respectively when the elbow was in 90° of flexion with the forearm supinated midpronation and pronation, and nerve-pin contact was observed in 2 elbows in the extended positions. The proximal medial portal and the proximal lateral portal for the anterior compartment, and the posterocentral portal for the posterior compartment, were shown to have an optimum effect with the least complications. All of the posterior approaches were safe. Condusions The proximal approaches are safer than the anteromedial and anterolateral approaches. The proximal medial portal, proximal lateral portal and posterocentral portal should be used as standard portals in elbow arthroscopy. Key words: Elbow; Arthroscopy; Anatomy; Approach