Basics of Elbow Arthroscopy

Abstract

Summary: Advances in arthroscopic surgery and equipment during the past several years have made elbow arthroscopy an effective and safe alternative for the management of a variety of elbow disorders. The positioning of a patient is a matter of personal preference. Originally, elbow arthroscopy was performed with the patient supine and the hand suspended to traction. The prone position allows better access to the posterior aspect of the elbow and easier conversion to open procedure. However, the lateral decubitus position allows better access to both the anterior and posterior compartments. A thorough knowledge of neurovascular anatomy of the elbow is required to safely perform elbow arthroscopy. The elbow anatomy is marked, specifically that of the ulnar nerve, and the elbow insufflated with a posterior soft spot or straight posterior portal. A proximal medial portal is established for initial visualization of the anterior aspect of the elbow. Proper placement of the portal allows a complete diagnostic arthroscopy of the anterior compartment, including the medial gutter. A lateral portal is established if necessary. Once the initial diagnostic arthroscopy of the anterior aspect of the elbow joint is completed, a posterior central portal is established. Accessory portals are established posterolaterally or in the soft spot to allow surgical procedures to be performed. Circumstances that may require arthroscopic surgery include removal of loose bodies, debridement of osteochondritis dissecans, synovectomy, arthritis, and fixation of fractures. The most commonly reported complications of elbow arthroscopy are injuries to neural structures. Additional complications include infection, instrument breakage, iatrogenic injury to articular cartilage, synovial fistula formation, and problems associated with use of a tourniquet. A thorough knowledge of regional anatomy, use of meticulous surgical technique, and strict attention to detail will minimize the risk of neuralgic complications. Strict adherence to the principles outlined will allow the use of arthroscopy to treat a variety of elbow disorders in a safe and effective manner.