Dual Direct Lateral Portals for Treatment of Osteochondritis Dissecans of the Capitellum: An Anatomic Study

Abstract

The purpose of this study was to quantify the distance of dual direct lateral (posterolateral radiocapitellar) arthroscopic portals to the lateral ligamentous structures and to report the percentage of capitellum accessible through these portals. Arthroscopy was performed on 10 fresh-frozen cadaveric elbows via a standard 6-portal approach. The portals included dual direct lateral portals created in the posterolateral soft spot. The arthroscope was placed through one direct lateral portal; an arthroscopic electrocautery device was placed through the other direct lateral portal and was used to mark all accessible areas of the capitellum. Open dissection allowed measurement of the distances of the portals from the lateral ligamentous structures, as well as determination of the percentage of capitellum accessible through these portals. The more ulnar of the dual lateral portals averaged 9.1 mm from the lateral ulnar collateral ligament, 11.5 mm from the annular ligament, and 13.1 mm from the radial collateral ligament. The more radial of the dual lateral portals averaged 1.5 mm, 9.7 mm, and 7.0 mm from these ligaments, respectively. Seventy-eight percent of the capitellum was accessible for instrumentation with these portals. Correct placement of dual direct lateral portals does not disrupt the lateral ligamentous complex and allows access to a large portion of the capitellum. Use of dual direct lateral portals is safe and practical for arthroscopic treatment of capitellar osteochondritis dissecans.