Paper 176: Wrist Arthroscopy: Volar Ulnar Portal using the “Inside-Out” Technique

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Volar Ulnar Portal using an “outside-in” technique has gained popularity in wrist arthroscopy although its establishment could be risky and demanding. The purpose of this study was to quantitatively determine the relationship between a volar ulnar wrist arthroscopic portal and the key neurovascular structures using an “inside-out” technique. Anatomic study. Four cadaveric wrist specimens were used for this study. Standard wrist arthroscopy was performed using the 3-4 and 4-5 portals. The VUP was established using the Wissinger rod technique. The rod was introduced from dorsal to volar between the ulnolunate and the ulnotriquetral ligaments, using the ulnar border of the FDS as the exit point. After the procedure, the specimens were dissected under magnification (2.5 x) and measurements were taken from the portal to the ulnar nerve and artery, flexor tendons, median nerve and pisiform. The mean distance from the VUP was 4 mm to the ulnar neurovascular bundle, 2 mm to the flexor tendons, 8 mm to the median nerve and 17.75 mm to the pisiform but no true internervous plane was seen. The VUP can provide a safe, standardized approach to the volar ulnar aspect of the radiocarpal joint. The “inside-out” technique seems to be reproducible and easy to perform. The space between the ulnolunate and ulnotriquetral ligament is a reliable landmark to introduce the rod.