Portal placement in elbow arthroscopy by novice surgeons: cadaver study
- 28 June 2016
- journal article
- elbow
- Published by Wiley in Knee Surgery, Sports Traumatology, Arthroscopy
- Vol. 25 (7), 2247-2254
- https://doi.org/10.1007/s00167-016-4186-y
Abstract
Purpose In this anatomical cadaver study, the distance between major nerves and ligaments at risk for injury and portal sites created by trainees was measured. Trainees, inexperienced in elbow arthroscopy, have received a didactic lecture and cadaver instruction prior to portal placement. The incidence of iatrogenic injury from novice portal placement was also determined. Methods Anterolateral, direct lateral, and anteromedial arthroscopic portals were created in ten cadavers by ten inexperienced trainees in elbow arthroscopy. After creating each portal, the trajectory of the portal was marked with a guide pin. Subsequently, the cadavers were dissected and the distances between the guide pin in the anterolateral, direct lateral, and anteromedial portals and important ligaments and nerves were measured. Results The difference between the distance of the direct lateral portal and the posterior antebrachial cutaneous nerve (PABCN) (22 mm, p < 0.001), the lateral antebrachial cutaneous nerve (4.0 mm, p < 0.001), and the radial nerve (25 mm, p < 0.001) was different from the average reported distances in the literature. A difference was found between the distance of the anterolateral portal and the PABCN (32 mm, p < 0.001) compared to previous studies. Three major iatrogenic complications were observed, including: laceration of the posterior bundle of the medial ulnar collateral ligament, lateral ulnar collateral ligament midsubstance laceration, and median nerve partial laceration. Conclusion Surgeons increasingly consider arthroscopic treatment as an option for elbow pathology. In the present study a surgical complication rate of 30 % was found with novice portal placement during elbow arthroscopy. Furthermore, as the results from this study have indicated, accurate, precise, and safe portal placement in elbow arthroscopy is not easily achieved by didactic lecture and cadaver instruction session alone. Level of evidence V.Keywords
This publication has 28 references indexed in Scilit:
- Radial Nerve Palsy After Arthroscopic Anterior Capsular Release for Degenerative Elbow ContractureArthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
- Guidelines to Becoming an Expert Elbow ArthroscopistArthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
- Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positionsJournal of Shoulder and Elbow Surgery, 2006
- Neuroanatomy in elbow arthroscopyJournal of Shoulder and Elbow Surgery, 1995
- Arthroscopy of the elbow joint: A cadaveric study of portal placementJournal of Shoulder and Elbow Surgery, 1994
- Das Risiko Neurovaskulärer Schädigungen bei der EllenbogengelenkarthroskopieZeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 1994
- Risks of neurovascular injury in elbow arthroscopy: Starting anteromedially or anterolaterally?Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1991
- Medial approach in elbow arthroscopyThe American Journal of Sports Medicine, 1990
- Neurovascular anatomy and elbow arthroscopy: Inherent risksArthroscopy: The Journal of Arthroscopic & Related Surgery, 1986
- Arthroscopy of the elbowArthroscopy: The Journal of Arthroscopic & Related Surgery, 1985