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Yang J, Zhao Q, Zhou Y, Zhen H, Wu J, Chen X, Ren F, Huang J. It is time to move forward: a bibliometric analysis of top 50 cited articles in elbow arthroscopy. J ISAKOS 2024:S2059-7754(24)00081-6. [PMID: 38649114 DOI: 10.1016/j.jisako.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To analyze the bibliometric characteristics of the top 50 cited articles in elbow arthroscopy. METHODS The Web of Science Core Collection was employed to systematically retrieve publications related to elbow arthroscopy. Subsequently, the top 50 cited articles meeting the predefined inclusion criteria were meticulously documented and subjected to comprehensive bibliometric analysis. RESULTS The top 50 cited articles spanned the years 1999-2017, with the 2010s emerging as the most prolific decade. Citations per article varied from 24 to 211, and citation density ranged from 1.61 to 9.17. The United States dominated in article production and citations. Predominantly, the articles took the form of case series and expert opinions, with a notable absence of level I or II evidence. The keywords with the highest frequencies were "arthrofibrosis," "complications," and "release." These keywords formed five main clusters: stiff elbow, osteoarthritis, osteochondritis dissecans, and lateral epicondylitis. CONCLUSIONS The majority of the top 50 cited articles in elbow arthroscopy comprised case series exhibiting Level IV or V evidence. Despite a dynamic development post-2010, elbow arthroscopy articles showed lower mean citations and citation density compared to other joints, potentially influenced by concerns about complications. However, with the increasing prevalence of elbow arthroscopy procedures, it is anticipated that higher-level articles, particularly those focusing on complications and exploring additional indications, will supersede some of the articles included in this analysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jiyong Yang
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510095, China
| | - Qian Zhao
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China
| | - Yi Zhou
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510095, China
| | - Huifeng Zhen
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China
| | - Jiang Wu
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China
| | - Xiao Chen
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China
| | - Fuji Ren
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China
| | - Jingmin Huang
- Department of Arthroscopy and Sports Medicine, Tianjin Hospital, Tianjin 300000, China.
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Lanham NS, Belyea CM, Peterson JR, Jobin CM. Elbow Arthroscopy: Essential Principles of Positioning, Anatomy, and Portal Placement. Tech Hand Up Extrem Surg 2024; 28:39-44. [PMID: 37899629 DOI: 10.1097/bth.0000000000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Elbow arthroscopy is an important surgical technique for the treatment of various elbow pathologies. Range of indications for elbow arthroscopy include, but are not limited to, diagnostic evaluation, removal of loose bodies, synovectomy, contracture releases, lateral epicondylitis treatment, and adjunct use for fracture reduction. Surgeons' understanding of anatomy and portal placement is critical for successful treatment. This article reviews the relevant surgical anatomy, portal placement, patient positioning, surgical indications, and complications for this technique.
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Affiliation(s)
- Nathan S Lanham
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Orthopedic Surgery and Rehabilitation, Womack Army Medical Center, Fort Liberty, NC
| | - Christopher Michael Belyea
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Orthopedic Surgery and Rehabilitation, Womack Army Medical Center, Fort Liberty, NC
| | - Joel R Peterson
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
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3
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Yang X, Ying L, Ying L, Zhang Q, Han D, Zhou X. Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study. J Shoulder Elbow Surg 2024; 33:536-543. [PMID: 37944746 DOI: 10.1016/j.jse.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Different arthroscopic techniques exist for managing the extensor carpi radials brevis (ECRB) when treating refractory lateral epicondylitis. The purpose of this study is to compare the outcomes of a standard arthroscopic débridement with ECRB tendon release to an arthroscopic ECRB tenotomy distal to its insertion without débridement using a retrospective cohort study design. METHODS This study included patients underwent arthroscopic treatment of lateral epicondylitis during 2 different time periods: 2016-2019 (débridement) and 2019-2021 (modified tenotomy without débridement). Patients were assessed preoperatively and at the last follow-up with Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale of pain. RESULTS A total of 69 patients completed the follow-up (38 in the débridement group and 31 in the tenotomy group). Patients in both groups showed significant improvements were found in MEPS, DASH, and Visual Analog Scale after surgery. Patients in the tenotomy group had higher MEPSs and reported less pain with a minimum 2 year follow-up after surgery. DASH scores between groups were similar at all time periods. CONCLUSION Arthroscopic modified tenotomy of the ECRB without débridement improves function and pain significantly for patients with refractory lateral epicondylitis, which is not inferior to arthroscopic débridement technique.
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Affiliation(s)
- Xiangdong Yang
- The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Liwei Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Qingguo Zhang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Dawei Han
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China.
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Wegmann S, Hackl M, Krane F, Wegmann K, Mueller LP, Leschinger T. Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study. Arch Orthop Trauma Surg 2024; 144:1297-1302. [PMID: 38172435 PMCID: PMC10896769 DOI: 10.1007/s00402-023-05172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals. MATERIALS AND METHODS An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured. RESULTS On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy. CONCLUSION Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- S Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Krane
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Wegmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstr. 6, 81369, Munich, Germany
| | - L-P Mueller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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5
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Ghayyad K, Ahmadi Z, Rajabi H, Alimohammadi MM, Kachooei AR. Arthroscopic Capsular Release for Post-traumatic Elbow Stiffness. Cureus 2023; 15:e47838. [PMID: 38021529 PMCID: PMC10676772 DOI: 10.7759/cureus.47838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Post-traumatic elbow stiffness (PTES) may substantially affect the patient's functional range of motion and quality of life. Open elbow release has been extensively studied, but arthroscopic techniques are limited, particularly in differentiating between post-traumatic and non-traumatic stiffness. The purpose of this study is to assess the clinical outcomes after arthroscopic release of PTES regarding the range of motion (ROM), pain, functional assessment, and complications. METHODS A prospective cohort was conducted on adult patients who underwent arthroscopic arthrolysis for PTES, with 32 patients included in the final analysis. The ROM was measured using the orthopedic goniometer. Grip strength was measured using the Camry digital hand dynamometer (Camry, CA, USA) and compared to their contralateral side. The functional status of the patients was evaluated using the American Shoulder and Elbow Surgeons Score (ASES)andthe Mayo Elbow Performance Index (MEPI). All measurements were done before surgery and at the last follow-up visit. Pre-operative and post-operative changes in MEPI, ASES, and visual analog (VAS) scores were compared with the paired t-test. RESULTS After surgery, the ROM significantly improved from 74 ± 11 to 110 ± 15 degrees (p<0.001). Additionally, the ASES score and MEPI index both significantly improved from 69 ± 3.4 to 79 ± 6.3 and from 64 ± 5.7 to 82 ± 8, respectively (p<0.001). VAS scores also significantly improved from 1.1 ± 0.87 to 0.31 ± 0.53 at rest (p<0.001). The complication rate was 12%, including three transient ulnar nerve paresthesia and one superficial infection. Post-traumatic elbow release was more offered in distal humerus fractures (53%), followed by proximal ulna fracture/dislocations (25%). CONCLUSION We believe that arthroscopic arthrolysis is a safe and reliable treatment of PTES, which improves joint visibility and reduces pain. Patients can be counseled regarding the risk of a secondary surgery following distal humerus or proximal ulna fractures, including the expected recovery and complication rate.
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Affiliation(s)
- Kassem Ghayyad
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Zahra Ahmadi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
| | - Hadi Rajabi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
| | | | - Amir R Kachooei
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, IRN
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Lavignac P, Herraudet P, Baudelle F, Commeil P, Legallois Y, Fabre T. Arthroscopic treatment of diffuse pigmented villonodular synovitis of the elbow. Orthop Traumatol Surg Res 2023; 109:103493. [PMID: 36455866 DOI: 10.1016/j.otsr.2022.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate. MATERIAL AND METHODS We performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected. RESULTS At a mean 66.4 months' follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series. DISCUSSION Arthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS. LEVEL OF EVIDENCE IV Retrospective study without control group.
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Affiliation(s)
- Pierre Lavignac
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Paul Herraudet
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Fabien Baudelle
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Paul Commeil
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Yohan Legallois
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Thierry Fabre
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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7
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So SP, Kwak JM, Lee JB, Ben H, Kim KH, Koh KH, Jeon IH. Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study. Orthop J Sports Med 2023; 11:23259671231162398. [PMID: 37250740 PMCID: PMC10214057 DOI: 10.1177/23259671231162398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background Arthroscopic osteocapsular arthroplasty (OCA) shows promising short-term outcomes for primary elbow osteoarthritis (OA). However, serial changes in clinical outcomes for medium-term follow-up are not well known. Purpose To evaluate clinical outcomes after arthroscopic OCA in primary elbow OA from preoperative to short- and medium-term follow-up and to analyze the correlation between the time from short- to medium-term follow-up and the changes in clinical outcomes between the periods. Study Design Case series; Level of evidence, 4. Methods Patients with primary elbow OA who were treated with arthroscopic OCA between January 2010 and April 2020 were evaluated. Elbow range of motion (ROM), visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were assessed preoperatively and at short-term (3-12 months) and medium-term (≥2 years) follow-up. The correlation between the time from short- to medium-term follow-up and the changes in clinical outcomes was analyzed using the Pearson correlation coefficient. Results Included were 56 patients who underwent short-term follow-up (mean [range], 5.9 [3-12] months) and medium-term follow-up (62.2 [24-129] months) after arthroscopic OCA. When compared with preoperative values, significant improvements were seen at short-term follow-up: ROM (from 89.4° to 111.7°; P < .001), VAS for pain (from 4.9 to 2.0; P < .001), and MEPS (from 62.3 to 83.7; P < .001). From short- to medium-term follow-up, ROM decreased (from 111.7° to 105.4°; P = .001) while VAS for pain (from 2.0 to 1.4; P = .031) and MEPS (from 83.7 to 87.8; P = .016) improved. All outcomes improved significantly at medium-term follow-up as compared with preoperative values (P < .001 for all). The time between short- and medium-term follow-up had a significant positive correlation with decreased ROM (r = 0.290; P = .030) and a significant negative correlation with improvement in MEPS (r = -0.274; P = .041). Conclusion Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA showed that the clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although ROM decreased between short- and medium-term follow-up. VAS for pain and MEPS showed continued improvement until medium-term follow-up.
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Affiliation(s)
- Sang-Pil So
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery,
Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si,
Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Hui Ben
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Keun Ho Kim
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
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8
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Lühmann P, Kremer T, Siemers F, Rein S. Comparative histomorphological analysis of elbow ligaments and capsule. Clin Anat 2022; 35:1070-1084. [DOI: 10.1002/ca.23913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Paul Lühmann
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery with Burn Unit Trauma Center Bergmannstrost Halle Germany
- Martin‐Luther‐University Halle‐Wittenberg Halle Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
- Martin‐Luther‐University Halle‐Wittenberg Halle Germany
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Abstract
With advances in the understanding of elbow anatomy, pathologies of the elbow, arthroscopic instrumentation, and surgical techniques over recent decades, elbow arthroscopy has become a valuable treatment modality for a variety of conditions. Elbow arthroscopy has gained utility for treating problems such as septic arthritis, osteoarthritis, synovitis, osteophyte and loose body excision, contracture release, osteochondral defects, select fractures, instability, and lateral epicondylitis. Accordingly, precise knowledge of the neurovascular anatomy, safe arthroscopic portal placement, indications, and potential complications are required to maximize patient outcomes and assist in educating patients. This comprehensive review provides the reader an understanding of the potential complications associated with arthroscopic procedures of the elbow and to describe strategies for prevention and management.
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10
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Gian Mario M, Luigi T, Alberto N, Andrea G, Giovanni M, Giuseppe P. Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up. J Orthop Traumatol 2021; 22:55. [PMID: 34928448 PMCID: PMC8688672 DOI: 10.1186/s10195-021-00619-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. MATERIALS AND METHODS In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. RESULTS In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. CONCLUSIONS Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Micheloni Gian Mario
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Tarallo Luigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Negri Alberto
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgini Andrea
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Merolla Giovanni
- Doctorate School in Clinical and Experimental Medicine, UNIMORE, Modena, Italy
| | - Porcellini Giuseppe
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio Emilia, Modena, Italy
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11
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Powell GM, Baffour FI, Moynagh MR, Skinner JA, Lam TK, O'Driscoll SW, Glazebrook KN. Preoperative sonographic ulnar nerve mapping in the postoperative elbow. Skeletal Radiol 2021; 50:1219-1225. [PMID: 33009582 DOI: 10.1007/s00256-020-03620-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the technique of sonographic ulnar nerve mapping in the postoperative elbow for surgical planning. MATERIALS AND METHODS A retrospective review of a surgical databank identified 24 patients, all aged 18 years and older with a history of orthopedic elbow surgery, who were referred for preoperative sonographic mapping of the ulnar nerve prior to subsequent surgery. All cases were reviewed for patient demographics, clinical presentation, prior surgical interventions, and ultrasound technique. Charts were reviewed for intraoperative and postoperative outcomes, including nerve injury. RESULTS The cohort included 12 males and 12 females with a mean age of 51 years (range 22-68 years) and a mean BMI of 29 (range 20-48). Preoperative sonographic ulnar nerve mapping occurred following various elbow surgeries including ulnar nerve transposition to assess nerve location prior to subsequent elbow surgery. Of the 24 patients with preoperative sonographic ulnar nerve mapping, subsequent surgery was performed arthroscopically in 14 and open in 10 cases. In 11 of the 24 cases, there was specific mention of a modified approach to joint access which was guided by the ulnar nerve map. There were no perioperative ulnar nerve-related complications, such as nerve transection. CONCLUSION Preoperative mapping can facilitate planning of surgical access and ulnar nerve dissection. Sonographic mapping of the ulnar nerve reduces the potential uncertainty of nerve palpation in a complex postoperative elbow following ulnar nerve transposition. This technique may mitigate the risk of ulnar nerve injury.
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Affiliation(s)
- Garret M Powell
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Francis I Baffour
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA.
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - John A Skinner
- Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Tiffany Keller Lam
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW., Rochester, MN, 55905, USA
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12
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[59/m and 86/f-Pain and restricted motion of the elbow joint : Preparation for the medical specialist examination: part 35]. DER ORTHOPADE 2021; 50:98-106. [PMID: 33141240 DOI: 10.1007/s00132-020-04018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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HY C, D E, B T. Elbow arthroscopy - Indications and technique. J Clin Orthop Trauma 2021; 19:147-153. [PMID: 34099974 PMCID: PMC8167286 DOI: 10.1016/j.jcot.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022] Open
Abstract
Throughout the years, elbow arthroscopy has advanced tremendously due to improvements in technology and surgical techniques. It is now considered a safe and effective treatment for a variety of elbow disorders. Due to the small working space and nearby neurovascular structures, it is a technically challenging procedure. It can be used to successfully treat complaints caused by loose bodies, osteoarthritis, arthrofibrosis, OCD, lateral epicondylitis, VEOS and fractures. The most devastating complication of elbow arthroscopy is (permanent) nerve injury. Therefore, distortion of the anatomy of the elbow joint and transposition of the ulnar nerve can be a contra-indication for elbow arthroscopy due to the higher risk of postoperative complications. The results of the arthroscopy depend on the experience, knowledge, technique and expertise of the performing surgeon.
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Affiliation(s)
- Chow HY
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4818, CK Breda, the Netherlands,Corresponding author.
| | - Eygendaal D
- Department of Orthopaedics, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - The B
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4818, CK Breda, the Netherlands
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14
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Hilgersom NFJ, Viveen J, Tuijthof GJM, Bleys RLAW, van den Bekerom MPJ, Eygendaal D. Arthroscopic localization of the ulnar nerve behind the medial capsule is unreliable. JSES Int 2020; 4:1031-1036. [PMID: 33345253 PMCID: PMC7738441 DOI: 10.1016/j.jseint.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Ulnar nerve injury is the most common neurologic complication of elbow arthroscopy. The purpose of this cadaveric study was to quantify the ability of surgeons to locate the ulnar nerve behind the posteromedial capsule during elbow arthroscopy using sole arthroscopic vision. Methods Twenty-one surgeons were asked to pin the ulnar nerve at the medial gutter and the posteromedial compartment using arthroscopic visualization of the medial capsule only. Pinning of the ulnar nerve was performed from extra-articular. Then, the cadaveric specimens were dissected and the shortest distances between the pins and ulnar nerve measured. Results Median pin-to-nerve distances at the medial gutter and posteromedial compartment were 0 mm (interquartile range [IQR], 0-3 mm) and 2 mm (IQR, 0-6 mm), respectively. The ulnar nerve was pinned by 11/21 surgeons (52%) at the medial gutter, and 7/21 surgeons (33%) at the posteromedial compartment. Three of 21 surgeons (14%) pinned the ulnar nerve at both the medial gutter and the posteromedial compartment. Surgeon's experience and operation volume did not affect these outcomes (P > .05). Conclusions Surgeons' ability to locate the ulnar nerve behind the posteromedial capsule using sole arthroscopic visualization, without external palpation, is poor. We recommend to proceed carefully when performing arthroscopic procedures in the posteromedial elbow, and identify and mobilize the ulnar nerve prior to any posteromedial capsular procedures.
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Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - Jetske Viveen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.,Department of Instrument Development, Engineering and Evaluation, Maastricht University, Maastricht, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
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15
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Grim C, Engelhardt M, Hoppe MW, Seil R, Hotfiel T. Lösungen für häufige Komplikationen der Ellenbogenarthroskopie. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Semicircumferential Detachment of the Extensor Enthesis For Surgical Treatment of Chronic Lateral Epicondylitis: A Prospective Study. Tech Hand Up Extrem Surg 2019; 23:146-150. [PMID: 31033781 DOI: 10.1097/bth.0000000000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
About 10% of patients with lateral epicondylitis are nonresponsive to conservative treatment; as controversy persists on etiology and pathogenesis of this pathology, there is no surgical technique universally approved. The purpose of this study is to describe and evaluate the clinical outcomes of our technique consisting in a semicircumferential and partial detachment of the entire extensor apparatus enthesis. The technique was performed on 14 consecutive patients affected by painful chronic epicondylitis between January 2010 and April 2016. Two patients were lost during follow-up. At 6 months, 1 year, and 2 years after surgery patients were revaluated. Outcomes were assessed using Visual Analog Scale, DASH score (Disability of the Arm, Shoulder, and Hand), Jamar test, and time to return to work. The mean surgical time was 16 minutes. The postoperative outcomes were excellent in most patients as mean Visual Analog Scale score improved from 9.25 to 2.6 and mean DASH score improved from 82.9 to 29.6. No recurrence was recorded at 2 years of follow-up. The procedure is rapid to perform, reproducible and provides low complication rates and no relapse in our experience. As a result, we recommend this technique in nonresponding to conservative treatment lateral epicondylitis.
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17
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Stetson WB, Vogeli K, Chung B, Hung NJ, Stevanovic M, Morgan S. Avoiding Neurological Complications of Elbow Arthroscopy. Arthrosc Tech 2018; 7:e717-e724. [PMID: 30094142 PMCID: PMC6074022 DOI: 10.1016/j.eats.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/08/2018] [Indexed: 02/03/2023] Open
Abstract
Elbow arthroscopy is an increasingly common procedure performed in orthopaedic surgery. However, because of the presence of several major neurovascular structures in close proximity to the operative portals, it can have potentially devastating complications. The largest series of elbow arthroscopies to date described a 2.5% rate of postoperative neurological injury. All of these injuries were transient nerve injuries resolved without intervention. A recent report of major nerve injuries after elbow arthroscopy demonstrated that these injuries are likely under-reported in literature. Because of the surrounding neurovascular structures, familiarity with normal elbow anatomy and portals will decrease the risk of damaging important structures. The purpose of this Technical Note is to review important steps in performing elbow arthroscopy with an emphasis on avoiding neurovascular injury. With a sound understanding of the important bony anatomic landmarks, sensory nerves, and neurovascular structures, elbow arthroscopy can provide both diagnostic and therapeutic intervention with little morbidity.
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Affiliation(s)
- William B. Stetson
- Stetson Powell Orthopedics & Sports Medicine, Burbank, California, U.S.A.,Address correspondence to William B. Stetson, M.D., Stetson Powell Orthopedics & Sports Medicine, 191 South Buena Vista Street, Suite #470, Burbank, CA 91505, U.S.A.
| | - Kevin Vogeli
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Brian Chung
- Stetson Powell Orthopedics & Sports Medicine, Burbank, California, U.S.A
| | - Nicole J. Hung
- Stetson Powell Orthopedics & Sports Medicine, Burbank, California, U.S.A
| | - Milan Stevanovic
- Keck School of Medicine at the University of Southern California, Los Angeles, California, U.S.A
| | - Stephanie Morgan
- Stetson Powell Orthopedics & Sports Medicine, Burbank, California, U.S.A
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18
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Yoo JS, Kim SJ, Jung JU, Seo JB. Proper elbow arthroscopy portal placement in pediatric and adolescent patients. J Orthop 2018; 15:455-458. [PMID: 29881176 DOI: 10.1016/j.jor.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
We sought to evaluate proper elbow arthroscopy portal placement in pediatric and adolescent patients. Overall, 109 pediatric and adolescent patients who underwent elbow arthrography were included. Condylar width was measured and the proximal anterior joint capsule location was determined using the ulna-capsular distance. Condylar width and Bone mass index(BMI) also had a high positive correlation coefficient with the proximal joint capsule location. Proximal ulnar border is recommended new bony landmark in pediatric and adolescent patients who undergo elbow arthroscopy. In particular, condylar width and BMI were found to have a high positive correlation with the proximal joint capsule location.
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Affiliation(s)
- Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Seong-Jun Kim
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jae-Uk Jung
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Joong-Bae Seo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
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19
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Burn MB, Mitchell RJ, Liberman SR, Lintner DM, Harris JD, McCulloch PC. Open, Arthroscopic, and Percutaneous Surgical Treatment of Lateral Epicondylitis: A Systematic Review. Hand (N Y) 2018; 13:264-274. [PMID: 28720043 PMCID: PMC5987981 DOI: 10.1177/1558944717701244] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Approximately 10% of patients with lateral epicondylitis go on to have surgical treatment; however, multiple surgical treatment options exist. The purpose of this study was to review the literature for the clinical outcomes of open, arthroscopic, and percutaneous treatment of lateral epicondylitis. The authors hypothesized that the clinical outcome of all 3 analyzed surgical treatments would be equivalent. Methods: A systematic review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar in July 2016 to compare the functional outcome, pain, grip strength, patient satisfaction, and return to work at 1-year follow-up for open, arthroscopic, and percutaneous treatment of lateral epicondylitis. Results: Six studies (2 Level I and 4 Level II) including 179 elbows (83 treated open, 14 arthroscopic, 82 percutaneous) were analyzed. Three outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH] score, visual analog scale [VAS], and patient satisfaction) were reported for more than one category of surgical technique. Of these, the authors noted no clinically significant differences between the techniques. Conclusions: This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.
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20
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Hilgersom NFJ, van Deurzen DFP, Gerritsma CLE, van der Heide HJL, Malessy MJA, Eygendaal D, van den Bekerom MPJ. Nerve injuries do occur in elbow arthroscopy. Knee Surg Sports Traumatol Arthrosc 2018; 26:318-324. [PMID: 28932881 DOI: 10.1007/s00167-017-4719-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose is to create more awareness as well as emphasize the risk of permanent nerve injury as a complication of elbow arthroscopy. METHODS Patients who underwent elbow arthroscopy complicated by permanent nerve injury were retrospectively collected. Patients were collected using two strategies: (1) by word-of-mouth throughout the Dutch Society of Shoulder and Elbow Surgery, and the Leiden University Nerve Centre, and (2) approaching two medical liability insurance companies. Medical records were reviewed to determine patient characteristics, disease history and postoperative course. Surgical records were reviewed to determine surgical details. RESULTS A total of eight patients were collected, four men and four women, ageing 21-54 years. In five out of eight patients (62.5%), the ulnar nerve was affected; in the remaining three patients (37.5%), the radial nerve was involved. Possible causes for nerve injury varied among patients, such as portal placement and the use of motorized instruments. CONCLUSIONS A case series on permanent nerve injury as a complication of elbow arthroscopy is presented. Reporting on this sequel in the literature is little, however, its risk is not to be underestimated. This study emphasizes that permanent nerve injury is a complication of elbow arthroscopy, concurrently increasing awareness and thereby possibly aiding to prevention. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Carina L E Gerritsma
- Department of Orthopaedic Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Huub J L van der Heide
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Martijn J A Malessy
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Langendijk 75, 4819 EV, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
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21
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22
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Claessen FMAP, Kachooei AR, Kolovich GP, Buijze GA, Oh LS, van den Bekerom MPJ, Doornberg JN. Portal placement in elbow arthroscopy by novice surgeons: cadaver study. Knee Surg Sports Traumatol Arthrosc 2017; 25:2247-2254. [PMID: 27351547 DOI: 10.1007/s00167-016-4186-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 05/31/2016] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Femke M A P Claessen
- Harvard Medical School, University of Amsterdam, Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Amir R Kachooei
- Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gregory P Kolovich
- Department of Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Geert A Buijze
- Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program (PGY3), Amsterdam, The Netherlands
| | - Luke S Oh
- Sports Medicine Service, Massachusetts General Hospital, Boston, MA, USA
| | | | - Job N Doornberg
- Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program (PGY6), Amsterdam, The Netherlands
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23
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Pierce TP, Issa K, Gilbert BT, Hanly B, Festa A, McInerney VK, Scillia AJ. A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin. Arthroscopy 2017; 33:1260-1268.e2. [PMID: 28412059 DOI: 10.1016/j.arthro.2017.01.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare complications, function, pain, and patient satisfaction after conventional open, percutaneous, or arthroscopic release of the extensor origin for the treatment of lateral epicondylitis. METHODS A thorough review of 4 databases-PubMed, EBSCOhost, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and Scopus-was performed to identify all studies that addressed surgical management of lateral epicondylitis. We included (1) studies published between 2000 and 2015 and (2) studies with clearly defined surgical techniques. We excluded (1) non-English-language manuscripts, (2) isolated case reports, (3) studies with fewer than 10 subjects, (4) animal studies, (5) studies with additional adjunctive procedures aside from release of the extensor origin, (6) clinical or systematic review manuscripts, (7) studies with a follow-up period of 6 months or less, and (8) studies in which less than 80% of patients completed follow-up. Each study was analyzed for complication rates, functional outcomes, pain, and patient satisfaction. RESULTS Thirty reports were identified that included 848 open, 578 arthroscopic, and 178 percutaneous releases. Patients within each release group had a similar age (46 years vs 46 years vs 48 years; P = .9 and P = .4, respectively), whereas there was a longer follow-up time in patients who underwent surgery by an open technique (49.4 months vs 42.6 months vs 23 months, P < .001). There were no differences in complication rates among these techniques (3.8% vs 2.9% vs 3.9%; P = .5 and P = .9, respectively). However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04). Mean Disabilities of the Arm, Shoulder and Hand scores were substantially better with both open and arthroscopic techniques than with percutaneous release (19.9 points vs 21.3 points vs 29 points, P < .001). In addition, there was less pain reported in the arthroscopic and percutaneous release groups as opposed to their open counterparts (1.9 points vs 1.4 points vs 1.3 points, P < .0001). There were no differences among the techniques in patient satisfaction rate (93.7% vs 89% vs 88%; P = .08 and P = .07, respectively). CONCLUSIONS Functional outcomes of open and arthroscopic releases may be superior to those of percutaneous release. In addition, patients may report less pain with arthroscopic and percutaneous techniques. Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. However, it is important to note that this statistical difference may not necessarily portend noticeable clinical differences. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV evidence.
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Affiliation(s)
- Todd P Pierce
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Kimona Issa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Benjamin T Gilbert
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Brian Hanly
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony Festa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Vincent K McInerney
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A..
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Hilgersom NFJ, Oh LS, Flipsen M, Eygendaal D, van den Bekerom MPJ. Tips to avoid nerve injury in elbow arthroscopy. World J Orthop 2017; 8:99-106. [PMID: 28251060 PMCID: PMC5314153 DOI: 10.5312/wjo.v8.i2.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy.
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25
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Camp CL, Degen RM, Dines JS, Altchek DW, Sanchez-Sotelo J. Basics of Elbow Arthroscopy Part III: Positioning and Diagnostic Arthroscopy in the Lateral Decubitus Position. Arthrosc Tech 2016; 5:e1351-e1355. [PMID: 28560136 PMCID: PMC5439271 DOI: 10.1016/j.eats.2016.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
In recent years, arthroscopy has gained popularity as a preferred treatment of a multitude of pathologies affecting the elbow. Since its initial description in 1985, many modifications have been made as our knowledge and technology have advanced. Currently, the majority of arthroscopic procedures are performed in either the lateral decubitus or supine suspended position. In this work, we discuss the history, patient positioning, and key steps for performing elbow arthroscopy in the lateral decubitus position. In addition to key steps, a number of strengths and limitations of this set up are discussed in detail. When properly executed, elbow arthroscopy can be performed in a safe and efficient manner with minimal risk to patients.
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Affiliation(s)
- Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to Christopher L. Camp, M.D., Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, U.S.A.Department of Orthopaedic SurgerySports Medicine and Shoulder Service Hospital for Special Surgery535 E. 70 StreetNew YorkNY10021U.S.A.
| | - Ryan M. Degen
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S. Dines
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - David W. Altchek
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
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Camp CL, Degen RM, Sanchez-Sotelo J, Altchek DW, Dines JS. Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk. Arthrosc Tech 2016; 5:e1339-e1343. [PMID: 28560134 PMCID: PMC5439187 DOI: 10.1016/j.eats.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
As our knowledge and technology advance, the indications for elbow arthroscopy continue to grow rapidly. During this expansion, a number of new portals have been described and reported using variable nomenclature and location descriptions. Accordingly, a comprehensive review of these portals is warranted. Given the concern for potential iatrogenic injury to surrounding neurovascular structures, a discussion of these critical nerves and vessels is also timely. In this work, we review pertinent surface anatomy; portal nomenclature, locations, and utility; and review distances to the nearest structures at risk.
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Affiliation(s)
- Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to Christopher L. Camp, M.D., Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70th St., New York, NY 10021, U.S.A.Department of Orthopaedic SurgerySports Medicine and Shoulder ServiceHospital for Special Surgery535 E 70th St.New YorkNY10021U.S.A.
| | - Ryan M. Degen
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | | | - David W. Altchek
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S. Dines
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
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Basics of Elbow Arthroscopy Part II: Positioning and Diagnostic Arthroscopy in the Supine Position. Arthrosc Tech 2016; 5:e1345-e1349. [PMID: 28560135 PMCID: PMC5439242 DOI: 10.1016/j.eats.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023] Open
Abstract
The field of elbow arthroscopy has evolved significantly since the procedure was first introduced more than 30 years ago. As our knowledge and understanding grows, numerous technical modifications have been made to improve the safety and efficacy of elbow arthroscopy. One of the most significant modifications is the change from the supine hanging position to the supine-suspended position with the use of a mechanical arm holder. Currently, the supine-suspended and lateral decubitus positions are the 2 most commonly used techniques. In this work, we discuss the history of the supine position, provide key points for proper patient positioning, and detail the steps of diagnostic elbow arthroscopy. It is our hope that this work will serve as an up-to-date review and summary of the most critical components of this procedure for emerging elbow arthroscopists.
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Prodromo J, Rackley J, Mulcahey MK. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery. PHYSICIAN SPORTSMED 2016; 44:231-9. [PMID: 27578242 DOI: 10.1080/00913847.2016.1221750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial.
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Affiliation(s)
- John Prodromo
- a Department of Orthopaedic Surgery , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Justin Rackley
- b Drexel University College of Medicine , Philadelphia , PA , USA
| | - Mary K Mulcahey
- c Department of Orthopaedic Surgery , Hahnemann University Hospital/Drexel University College of Medicine , Philadelphia , PA , USA
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Park SE, Bachman DR, O'Driscoll SW. The Safety of Using Proximal Anteromedial Portals in Elbow Arthroscopy With Prior Ulnar Nerve Transposition. Arthroscopy 2016; 32:1003-9. [PMID: 26970834 DOI: 10.1016/j.arthro.2015.12.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 10/06/2015] [Accepted: 12/04/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the safety of using the proximal anteromedial portal, using a simplified ulnar nerve management strategy derived from an earlier study, in a series of patients with previously transposed ulnar nerves. METHODS A retrospective review of all elbow arthroscopies performed by a single surgeon from 2009 to 2014 was performed. The following techniques were used if, by palpation, localization of the ulnar nerve was considered to be certain (group 1) or uncertain (group 2): In group 1 (certain) the proximal anteromedial portal was established in the normal antegrade fashion. In group 2 (uncertain) a 1- to 3-cm incision was made at the planned proximal anteromedial portal site, and blunt dissection down to the capsule was performed without identification of the nerve. The nerve was not visualized but sometimes was palpated through the wound to confirm its location anteriorly or posteriorly. If there was a disparity between the prior operative records and the physical examination findings, the nerve was explored through a 3- to 4-cm incision. RESULTS We reviewed 394 elbow arthroscopy cases, 22 of which had a prior transposed ulnar nerve (21 subcutaneous and 1 submuscular) that required anterior-compartment arthroscopic surgery. Group 1 (certain location) consisted of 9 elbows (41%), whereas group 2 (uncertain location) consisted of 13 (59%). In 2 cases in group 2, the ulnar nerve was explored because of the disparity between the previous medical records and the physical examination findings. There were no operative ulnar nerve injuries related to the use of the proximal anteromedial portal. CONCLUSIONS The proximal anteromedial portal was able to be used safely in patients with prior transposition of the ulnar nerve. This was achieved by using an algorithm based on the degree of certainty with which the nerve can be localized in the region of the planned portal by clinical palpation. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sang-Eun Park
- Department of Orthopedic Surgery, Mayo Clinic Rochester, Minnesota, U.S.A.; Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Daniel R Bachman
- Department of Orthopedic Surgery, Mayo Clinic Rochester, Minnesota, U.S.A
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic Rochester, Minnesota, U.S.A..
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Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures. Reg Anesth Pain Med 2016; 40:431-42. [PMID: 26192546 DOI: 10.1097/aap.0000000000000178] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. WHAT'S NEW As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.
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Werner BC, Fashandi AH, Chhabra AB, Deal DN. Effect of Obesity on Complication Rate After Elbow Arthroscopy in a Medicare Population. Arthroscopy 2016; 32:453-7. [PMID: 26563649 DOI: 10.1016/j.arthro.2015.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/22/2015] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To use a national insurance database to explore the association of obesity with the incidence of complications after elbow arthroscopy in a Medicare population. METHODS Using Current Procedural Terminology (CPT) and International Classification of Diseases, 9th Revision (ICD-9) procedure codes, we queried the PearlDiver database for patients undergoing elbow arthroscopy. Patients were divided into obese (body mass index [BMI] >30) and nonobese (BMI <30) cohorts using ICD-9 codes for BMI and obesity. Nonobese patients were matched to obese patients based on age, sex, tobacco use, diabetes, and rheumatoid arthritis. Postoperative complications were assessed with ICD-9 and Current Procedural Terminology codes, including infection, nerve injury, stiffness, and medical complications. RESULTS A total of 2,785 Medicare patients who underwent elbow arthroscopy were identified from 2005 to 2012; 628 patients (22.5%) were coded as obese or morbidly obese, and 628 matched nonobese patients formed the control group. There were no differences between the obese patients and matched control nonobese patients regarding type of elbow arthroscopy, previous elbow fracture or previous elbow arthroscopy. Obese patients had greater rates of all assessed complications, including infection (odds ratio [OR] 2.8, P = .037), nerve injury (OR 5.4, P = .001), stiffness (OR 1.9, P = .016) and medical complications (OR 6.9, P < .0001). CONCLUSIONS Obesity is associated with significantly increased rates of all assessed complications after elbow arthroscopy in a Medicare population, including infection, nerve injury, stiffness, and medical complications. LEVEL OF EVIDENCE Therapeutic Level III, case-control study.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Ahmad H Fashandi
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - D Nicole Deal
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A..
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Abstract
Several types of elbow fractures are amenable to arthroscopic or arthroscopic-assisted fracture fixation, including fractures of the coronoid, radial head, lateral condyle, and capitellum. Other posttraumatic conditions may be treated arthroscopically, such as arthrofibrosis or delayed radial head excision. Arthroscopy can be used for assessment of stability or intra-articular fracture displacement. The safest portals are the midlateral (soft spot portal), proximal anteromedial, and proximal anterolateral. Although circumstances may vary according to the injury pattern, a proximal anteromedial portal is usually established first. Arthroscopy enables a less invasive surgical exposure that facilitates visualization of the fracture fragments in select scenarios.
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Affiliation(s)
- Leslie A Fink Barnes
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
| | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
| | - Michael Hausman
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
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Carroll MJ, Hildebrand KA. Bilateral pulmonary emboli after elective elbow arthroscopy: a case report. J Shoulder Elbow Surg 2015; 24:e141-3. [PMID: 25769905 DOI: 10.1016/j.jse.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/01/2015] [Accepted: 01/03/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J Carroll
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
| | - Kevin A Hildebrand
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
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Rodriguez-Merchan EC. Hemophilic synovitis of the knee: radiosynovectomy or arthroscopic synovectomy? Expert Rev Hematol 2014; 7:507-11. [DOI: 10.1586/17474086.2014.926809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Wada T, Yamauchi M, Oki G, Sonoda T, Yamakage M, Yamashita T. Efficacy of axillary nerve block in elbow arthroscopic surgery: a randomized trial. J Shoulder Elbow Surg 2014; 23:291-6. [PMID: 24439245 DOI: 10.1016/j.jse.2013.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate postoperative pain levels after arthroscopic elbow surgery under general anesthesia and to determine whether an axillary nerve block provides additional pain management benefits compared with a portal site injection of local anesthetic. METHODS Thirty-six patients undergoing arthroscopic elbow surgery under general anesthesia were randomized to either a study group receiving axillary nerve block (Ax group) or a control group receiving portal site injections of local anesthetic (Lo group). During the first 48 hours after surgery, pain visual analog scale (VAS) scores (0-100), total amount of oral analgesics required, and patient satisfaction were assessed. RESULTS Among all 36 patients, mean pain VAS scores at rest were 37, 18, and 9 for the first 12-hour period and at 24 and 48 hours after surgery, respectively. The mean pain VAS scores during physiotherapy were 47 and 33 at 24 and 48 hours postoperatively, respectively. No intergroup differences were observed between the Ax and Lo groups at any time point after surgery (P value range, .41 to .87). The mean number of loxoprofen tablets required during the 48-hour study period was 5.1 in the Ax group and 4.5 in the Lo group (P = .90). The Ax and Lo groups had mean overall patient satisfaction scores of 91 and 91, respectively (P = .98). CONCLUSIONS Postoperative pain levels after arthroscopic elbow surgery could be well managed with oral analgesics and local anesthetic. An axillary nerve block was not found to provide any postoperative pain control benefits.
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Affiliation(s)
- Takuro Wada
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.
| | | | - Gosuke Oki
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Tomoko Sonoda
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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Abstract
Venous thromboembolism (VTE) is a relatively rare complication of arthroscopic surgery but has the potential to cause significant morbidity and even mortality. VTE has been reported after shoulder and knee arthroscopy prompting controversial guidelines to be proposed. More limited studies are available regarding hip and ankle arthroscopy and 1 case of deep venous thrombosis in the contralateral leg status after hip arthroscopy exists. No reports have been published regarding VTE after elbow or wrist arthroscopy to these authors' knowledge. In this article, a systematic review of the literature was conducted to analyze the incidence, treatment, and prevention of thromboembolic complications in arthroscopy.
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Byram IR, Kim HM, Levine WN, Ahmad CS. Elbow arthroscopic surgery update for sports medicine conditions. Am J Sports Med 2013; 41:2191-202. [PMID: 23572098 DOI: 10.1177/0363546513482106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity.
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Affiliation(s)
- Ian R Byram
- Center for Shoulder, Elbow and Sports Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
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Rodriguez-Merchan EC. Haemophilic synovitis of the elbow: radiosynovectomy, open synovectomy or arthroscopic synovectomy? Thromb Res 2013; 132:15-8. [PMID: 23786892 DOI: 10.1016/j.thromres.2013.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/21/2013] [Accepted: 05/26/2013] [Indexed: 11/26/2022]
Abstract
Arthroscopic synovectomy (AS) of the elbow, while providing similar pain relief to open synovectomy (OS), may place patients at higher risk for recurrence. The primary predictor of outcome is degree of pre-existing degenerative changes within the joint. Regarding haemophilia patients, radiosynovectomy (RS) is the best choice for patients with persistent synovitis of the elbow. In the elbow we recommend a dose of 30-40 megabecquerels (mBq) in children and a dose of 56-74 mBq in adults. If three consecutive RSs with 6 months intervals are ineffective, an AS or OS must be indicated. Synovectomy (by any method) significantly reduces bleeding episodes. Although the dose of radiation of RS is minimal, 0.32 millisieverts (mSv) in children, 0.54 mSv in adults, and neither articular nor systemic neoplastic changes related to RS have been reported so far, all patients must be given opportunity to consider risk/benefit ratios. Radiation dose due to natural sources is 2 mSv per year and the recommended limit for patients (apart from natural sources is 1 mSv per year). My current recommendation is to use RS in children older than 12 years of age. Therefore, in children younger than 12 years of age an AS should be indicated. OS should be reserved for adults requiring radial head excision (due to a severe limitation of pronation-supination) and synovectomy in the same surgical session.
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Sinha A, Pydah SKV, Webb M. Elbow arthroscopy: a new setup to avoid visual paradox and improve triangulation. Arthrosc Tech 2013; 2:e65-7. [PMID: 23875151 PMCID: PMC3716023 DOI: 10.1016/j.eats.2012.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/21/2012] [Indexed: 02/03/2023] Open
Abstract
Elbow arthroscopy is a useful diagnostic and therapeutic tool for various conditions. Conventional arthroscopy with the patient in the prone or lateral position where the screen is placed on the opposite side makes it difficult to interpret the image, results in visual paradox, and is associated with difficult triangulation. We present a modified setup for the operating room to help eliminate these problems and improve triangulation.
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Affiliation(s)
| | - Satya Kanth V. Pydah
- Address correspondence to Satya Kanth V. Pydah, M.S.Orth., M.Ch.Orth., F.R.C.S.(Tr&Orth), Department of Orthopaedics & Trauma, Countess of Chester Hospital, Liverpool Road, Chester, England.
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Abstract
Elbow arthroscopy has become an accepted surgical option for treating numerous conditions of the elbow, including septic, degenerative, or traumatic arthritis; capsular release; removal of loose bodies; synovectomy or plica excision; and chondral lesions of the capitellum. Surgeon experience, knowledge of elbow anatomy, patient positioning, and portal selection and placement are important factors for successful arthroscopy and avoiding complications. This article describes the basic surgical setup and technique for elbow arthroscopy.
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Elbow arthroscopy in acute injuries. Knee Surg Sports Traumatol Arthrosc 2012; 20:2542-8. [PMID: 22278657 DOI: 10.1007/s00167-012-1904-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 01/12/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Arthroscopy of the elbow has become a standard treatment option for many indications. The purpose of this article is to review literature concerning the use of arthroscopy for acute elbow injuries. METHODS The main medical literature databases were searched for articles on the use of elbow arthroscopy in acute injuries. A total of 13 publications relevant to the topic were included. The Coleman methodology score was used to assess the methods of each article. RESULTS All published articles have been case reports or retrospective case series. In fracture treatment, arthroscopy has been used in the treatment of displaced radial head, coronoid and capitellum fractures in adults and displaced radial neck and lateral humeral condyle fractures in children with good results. Endoscopic techniques have been used in distal biceps rupture and medial avulsion of the triceps. And also new techniques have been developed for the treatment of intra-articular soft-tissue lesions like rupture of the radial ulnohumeral ligament complex. One of the 13 studies analyzed was considered of good quality, 5 of moderate quality and all others of poor quality with inconsistent methodology and outcomes. CONCLUSION The range of treatments using elbow arthroscopy in acute injuries is expanding and brings new controversies and challenges. Single reports of arthroscopically treated bony and soft-tissue injuries of the elbow showed satisfactory results. However, further randomized prospective studies are needed to evaluate their safety and efficacy compared with open 'gold standard' techniques. LEVEL OF EVIDENCE IV.
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Maak TG, Osei D, Delos D, Taylor S, Warren RF, Weiland AJ. Peripheral nerve injuries in sports-related surgery: presentation, evaluation, and management: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94:e1211-10. [PMID: 22992827 DOI: 10.2106/jbjs.k.01448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Peripheral nerve injuries during sports-related operative interventions are rare complications, but the associated morbidity can be substantial. Early diagnosis, efficient and effective evaluation, and appropriate management are crucial to maximizing the prognosis, and a clear and structured algorithm is therefore required. We describe the surgical conditions and interventions that are commonly associated with intraoperative peripheral nerve injuries. In addition, we review the common postoperative presentations of patients with these injuries as well as the anatomic structures that are directly injured or associated with these injuries during the operation. Some examples of peripheral nerve injuries incurred during sports-related surgery include ulnar nerve injury during ulnar collateral ligament reconstruction of the elbow and elbow arthroscopy, median nerve injury during ulnar collateral ligament reconstruction of the elbow, axillary nerve injury during Bankart repair and the Bristow transfer, and peroneal nerve injury during posterolateral corner reconstruction of the knee and arthroscopic lateral meniscal repair. We also detail the clinical and radiographic evaluation of these patients, including the utility and timing of radiographs, magnetic resonance imaging (MRI), ultrasonography, electromyography (EMG), and nonoperative or operative management. The diagnosis, evaluation, and management of peripheral nerve injuries incurred during sports-related surgical interventions are critical to minimizing patient morbidity and maximizing postoperative function. Although these injuries occur during a variety of procedures, common themes exist regarding evaluation techniques and treatment algorithms. Nonoperative treatment includes physical therapy and medical management. Operative treatments include neurolysis, transposition, neurorrhaphy, nerve transfer, and tendon transfer. This article provides orthopaedic surgeons with a simplified, literature-based algorithm for evaluation and management of peripheral nerve injuries associated with sports-related operative procedures.
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Affiliation(s)
- Travis G Maak
- Hospital for Special Surgery, New York, NY 10021, USA.
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Desai VN, Cheung EV. Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study. J Shoulder Elbow Surg 2012; 21:441-50. [PMID: 22192767 DOI: 10.1016/j.jse.2011.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the last 2 decades, extensive research in postoperative pain management has been undertaken to decrease morbidity. Orthopedic procedures tend to have increased pain compared with other procedures, but further research must be done to manage pain more efficiently. Postoperative pain morbidities and analgesic dependence continue to adversely affect health care. MATERIALS AND METHODS The study assessed the pain of 78 elbow and shoulder surgery patients preoperatively and postoperatively using the Short-Form McGill Pain Questionnaire (SF-MPQ). Preoperatively, each patient scored their preoperative pain (PP) and anticipated postoperative pain (APP). Postoperatively, they scored their 3-day (3dpp) and 6-week postoperative pain (6wpp). The pain intensities at these 4 intervals were then compared and analyzed using Pearson coefficients. RESULTS APP and PP were strong predictors of postoperative pain. The average APP was higher than the average postoperative pain. The 6wpp was significantly lower than the 3dpp. Sex, chronicity, and type of surgery were not significant factors; however, the group aged 18 to 39 years had a significant correlation with postoperative pain. CONCLUSION PP and APP were both independent predictors of increased postoperative pain. PP was also predictive of APP. Although, overall postoperative pain was lower than APP or PP due to pain management techniques, postoperative pain was still significantly higher in patients with increased APP or PP than their counterparts. Therefore, surgeons should factor patient's APP and PP to better manage their patient's postoperative pain to decrease comorbidities.
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Affiliation(s)
- Vimal N Desai
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA 94063, USA
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Raphael BS, Weiland AJ, Altchek DW, Gay DM. Revision arthroscopic contracture release in the elbow resulting in an ulnar nerve transection: surgical technique. J Bone Joint Surg Am 2011; 93 Suppl 1:100-8. [PMID: 21411691 DOI: 10.2106/jbjs.j.01272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Sahajpal DT, Blonna D, O'Driscoll SW. Anteromedial elbow arthroscopy portals in patients with prior ulnar nerve transposition or subluxation. Arthroscopy 2010; 26:1045-52. [PMID: 20678701 DOI: 10.1016/j.arthro.2009.12.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to document management strategies and complications relating to the use of anteromedial portals for elbow arthroscopy in a series of patients with subluxating or previously transposed ulnar nerves. METHODS A review of 913 elbow arthroscopies showed that 59 elbows with a subluxating or previously transposed ulnar nerve required anterior compartment arthroscopic surgery. The patients with subluxating nerves had proximal anteromedial portals established by reducing and holding the nerve behind the epicondyle with a thumb while establishing or entering the portal. In cases of prior nerve transposition, the following techniques were used if, by palpation, localization of the ulnar nerve was considered to be (1) unequivocal, (2) equivocal, or (3) impossible: In group 1 (unequivocal) the proximal anteromedial portal was established in the normal antegrade fashion. In group 2 (equivocal) a 1-cm incision was made at the planned proximal anteromedial portal site and blunt dissection down to the capsule was performed without identification of the nerve. In group 3 (impossible) a 2- to 4-cm skin incision was made and the nerve was identified before placement of the portal. RESULTS We found that 59 elbows in 56 patients had a subluxating ulnar nerve (31 elbows) or previous ulnar nerve transposition (28 elbows). The transposition had been subcutaneous in 21 and submuscular in 7. The proximal anteromedial portal was used in all but 3 cases (2 patients) of submuscular transposition that were early in the series. In those cases only 2 lateral portals were used for anterior compartment surgery. There were no operative ulnar nerve injuries related to the use of the proximal anteromedial portal. CONCLUSIONS Neither elbow arthroscopy nor specifically the use of the proximal anteromedial portal is contraindicated in patients with prior transposition or subluxation of the ulnar nerve. The management of the nerve can be based on the degree of certainty with which the nerve can be localized by palpation in the region of the planned portal. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Elbow Stiffness: Effectiveness of Conventional Radiography and CT to Explain Osseous Causes. AJR Am J Roentgenol 2010; 194:W515-20. [DOI: 10.2214/ajr.09.3741] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zonno A, Manuel J, Merrell G, Ramos P, Akelman E, DaSilva MF. Arthroscopic technique for medial epicondylitis: technique and safety analysis. Arthroscopy 2010; 26:610-6. [PMID: 20434657 DOI: 10.1016/j.arthro.2009.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The goals of this study are to report on a novel arthroscopic technique for the treatment of medial epicondylitis and to further describe the anatomic relations between the site of arthroscopic debridement and both the ulnar nerve and medial collateral ligament (MCL) complex. METHODS Arthroscopic debridement of the medial epicondyle was performed on 8 fresh-frozen cadaveric specimens. Each specimen was dissected, and the shortest distance from the debridement site to both the ulnar nerve and MCL complex was measured with a 3-dimensional motion-tracking system. RESULTS The mean distance between the debridement site and the ulnar nerve was 20.8 mm (range, 14.4 to 25.1 mm), and the mean distance between the medial debridement site and the origin of the anterior bundle of the MCL was 8.3 mm (range, 5.9 to 10.4 mm). CONCLUSIONS Our results suggest that arthroscopic debridement of the medial epicondyle can be performed with low risk of injury to the ulnar nerve or MCL complex. CLINICAL RELEVANCE This cadaveric study indicates a potential role for elbow arthroscopy in the surgical management of refractory medial epicondylitis.
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Affiliation(s)
- Alan Zonno
- Department of Orthopaedics, The Warren Alpert School of Medicine at Brown University/Rhode Island Hospital, Providence, Rhode Island 02818, USA
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