Diagnostic arthroscopy of the elbow: Set-up, portals, and technique

Development and verification of a mathematical model to quantify the joint spaces of the elbow

The purpose of the study was a development and verification of a model to quantify elbow joint spaces focusing on posterolateral rotatory instability. The model was tested for feasibility and applied to open and arthroscopic surgeries. A mathematical kinematic model was created, consisting of two segments representing the humerus and radius and ulna. Model calculations of the joint opening were compared with direct measurements on a mechanical model with attached marker arrays, and compared with values determined by a digital sliding caliper in order to evaluate the mathematical kinematic rigid body model of the elbow joint. Joint angles predicted by the mathematical model were compared with values determined by a two axis goniometer. The evaluation showed significant accordance (intercorrelation coefficient ≥0.8). The highest difference was 1.54° (root mean square: 0.46°) for all movement conditions. Ligament transaction at the open surgery situation affected an increase in joint opening (maximum joint opening: 10.9 mm±0.3). Distances in the ulnohumeral joint space (ligaments intact) under arthroscopic surgery situation varied between 4.0 and 6.8 mm (mean: 5.2 mm±1.0). Thus a possibility is created to achieve an objective assessment of joint space opening to provide a more complete description of the elbow kinematics using this approach.

State of the art: Elbow arthroscopy: review of the literature and application for osteochondritis dissecans of the capitellum

Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. The 70° arthroscope provides a greater operative field than the 30° arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail.