Stothers and colleagues measured how close each standard elbow arthroscopy portal passes to nerves and vessels, and described a proximal lateral portal.
Dissection of 7 portals in 12 fresh cadaver elbows. The proximal lateral portal was later used in 62 patients, without reported outcome data.
Key Findings
The anterolateral portal, 3 cm distal and 1 cm anterior to the lateral epicondyle, lay a mean 1.4 mm (0 to 4) from the radial nerve in extension and 4.9 mm in flexion.
The proximal lateral portal, 1 to 2 cm proximal to the lateral epicondyle on the anterior humerus, lay about twice as far from the radial nerve: 4.8 mm in extension and 9.9 mm in flexion.
It also gave the wider view, including the medial and lateral joint, anterior and lateral radial head, capitellum and lateral gutter.
The anteromedial portal lay a mean 2 mm (0 to 10) from the median nerve in extension and 7 mm in flexion. The medial antebrachial cutaneous nerve averaged 1 mm away.
The proximal medial portal, 2 cm proximal to the medial epicondyle and anterior to the septum, lay 7.6 mm from the median nerve in extension and 12.4 mm in flexion, with brachialis between them. The ulnar nerve averaged 12 mm away.
Every posterior portal was 15 to 20 mm from the nearest cutaneous or major mixed nerve. The transhumeral variant reaches the anterior compartment but is technically difficult.
Board pearl
The radial nerve is most at risk in elbow arthroscopy, lying over the radial head against the capsule. The authors no longer use the anterolateral portal as described and place it proximal to the radial head.
Authors' conclusion
We have found that in arthroscopy of the elbow joint, the proximal approaches (proximal medial and proximal lateral), are safer than the anteromedial and anterolateral approaches. All areas of the anterior compartment can be visualized using these two portals, and we recommend that they be the standard anterior portals used in elbow arthroscopy. All of the posterior approaches are safe.
Stothers and colleagues measured how close each standard elbow arthroscopy portal passes to nerves and vessels, and described a proximal lateral portal.
Dissection of 7 portals in 12 fresh cadaver elbows. The proximal lateral portal was later used in 62 patients, without reported outcome data.
Key Findings
The anterolateral portal, 3 cm distal and 1 cm anterior to the lateral epicondyle, lay a mean 1.4 mm (0 to 4) from the radial nerve in extension and 4.9 mm in flexion.
The proximal lateral portal, 1 to 2 cm proximal to the lateral epicondyle on the anterior humerus, lay about twice as far from the radial nerve: 4.8 mm in extension and 9.9 mm in flexion.
It also gave the wider view, including the medial and lateral joint, anterior and lateral radial head, capitellum and lateral gutter.
The anteromedial portal lay a mean 2 mm (0 to 10) from the median nerve in extension and 7 mm in flexion. The medial antebrachial cutaneous nerve averaged 1 mm away.
The proximal medial portal, 2 cm proximal to the medial epicondyle and anterior to the septum, lay 7.6 mm from the median nerve in extension and 12.4 mm in flexion, with brachialis between them. The ulnar nerve averaged 12 mm away.
Every posterior portal was 15 to 20 mm from the nearest cutaneous or major mixed nerve. The transhumeral variant reaches the anterior compartment but is technically difficult.
Board pearl
The radial nerve is most at risk in elbow arthroscopy, lying over the radial head against the capsule. The authors no longer use the anterolateral portal as described and place it proximal to the radial head.
Authors' conclusion
We have found that in arthroscopy of the elbow joint, the proximal approaches (proximal medial and proximal lateral), are safer than the anteromedial and anterolateral approaches. All areas of the anterior compartment can be visualized using these two portals, and we recommend that they be the standard anterior portals used in elbow arthroscopy. All of the posterior approaches are safe.