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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Portal placement in elbow arthroscopy by novice surgeons: cadaver study

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  • Femke M. A. P. Claessen - Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, United States; University of Amsterdam, Amsterdam, Netherlands
  • Amir Reza Kachooei - Orthopedic Research Center, Ghaem Hospital, Mashhad, Iran
  • Gregory P. Kolovich - Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, United States
  • Geert A. Buijze - Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program, Amsterdam, Netherlands
  • Luke S. Oh - Sports Medicine Service, Massachusetts General Hospital, Boston, United States
  • Michel P. J. van den Bekerom - Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
  • Job N. Doornberg - Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program, Amsterdam, Netherlands

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-540

doi: 10.3205/19ifssh1309, urn:nbn:de:0183-19ifssh13095

Published: February 6, 2020

© 2020 Claessen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: 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 and Conclusions: 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.

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.