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. 2017 May;33(5):953-958.
doi: 10.1016/j.arthro.2017.01.031. Epub 2017 Mar 23.

An Anatomic Evaluation of Arthroscopic Access to the Radial Head

Jonathan D Hodax  1 , Travis D Blood  2 , Dominic T Kleinhenz  2 , Megan Gorman  3 , Alison Biercevicz  4 , Manuel DaSilva  2
Affiliations

An Anatomic Evaluation of Arthroscopic Access to the Radial Head

Jonathan D Hodax et al. Arthroscopy. 2017 May.

Abstract

Purpose: To determine the area of the radial head accessible for visualization and screw placement from the standard anteromedial and anterolateral portals used in elbow arthroscopy.

Methods: Five cadaveric elbows were arthroscopically evaluated using standard anteromedial and anterolateral portals. Markers (pins) were placed into the accessible portions of the radial head at maximal pronation and supination. Specimens were then evaluated by computed tomography, and the arc of the radial head accessible from each portal was determined.

Results: A continuous 220.04° ± 37.58° arc of the radial head was accessible from the combination of the anterolateral and anteromedial portals. From the anteromedial portal, the arc obtained measured 147.96° ± 21.81°, and from the anterolateral portal, the arc obtained measured 156.02° ± 33.32°. Using the radial styloid as a marker for 0°, the mean total arc ranged from 92.3° ± 34.06° dorsal to 127.74° ± 23.65° volar relative to the radial styloid.

Conclusions: Standard anteromedial and anterolateral portals used for elbow arthroscopy allow access to an average 220° area of the radial head.

Clinical relevance: This study defines the area of the radial head that can be contacted using commonly used, safe, and simple portals.

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Figures

Figure 1:
Figure 1:
Surgical positioning. A: Cadaveric specimens were positioned to mimic the operating room setup seen here. B and C: Representative arthroscopic images from the anteromedial (B) and anterolateral (C) portals with a shaver indicating the radial head in each.
Figure 2:
Figure 2:
Pin placement device designed for arthroscopic marker placement. Shown are three pins (top), the outer cannula (middle) and the trochar used to advance pins (bottom).
Figure 3:
Figure 3:
A: Representative CT images of pin placement in the radial head. B: Measurements of the arc between pin origin sites. C: Evaluation of the accuracy of pin placement relative to the center of the radial head.
Figure 4:
Figure 4:
Diagram of the radial head demonstrating the average arc of the radial head available from the AM portal, AL portal, and the total area. Solid blue lines border the mean arc, while dashed lines border standard deviation. The radial styloid is used as an anatomic reference for 0°. SI: Superior/Inferior axis; PD: Proximal/Distal axis; ML: Medial/Lateral axis.
See this image and copyright information in PMC

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