Advanced elbow arthroscopy: Tips and tricks

Abstract

Elbow arthroscopy can be a challenge, however, indications and benefits compared to open elbow surgery are rapidly evolving. The elbow has seemed to lag behind other joints including the knee, shoulder, ankle and the hip, both in number of cases and in widespread acceptance, as a joint amenable to arthroscopic management. This has occurred despite literature demonstrating successful utilization of arthroscopy in the management of a variety of injuries. The purpose of this review is to clarify and expand the indications for arthroscopy of the elbow in 2021. We will also offer tips and tricks to help make elbow arthroscopy more successful. Since originally publishing these guidelines in 2007, elbow arthroscopy has evolved, although the principles and progressions remain the same.

Keywords: Elbow; Elbow arthroscopy; Sports medicine.

Fig. 1

The (A) medial and (B) lateral aspects of the elbow illustrate the access sites for arthroscopic instruments and retractors. The grey tube indicates the arthroscope. (n, nerve; a, artery.)

Fig. 2

Loose body noted in the anterior compartment of a left elbow. The spinal needle can be used to hold it in place in preparation for removal.

Fig. 3

Arthroscopic view of a total elbow arthroplasty after ankyloses takedown and restoration of normal motion.

Fig. 4

View from the medial portal of the Extensor Carpi Radialis Brevis origin. The grey tissue represents angiofibrotic dyplasia, or Nirschle lesion. The shiny white tissue is normal tendon. Excision of the grey tissue is essential for a successful “tennis elbow” procedure.

Fig. 5A

This view from a posterior lateral portal with a 70-degree arthroscope shows an osteochondritis dissecans of the capitellum (above), with an inflamed plica laterally and the intact radial head below.

Fig. 5B

Similar view to Fig. 5A with a 70-degree arthroscope from a posterior lateral portal showing the capitellum (above) after debridement and microfracture of the osteochondral lesion and resection of the plica.

Fig. 6

Repair of a lateral capitellar fracture utilizing an absorbable suture anchor and substituting the normal suture with an absorbable suture, a modification of the Michael Hausman technique for repair.