Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study

Abstract

Introduction: Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals.

Materials and methods: An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured.

Results: On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy.

Conclusion: Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments.

Keywords: Arthroscopy; Elbow; Nanodrilling; Osteochondrosis dissecans.

Fig. 1

The A + B View from the PLP inserting the K-Wire using the DLP. The radial head (RH) and the capitellum (CA) can be clearly visualized. C View from AMP and marking the most anterior capitellar surface in maximum extension using the PALP

Fig. 2

Lateral radiograph with the rogers line (R) and the radio capitellar line (RC) intersecting in the center of rotation (C). The intersection of the capitellar surface with both K-wires (A and B) is marked and the angle between R and the intersection is digitally measured, leaving the corridor which is not reachable (red surface) in between