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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 7, pp 2247–2254 | Cite as

Portal placement in elbow arthroscopy by novice surgeons: cadaver study

  • Femke M. A. P. Claessen
  • Amir R. Kachooei
  • Gregory P. Kolovich
  • Geert A. Buijze
  • Luke S. Oh
  • Michel P. J. van den Bekerom
  • Job N. Doornberg
Elbow

Abstract

Purpose

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

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.

Conclusion

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.

Keywords

Cadaver study Elbow arthroscopy Iatrogenic adverse events Training 

Notes

Acknowledgments

We would like to thank Franck Forget and John Dailey of Smith and Nephew for providing us the course and the cadavers. We would like to thank Dr. Luke S. Oh, Dr. Gregory Kolovich, and Dr. Patrick Vavken for teaching us the basics of elbow arthroscopy. We would like to thank Dr. David Ring for revising the manuscript.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Femke M. A. P. Claessen
    • 1
  • Amir R. Kachooei
    • 2
    • 3
  • Gregory P. Kolovich
    • 4
  • Geert A. Buijze
    • 5
  • Luke S. Oh
    • 6
  • Michel P. J. van den Bekerom
    • 7
  • Job N. Doornberg
    • 8
  1. 1.Harvard Medical School, University of Amsterdam, Orthopaedic Hand and Upper Extremity Service, Yawkey CenterMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical School, Orthopaedic Hand and Upper Extremity ServiceMassachusetts General HospitalBostonUSA
  3. 3.Orthopedic Research CenterMashhad University of Medical SciencesMashhadIran
  4. 4.Department of Orthopaedic Hand and Upper Extremity ServiceMassachusetts General HospitalBostonUSA
  5. 5.Orthotrauma Research Center Amsterdam ResidentUniversity of Amsterdam Orthopaedic Residency Program (PGY3)AmsterdamThe Netherlands
  6. 6.Sports Medicine ServiceMassachusetts General HospitalBostonUSA
  7. 7.Shoulder and Elbow UnitOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  8. 8.Orthotrauma Research Center Amsterdam ResidentUniversity of Amsterdam Orthopaedic Residency Program (PGY6)AmsterdamThe Netherlands

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