Tucker Cushing1, Zachary Finley2, Michael J O'Brien2, Felix H Savoie2, Leann Myers3, Gleb Medvedev2. 1. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, U.S.A.. Electronic address: tcushing@tulane.edu. 2. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, 70112, U.S.A. 3. Department Global Biostatistics and Data Science, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, 70112, U.S.A.
Abstract
PURPOSE: To systematically review available literature comparing location and safety of 2 common anteromedial portals with nearby neurovascular structures in cadaveric models and to determine the correct positioning and preparation of the joint before elbow arthroscopy. METHODS: The review was devised in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of original, cadaveric studies performed by experienced surgeons on male or female elbows evaluating anteromedial portal placement with regard to proximity of the arthroscope to neurovascular structures. Exclusion criteria consisted of case reports, clinical series, non-English language studies, and noncadaveric studies. Statistical analysis was done to measure reviewer reliability after scoring of each study. RESULTS: During screening, 2,596 studies were identified, and 10 studies met final inclusion as original, cadaveric investigations of anteromedial portal proximity to neurovascular structures. The difference in distance between proximal and distal portals was <1 mm for the brachial artery and <1.5 mm for the medial antebrachial cutaneous nerve, whereas the ulnar nerve was 4.17 mm further from the distal portal and the median nerve was 5.07 mm further from the proximal portal. Joint distension increased the distances of neurovascular structures to portal sites, with the exception of the ulnar nerve in distal portals. Elbow flexion to 90° increased distances of all neurovascular structures to portal sites. CONCLUSION: The results show that the proximal anteromedial portal puts fewer structures at risk compared with the distal portal. Elbows in 90° flexion with joint distension carry a lower risk for neurovascular injury during portal placement. These findings suggest the proximal anteromedial portal to be the safer technique in anteromedial arthroscopy of the elbow. CLINICAL RELEVANCE: Discrepancies in placement of portals have existed in the literature, indicating differing safety margins regarding surrounding neurovascular anatomy. The present study aims to link together the literature-based evidence to describe the safest anteromedial portal variation.
PURPOSE: To systematically review available literature comparing location and safety of 2 common anteromedial portals with nearby neurovascular structures in cadaveric models and to determine the correct positioning and preparation of the joint before elbow arthroscopy. METHODS: The review was devised in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of original, cadaveric studies performed by experienced surgeons on male or female elbows evaluating anteromedial portal placement with regard to proximity of the arthroscope to neurovascular structures. Exclusion criteria consisted of case reports, clinical series, non-English language studies, and noncadaveric studies. Statistical analysis was done to measure reviewer reliability after scoring of each study. RESULTS: During screening, 2,596 studies were identified, and 10 studies met final inclusion as original, cadaveric investigations of anteromedial portal proximity to neurovascular structures. The difference in distance between proximal and distal portals was <1 mm for the brachial artery and <1.5 mm for the medial antebrachial cutaneous nerve, whereas the ulnar nerve was 4.17 mm further from the distal portal and the median nerve was 5.07 mm further from the proximal portal. Joint distension increased the distances of neurovascular structures to portal sites, with the exception of the ulnar nerve in distal portals. Elbow flexion to 90° increased distances of all neurovascular structures to portal sites. CONCLUSION: The results show that the proximal anteromedial portal puts fewer structures at risk compared with the distal portal. Elbows in 90° flexion with joint distension carry a lower risk for neurovascular injury during portal placement. These findings suggest the proximal anteromedial portal to be the safer technique in anteromedial arthroscopy of the elbow. CLINICAL RELEVANCE: Discrepancies in placement of portals have existed in the literature, indicating differing safety margins regarding surrounding neurovascular anatomy. The present study aims to link together the literature-based evidence to describe the safest anteromedial portal variation.
Authors: Mehmet Can Unlu; Hayrettin Kesmezacar; Isik Akgun; Tahir Ogut; Ibrahim Uzun Journal: J Shoulder Elbow Surg Date: 2006 Jul-Aug Impact factor: 3.019
Authors: Nick F J Hilgersom; Derek F P van Deurzen; Carina L E Gerritsma; Huub J L van der Heide; Martijn J A Malessy; Denise Eygendaal; Michel P J van den Bekerom Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-09-20 Impact factor: 4.342
Authors: Leland C McCluskey; Tucker J Cushing; John M Weldy; Nisha N Kale; Felix H Savoie; Gleb Medvedev Journal: Arthrosc Sports Med Rehabil Date: 2021-12-30
Authors: Nick F J Hilgersom; Jetske Viveen; Gabriëlle J M Tuijthof; Ronald L A W Bleys; Michel P J van den Bekerom; Denise Eygendaal Journal: JSES Int Date: 2020-07-15