Arthroscopic Management of Elbow Arthritis

Abstract

The arthroscopic management of the arthritic elbow is technically challenging. Disastrous complications, such as permanent nerve damage, have been described. However, the frequency of complications is low and the results are usually very good. There are several pearls to achieve success. Firstly, the surgeons should know their limitations. Not all arthritic elbows may be treatable with an arthroscopic technique. Once the correct indication has been made, complications can usually be avoided. The elbow is thoroughly examined once anesthesia has been administered. A capsulectomy is, for example, not indicated if the patient has a full range of motion. The surface anatomy is marked on the skin and the elbow is insufflated to increase the space between the trocar and the neurovascular structures. A perfect knowledge of the anatomy is not only necessary for the correct placement of the portals, but also during the procedure when a shaver and other instruments are introduced into the joint. The tip of the shaver should be visible at all times and suction should not be used when the shaver is active. Patients can expect a significant improvement in pain and function and as a general rule, a 30° increase in arc of motion is realistic. When compared to open techniques, arthroscopy offers an excellent view of all intra-articular structures and decreases damage to extra-articular soft tissues. Arthroscopy of the elbow has evolved to a standard technique in the treatment of elbow pathology and every surgeon involved in the treatment of these patients should train themselves to face the technical challenges it brings.