Elbow arthroscopy has not become a commonly performed procedure for a multitude of reasons, not the least of which is the steep learning curve of the technique. Outside of a few individuals in very specialized practices, very few surgeons who concentrate on the upper limb have a steady flow of pediatric patients that would benefit from elbow arthroscopy. The surgery is technically challenging, is not performed at a high volume in most training centers, and carries with it substantial risks. Even a basic diagnostic arthroscopy is challenging for the novice. Additionally, there is nothing in the elbow that can be done arthroscopically that can’t be done open.
However, the elbow is an unforgiving joint, and the promise of decreasing the surgical insult to the elbow from the use of arthroscopic techniques is appealing. For those surgeons wishing to provide elbow arthroscopy to their patients, some form of hands-on instruction is highly recommended. Begin by incorporating the arthroscope as an adjunct to open procedures where visualization inside the joint would be of benefit. Progress to simple arthroscopic techniques where conversion to the open technique is easily accomplished. Arthroscopy is ideal for the treatment of osteochondritis dissecans, posterolateral plicas, and intra-articular loose bodies. Do not attempt an arthroscopy in a patient with altered anatomy, either because of trauma or disease, without having some experience with this technique.
KeywordsCatheter Depression Epinephrine Bivalved Kelly
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