Elbow Arthroscopy, Prone Position: Setup and Portals

This classic discusses the original publication‘Elbow Arthroscopy: A New Technique’byPoehling et al,published in 1989 inThe Journal of Arthroscopic and Related Surgeryon the introduction of the prone position and the proximal medial portal to elbow arthroscopy. The first attempt to perform elbow arthroscopy was on a cadaveric specimen by Burman in 1931, after which it took approximately 50 years until the first reports on the successful clinical use of elbow arthroscopy were published. By then patients were commonly placed in the supine(-suspended) position, wherein access to the posterior compartment was somewhat difficult, and entry to the anterior compartment of the elbow was commonly established using anteromedial and anterolateral portals, which were increasingly associated with nerve injury. In 1989, Poehlinget alpublished on the successful clinical use of two new techniques: the prone position and the proximal medial portal. The proximal medial portal meant a first established safe and reproducible entry into the anterior compartment of the elbow that is still commonly used today. With these techniques, Poehlinget alimproved visualisation of the elbow joint and showed that elbow arthroscopy could be performed safely and reliably despite the closeness of neurovascular structures, transitioning elbow arthroscopy from being pioneer work into a safe surgical procedure that would become part of the common orthopaedic practice. This classic places the work of Poehlinget alin a historic perspective, discusses its impact at the time and relates it to scientific developments up to the present day.

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Prone Elbow Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00238 ◽

2014 ◽

Vol 2 (12_suppl4) ◽

pp. 2325967114S0023

Author(s):

Mario Larrain ◽

Eduardo Di Rocco ◽

Patricio Riatti ◽

Martín Vallone ◽

Facundo Ferreyra ◽

...

Keyword(s):

Prone Position ◽

Joint Stiffness ◽

Case Series ◽

Joint Involvement ◽

Osteochondral Lesions ◽

Tire Pressure ◽

Elbow Arthroscopy ◽

Articular Fractures ◽

Post Traumatic ◽

One Year

Introduction: In the last years the elbow arthroscopy reports have increased. It is very important to perform meticulous portals technique, appropriate selection thereof, and precise diseases treatments. The surgical technique has been described in different decubitus (dorsal, lateral and ventral). According to F. Savoie and L. Field, we believe that the prone position allows anterior and posterior access simultaneously, comprising the entire joint. The aim of the study is to describe our experience in the prone position in the last 10 years, analyzing indications, patient satisfaction and complications. Material and Methods: We retrospectively analyzed case series of surgeries in the last 10 years. We performed 31 elbow arthroscopies, 24 men and 7 women, the most common sport was rugby followed tennis. Results: The most common pathology was anterior and posterior post-traumatic joint stiffness (12 cases), 7 epicondylitis with joint involvement, 7 articular fractures, five loose bodies with osteochondral lesions. One year after surgery, 95% of patients were satisfied with the outcome. Complications, transient palsy in 2 patients, which recovered ad integrum, due to compression secondary to high cuff tire pressure. Conclusion: We believe the prone position elbow arthroscopy technique is ideal for solving most of the surgical indications. Although the high potential of complications ought to important structures proximity, a profound anatomical knowledge and skill arthroscopic make it a safe and reproducible technique.

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