Visibility During Elbow Arthroscopy Using Needle Arthroscope: A Cadaveric Study.

Abstract

Background: The visibility of the elbow joint during needle arthroscopy with 0° viewing is unknown. Moreover, the surgeon's level of experience required to perform needle arthroscopy with adequate proficiency has not been established.

Purpose: To clarify visibility during elbow needle arthroscopy and investigate how the surgeon's experience affects it.

Study design: Descriptive laboratory study.

Methods: Twenty elbow specimens from 11 cadavers were used. A 1.9-mm needle arthroscope with a 0º viewing angle was inserted into 4 standard portals (anterolateral [ALP], anteromedial [AMP], lateral [LP], and posterior [PP]) to observe 18 different anatomic landmarks. The procedure was performed by 3 surgeons with >15 years of experience (ME) and 3 surgeons with lesser experience (LE) in elbow arthroscopy, defined as having performed ≤5 procedures. Each examiner evaluated 10 elbows. The observation times of all checkpoints from each portal were recorded and the mean durations compared.

Results: The percentage of each structure that was adequately visualized using the ALP and AMP were 100% for each group. Successful visualization of structures through the LP was 100% in the ME group and ranged from 86.7% to 100% in the LE group. Visualization through the PP ranged from 56.7% to 86.7% in the ME group and from 53.3% to 83.3% in the LE group. The percentage of visibility for the posterior aspect of the lateral epicondyle was significantly lower in the ME group (56.7%; P = .008), and that for the border between the trochlear cartilage (56.7%; P = .008) and olecranon fossa (53.3%; P = .003) was significantly lower in the LE group. No significant differences in visibility rates were observed between the ME and LE groups across all 18 checkpoints. The mean observation times were not significantly different between groups for all portals.

Conclusion: The needle arthroscope is a valuable tool for the arthroscopic examination of the anterior joint space and humeroulnar joints; however, visualizing the posterior joint space can be challenging, regardless of the surgeon's experience level. No significant difference was observed in the visibility probability based on experience.

Clinical relevance: The needle arthroscope can be beneficial for the management of elbow diseases in the anterior joint space and humeroulnar joints, regardless of the surgeon's experience level, and enables more precise diagnosis and treatment planning.