Published on 11/04/2015 by admin
Filed under Orthopaedics
Last modified 22/04/2025
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CHAPTER 43 The Future of Arthroscopy of the Elbow
Felix H. Savoie, III, Bernard F. Morrey
As with many joints, arthroscopy of the elbow has become more common. Case reports and anecdotal evidence support the rapid growth of the use of arthroscopy in a variety of disorders of the elbow. The future holds much promise in the expansion of the application of arthroscopic techniques. The success of arthroscopy over open procedures in other areas has pushed both the surgeon and the public to advance the application of these techniques to the elbow. Minimally invasive surgery, with its advantage of causing less surgical damage while achieving the same results, is the current preferred method in all areas of orthopedics. The elbow is no different. The key to the advancement of elbow surgery will be the development of guidelines and teachers to improve the safety of these surgeries.
O’Driscoll, in the last edition of this text, detailed the learning curve necessary to allow advancement, using the arthrofibrotic elbow as an example. Although complications occurred during the development of the process, the procedure now is the method of choice for most elbow surgeons in managing this complex problem. These advances were attributable to the honesty of the investigating surgeons and their willingness to share the complications and problems with their colleagues, leading to improved results and decreased risk. The key is to advance the investigations and procedures while always operating within one’s own personal “safe zone” of experience and comfort. One of the most comfor-ting advances, popularized by O’Driscoll, is the use of arthroscopic retractors to protect the neurovascular structures. This single advance has allowed the application of elbow arthroscopy to many more complex procedures.
Of particular interest are arthroscopy’s potential applications to the management of extra-articular pathology. Recent reports have detailed the use of arthroscopic techniques in the evaluation and management of olecrenon bursitis, distal biceps tears, and triceps tendon tears. The possibility of arthroscopic management of various instability patterns of the elbow, including eventually medial ulnar collateral ligament reconstruction, is also emerging.
There is every expectation that the management of some fractures will be amenable to or assisted by arthroscopy. These include fractures of the radial head, coronoid, olecranon, and distal humerus. The main limitation to the use of these future techniques is imposed by the neurovascular anatomy. Future advances will depend on the increased familiarity with normal and pathologic anatomy of the elbow. Technically, the ability of the surgeon to protect these structures is critical. Localization and retraction of the nerves and arteries while maintaining visualization and safely proceeding with the surgery holds the key to progression of the application of arthroscopy to the elbow.
The Elbow and Its Disorders
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