Diagnostic and Therapeutic Elbow Arthroscopy Using Small-Bore Needle Arthroscopy

Abstract

Needle arthroscopy may provide several potential advantages over standard arthroscopy. The smaller camera size and weight allows for a minimally invasive and percutaneous approach with decreased fluid use. As resolution and image quality improve, the potential to expand clinical use for therapeutic applications becomes possible. One promising use is in elbow arthroscopy. Difference in the technology, such as a zero-degree optic and less-rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy and therapeutic procedures. This manuscript introduces the authors' approach to diagnostic needle arthroscopy of the anterior and posterior elbow compartments and placement of therapeutic instrumentation. This technique could theoretically decrease the risk of iatrogenic neurovascular injuries, reduce postoperative swelling and pain due to decreased fluid use, and potentially lead to faster recovery.

Minimally invasive arthroscopy of the knee using a new 2 mm device

“…Safety and effectiveness of ankle arthroscopy 8 and tendoscopy 9 have been demonstrated recently in two cadaver studies. It can also be used in shoulder 10 and elbow 11 arthroscopy. More clinical research for further evaluation is needed in the future.…”

Arthroscopically Assisted Fixation of Terrible Triad Variant Injuries of the Elbow With Small-Bore Needle Arthroscopy

“…The role for small bore needle arthroscopy for both diagnostic and therapeutic applications is becoming clearer in the literature. 1 , 2 , 3 NA has been used in the diagnosis of idiopathic knee pain in the clinic setting and as a useful tool for diagnostic shoulder arthroscopy. Its advantages in terms of fluid management also have been described, possibly resulting in reduced extravasation and shorter operative times.…”

“…The technique for diagnostic elbow arthroscopy with the NA system has been previously described in detail. 3 The olecranon, medial epicondyle, lateral epicondyle, and ulnar nerve are identified and marked, as well as the following described portals. For access to the anterior elbow, a modified proximal anteromedial portal (mPAMP), proximal anterolateral portal (PALP), mid-anterolateral portal (MALP), and distal anterolateral portal are used.…”

“…Needle arthroscopy (NA) has been described in the diagnostic and therapeutic evaluation of the knee, shoulder, and elbow. 1 , 2 , 3 In this Technical Note, we describe our technique for NA-assisted fixation of a coronoid fracture with an intact radial head and neck. Potential benefits and disadvantages are reviewed.…”

Concurrent Needle and Standard Arthroscopy for Posterior Cruciate Ligament Reconstruction

“…Needle arthroscopy has been shown to be a safe, useful instrument in the visualization and treatment of a wide array of pathologies. [7][8][9] It incorporates a 1.9-mm arthroscope, which is smaller and less rigid than a standard arthroscope (4 mm), allowing it to be used with smaller incisions and in areas where minimal soft tissue disruption is desired. For most standard PCL reconstructions, accessory portals, moving the arthroscope back and forth the between portals, and the use of a 70 arthroscope are necessary to appropriately visualize the tibial insertion on the posterior tibial facet.…”