Modified Anterolateral Portals in Elbow Arthroscopy: A Cadaveric Study on Safety

Thon, Stephen G.; Gold, Peter A.; Rush, Lane; O’Brien, Michael J.; Savoie, Felix H.

doi:10.1016/j.arthro.2017.06.012

Cited by 10 publications

(15 citation statements)

References 19 publications

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“…The original AL portal, established by Andrews and Carson,3 is now regarded as a distal AL portal 3 6 11. Of note, only the studies by Field et al ,6 Stothers et al 11 and Thon et al 12 had comparisons of AL portals across different categories. Figure 2 shows each of the different definitions in relation to each other at the lateral elbow.…”

Section: Resultsmentioning

confidence: 99%

“…This definition was regarded as being directly in line with the joint, and therefore it was placed into the direct category. The authors of this study recently published the safety margin of a ‘modified direct AL portal.’12 The portal site is modified from Field et al ’s6 site by placing it an additional 1 cm anterior, or ‘2 cm directly anterior to the LE.’12 …”

Section: Resultsmentioning

confidence: 99%

“…To date, three cadaveric studies have been performed on portal sites proximal to the LE, those of Field et al ,6 Stothers et al 11 and Thon et al 12. In each of those studies, different AL portal sites and their comparison to each other were examined.…”

Section: Resultsmentioning

confidence: 99%

“…Stothers et al 11 used ‘1–2 cm proximal to the lateral epicondyle, directly on the anterior surface of the humerus’ as their definition of portal placement. Similar to the direct AL portal, Thon et al 12 described a ‘modified proximal AL portal’ which was moved an additional 1 cm anterior compared with Field et al ’s6 portal site. This portal was defined as ‘2 cm proximal and 2 cm anterior to the LE.’12 …”

Section: Resultsmentioning

confidence: 99%

“…Similar to the direct AL portal, Thon et al 12 described a ‘modified proximal AL portal’ which was moved an additional 1 cm anterior compared with Field et al ’s6 portal site. This portal was defined as ‘2 cm proximal and 2 cm anterior to the LE.’12 …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Proximal anterolateral portals in elbow arthroscopy are safer for use relative to the radial nerve: a systematic review

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Proximal anterolateral portals in elbow arthroscopy are safer for use relative to the radial nerve: a systematic review

et al. 2018

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Modified anteromedial and anterolateral elbow arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation

Cucchi

Arrigoni²,

Luceri

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Arthroscopic ixation of radial head radial head fractures is an appealing alternative to open reduction and internal ixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modiications to the standard anteromedial (AM) and anterolateral (AL) portals could allow screw placement for radial head fracture osteosynthesis closer to the plane of the radial head articular surface. Methods Eight fresh-frozen specimens were prepared to mimic arthroscopic setting. Standard AL (ALst) and AM (AMst) and distal AL (ALdi) and AM (AMdi) portals were established. Eleven independent examiners were asked to indicate the optimal trajectory, when aiming to place a cannulated screw parallel to the radial head surface for radial head osteosynthesis. A three-dimensional digital protractor was used to measure the angle between the indicated position and a Kirschner wire placed parallel to the radial head articular surface (α). The Shapiro-Wilk normality test was used to evaluate the normal distribution of the samples. Means, standard deviations, and 95% conidence intervals (95% CI) were calculated for each portal. A coeicient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. Results Mean α angles were 25.1 ± 11.5° for AMst, 13.8 ± 4.8° for AMdi, 17.1 ± 13.4° for ALst, -2.6 ± 9.2° for ALdi. No overlapping in the 95% CI of ipsilateral standard and distal portals was observed, indicating that the diference between these means was statistically signiicant. The distal portals showed smaller inter-observer CoV as compared to the standard ones

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Editorial Commentary: Safety in Anteromedial Elbow Portal Placement? Go North!

Hartzler

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Since iatrogenic injury to surrounding structures is more likely in the elbow than in the other major joints, many studies have examined the relationship of elbow arthroscopy portals to the at-risk anatomy. In accessing the anterior compartment of the elbow from the medial side, the brachial artery and median, ulnar, and medial antebrachial cutaneous nerves are at risk. Factors that improve the safety of this approach include the use of a proximal versus distal anteromedial portal, a distended versus and nondistended joint, and a flexed versus extended elbow position, all of which result in an approximate margin of safety of 2 cm from the deep at-risk structures.

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Modified Anterolateral Portals in Elbow Arthroscopy: A Cadaveric Study on Safety

Cited by 10 publications

References 19 publications

Proximal anterolateral portals in elbow arthroscopy are safer for use relative to the radial nerve: a systematic review

Proximal anterolateral portals in elbow arthroscopy are safer for use relative to the radial nerve: a systematic review

Modified anteromedial and anterolateral elbow arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation

Editorial Commentary: Safety in Anteromedial Elbow Portal Placement? Go North!

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