Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy

Summary

Objectives: To describe the relationship of the major muscular, ligamentous and neurovascular structures in relation to standard medial elbow arthroscopic portals used in dogs, and to evaluate their potential iatrogenic lesions.

Design: Anatomical study using 20 canine cadaveric elbows.

Methods: Arthroscopic explorations were performed using medial portals. Three 4 mm orthopaedic pins were introduced in place of the arthroscope, egress canula and instrumental portals. Limbs were dissected. Distances between pins and neurovascular structures were measured. Muscle, ligament and cartilage lesions were recorded.

Results: Minimal muscular lesions were observed. No ligament injury was evidenced. Superficial iatrogenic cartilage lesions were observed in three joints. The arthroscopic portal was 23.1 mm (range: 16 to 28.5 mm) caudal to the brachial artery, 21.0 mm (13–30.5 mm) caudal to the median nerve, and 4.0 mm (1–7 mm) cranial to the ulnar nerve. The instrumental portal was 16.3 (9–24 mm) caudal to the brachial artery, 13.5 mm (7–24.5 mm) caudal to the median nerve, and 11.8 (8–18 mm) cranial to the ulnar nerve. The egress portal was 21.4 mm (12–37 mm) caudal to the ulnar nerve.

Conclusions and clinical relevance: The study confirmed the safety of elbow medial arthroscopic portals. Care must be taken when placing the camera portal so as to avoid injury of the ulnar nerve. Should extensive intra-articular procedures be needed, manipulation of instruments should be done cautiously in the cranio-medial compartment of the joint due to the proximity of the median nerve to the capsule.

Keywords

Elbow - arthroscopy - anatomy - canine

• References

• 1 Beale BS, Hulse DA, Schultz KS. et al. Arthroscopically assisted surgery of the elbow. in Beale BS, Hulse DA, Schultz KS. et al. (editors) Small animal arthroscopy. 1st ed. Philadelphia (PA) Saunders: 2003: 50-79.
• 2 Belin P.. Arthroscopie de l'épaule et du coude chez le chien. Thèse pour le doctorat vétérinaire. Ecole nationale vétérinaire d’Alfort. 1997
• 3 Meyer-Lindenberg A, Langhann A, Fehr M. et al. Arthrotomy versus arthroscopy in the treatment of the fragmented medial coronoid process of the ulna (FCP) in 421 dogs. Vet Comp Orthop Traumatol 2003; 16: 204-210.
• 4 Van Ryssen B, Van Bree H, Gielen I.. Diagnostic and surgical arthroscopy in small animals. Proc 5th basic course in Small Animal Arthroscopy, Ghent, Belgium, January 2001; 1-15.
• 5 Bardet JF.. Arthroscopy of the elbow in dogs. Part II: the cranial portal in the diagnosis and treatment of the lesions of the coronoid process. Vet Comp Orthop Traumatol 1997; 10: 60-65.
• 6 Rochat MC.. Arthroscopy. Veterinary Clinics of North America: J Small Anim Pract 2001; 31: 761-787.
• 7 Andrews JR, Baumgarten TE.. Arthroscopic anatomy of the elbow. Orthop Clin North Am 1995; 671-677.
• 8 Bardet JF.. Arthroscopy of the elbow in dogs: Part I: the normal arthroscopic anatomy using the cranio-lateral portal. Vet Comp Orthop Traumatol 1997; 10: 5-9.
• 9 Snaps FR, Balligand MH, Saunders JH. et al. Comparison of radiography, magnetic resonance imaging, and surgical findings in dogs with elbow dysplasia. Am J Vet Res 1997; 58: 1367-1370.
• 10 Van Ryssen B, Van Bree H, Simoens P.. Elbow arthroscopy in clinically normal dogs. Am J Vet Res 1993; 54: 191-198.
• 11 Viguier E.. La sémiologie des boiteries du coude. Examens complémentaires. Point Vét 1999; 30: 385-390.
• 12 Nguyen G.. Traitement video-assisté des lésions du processus coronoïde médial chez le chien : Etude rétrospective pour 50 coudes. Thèse pour le doctorat vétérinaire. Ecole nationale vétérinaire d’Alfort?. 2004
• 13 Evans RB, Gordon-Evans WJ, Conzemius MG.. Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol 2008; 21: 106-109.
• 14 Kelly EW, Morrey BF, O'Driscoll SW.. Complications of elbow arthroscopy. J Bone Joint Surg Am 2001; 83: 25-34.
• 15 Van Ryssen B, Van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-362.
• 16 Lecoeur C.. Traitement de la dysplasie du coude associée à une fragmentation du processus coronoïde médial par ostéotomie ulnaire dynamique chez le chien : étude rétrospective pour 45 coudes. Thèse pour le doctorat vétérinaire. Ecole nationale vétérinaire d’Alfort. 2003
• 17 Kelly E. Avoiding nerve injury, in Yamaguchi’sAdvanced reconstruction. Elbow. Amercan Academy of Orthopaedic Surgeons, Rosemont, IL 60018, USA, 470.
• 18 O’Driscoll SWM. Arthroscopic osteocapsular arthroplasty in Yamaguchi’sAdvanced reconstruction. Elbow. American Academy of Orthopaedic Surgeons, Rosemont, IL 60018, USA, 470.
• 19 Flo G.. Surgical removal of fragmented coronoid processes and fractured anconeal process in an older dog with evidence of severe degenerative joint disease. J Am Vet Med Assoc 1998; 213: 1780-1782.
• 20 Tatarunas AC, Matura JM.. Arthroscopic study of the elbow joint in dog cadavers. Acta Cir Bras 2006; (Nov-Dec) 21: 362-365.
• 21 Piermattei DL, Flo GL.. The elbow joint. In Piermattei DL, Flo GL. (editors) Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopaedics and Fracture Treatment. 3rd ed. Philadelphia: PA, Saunders; 1997: 288-320.
• 22 Unlu MC, Kesmezacar H, Akgun I. et al. Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions. J Shoulder Elbow Surg 2006; 15: 457-462.
• 23 Marshall PD, Fairclough JA, Johnson SR. et al. Avoiding nerve damage during elbow arthroscopy. Bone Joint Surg Br 1993; (Jan) 75: 129-131.
• 24 Greis PE, Burks RT, Schickendantz MS. et al. Axillary nerve injury after thermal capsular shrinkage of the shoulder. J Shoulder Elbow Surg 2001; 10: 231-235.
• 25 McCarty EC, Warren RF, Deng XH. et al. Temperature along the axillary nerve during radiofrequency-induced thermal capsular shrinkage. Am J Sports Med 2004; 32: 909-914.