The Experts below are selected from a list of 774 Experts worldwide ranked by ideXlab platform

Davide Cucchi - One of the best experts on this subject based on the ideXlab platform.

  • Modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    PurposeArthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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.MethodsEight 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability.ResultsMean 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%).ConclusionsThe use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

  • locating the ulnar nerve during Elbow Arthroscopy using palpation is only accurate proximal to the medial epicondyle
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Francesco Luceri, Denise Eygendaal, Nick F J Hilgersom, Michel P J Van Den Bekerom, Esska Elbow, Wrist Study Collaborative
    Abstract:

    Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in Elbow Arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Seven cadaveric Elbows were used and seven experienced surgeons in Elbow Arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric Elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the Elbows were dissected using a standard medial Elbow approach and the distances between the pins and ulnar nerve were measured. The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0–0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0–10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced Elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety.

  • modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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. 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%). The use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

  • distance of the posterior interosseous nerve from the radial head during Elbow Arthroscopy an anatomical study
    Joints, 2017
    Co-Authors: Paolo Arrigoni, Davide Cucchi, Enrico Guerra, Alessandra Menon, Alessandro Marinelli, Pietro Randelli, Luigi Adriano Pederzini
    Abstract:

    Purpose The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements. Methods Five fresh frozen cadaver specimens were dissected under Arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position. Conclusion This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN. Clinical Relevance Knowledge of PIN position in relation to the anterior Elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during Elbow Arthroscopy.

Denise Eygendaal - One of the best experts on this subject based on the ideXlab platform.

  • Modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    PurposeArthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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.MethodsEight 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability.ResultsMean 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%).ConclusionsThe use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

  • locating the ulnar nerve during Elbow Arthroscopy using palpation is only accurate proximal to the medial epicondyle
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Francesco Luceri, Denise Eygendaal, Nick F J Hilgersom, Michel P J Van Den Bekerom, Esska Elbow, Wrist Study Collaborative
    Abstract:

    Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in Elbow Arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Seven cadaveric Elbows were used and seven experienced surgeons in Elbow Arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric Elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the Elbows were dissected using a standard medial Elbow approach and the distances between the pins and ulnar nerve were measured. The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0–0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0–10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced Elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety.

  • modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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. 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%). The use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

  • force measurement metrics for simulated Elbow Arthroscopy training
    Journal of Experimental Orthopaedics, 2018
    Co-Authors: Nick F J Hilgersom, Denise Eygendaal, Michel P J Van Den Bekerom, Tim Horemanfranse, Ronald L A W Bleys, Gabrielle J M Tuijthof, Elbow Study Collaborative
    Abstract:

    Background Elbow Arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in Elbow Arthroscopy. Force exerted on the Elbow tissue during Arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic Elbow navigation in cadaveric specimens and assess their applicability in Elbow Arthroscopy training.

  • force measurement metrics for simulated Elbow Arthroscopy training
    Journal of Experimental Orthopaedics, 2018
    Co-Authors: Nick F J Hilgersom, Denise Eygendaal, Michel P J Van Den Bekerom, Tim Horemanfranse, Ronald L A W Bleys, Gabrielle J M Tuijthof
    Abstract:

    Elbow Arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in Elbow Arthroscopy. Force exerted on the Elbow tissue during Arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic Elbow navigation in cadaveric specimens and assess their applicability in Elbow Arthroscopy training. Two cadaveric Elbows were mounted on a Force Measurement Table (FMT) that allowed 3-dimensional measurements (x-, y-, and z-plane) of the forces exerted on the Elbow. Five experts in Elbow Arthroscopy performed arthroscopic navigation once in each of two cadaveric Elbows, navigating through the posterior, posterolateral and anterior compartment in a standardized fashion with visualization of three to four anatomic landmarks per compartment. The total absolute force (Fabs) and force direction exerted (α and β) on the Elbow during Arthroscopy were recorded. α being the angle in the horizontal plane and β being the angle in the vertical plane. The 10th–90th percentiles of the data were used to set threshold levels for training. The median Fabs was 24 N (19 N – 30 N), 27 N (20 N – 33 N) and 29 N (23 N – 32 N) for the posterior, posterolateral and anterior compartment, respectively. The median α was - 29° (- 55° – 5°), - 23° (- 56° – -1°) and 4° (- 22° – -18°) for the posterior, posterolateral and anterior compartment, respectively. The median β was - 71° (- 80° – -65°), - 76° (- 86° – -69°) and - 75° (- 81° – -71°) for the posterior, posterolateral and anterior compartment, respectively. Expert data on force magnitude and force direction exerted on the Elbow during arthroscopic navigation in cadaveric specimens were collected. The proposed maximum allowable force of 30 N (smallest 90th percentile of Fabs) exerted on the Elbow tissue, and the 10th–90th percentile range of the force directions (α and β) for each compartment may be used to provide objective feedback during arthroscopic skills training.

Kilian Wegmann - One of the best experts on this subject based on the ideXlab platform.

  • Modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    PurposeArthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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.MethodsEight 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability.ResultsMean 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%).ConclusionsThe use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

  • modified anteromedial and anterolateral Elbow Arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Christof Burger, Francesco Luceri, Denise Eygendaal, Enrico Guerra, Alessandra Menon, Lars Peter Müller, Kilian Wegmann
    Abstract:

    Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications 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. 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% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. 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 difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%). The use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL Elbow Arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

Michel P J Van Den Bekerom - One of the best experts on this subject based on the ideXlab platform.

  • locating the ulnar nerve during Elbow Arthroscopy using palpation is only accurate proximal to the medial epicondyle
    Knee Surgery Sports Traumatology Arthroscopy, 2019
    Co-Authors: Davide Cucchi, Paolo Arrigoni, Francesco Luceri, Denise Eygendaal, Nick F J Hilgersom, Michel P J Van Den Bekerom, Esska Elbow, Wrist Study Collaborative
    Abstract:

    Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in Elbow Arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Seven cadaveric Elbows were used and seven experienced surgeons in Elbow Arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric Elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the Elbows were dissected using a standard medial Elbow approach and the distances between the pins and ulnar nerve were measured. The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0–0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0–10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced Elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety.

  • force measurement metrics for simulated Elbow Arthroscopy training
    Journal of Experimental Orthopaedics, 2018
    Co-Authors: Nick F J Hilgersom, Denise Eygendaal, Michel P J Van Den Bekerom, Tim Horemanfranse, Ronald L A W Bleys, Gabrielle J M Tuijthof, Elbow Study Collaborative
    Abstract:

    Background Elbow Arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in Elbow Arthroscopy. Force exerted on the Elbow tissue during Arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic Elbow navigation in cadaveric specimens and assess their applicability in Elbow Arthroscopy training.

  • force measurement metrics for simulated Elbow Arthroscopy training
    Journal of Experimental Orthopaedics, 2018
    Co-Authors: Nick F J Hilgersom, Denise Eygendaal, Michel P J Van Den Bekerom, Tim Horemanfranse, Ronald L A W Bleys, Gabrielle J M Tuijthof
    Abstract:

    Elbow Arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in Elbow Arthroscopy. Force exerted on the Elbow tissue during Arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic Elbow navigation in cadaveric specimens and assess their applicability in Elbow Arthroscopy training. Two cadaveric Elbows were mounted on a Force Measurement Table (FMT) that allowed 3-dimensional measurements (x-, y-, and z-plane) of the forces exerted on the Elbow. Five experts in Elbow Arthroscopy performed arthroscopic navigation once in each of two cadaveric Elbows, navigating through the posterior, posterolateral and anterior compartment in a standardized fashion with visualization of three to four anatomic landmarks per compartment. The total absolute force (Fabs) and force direction exerted (α and β) on the Elbow during Arthroscopy were recorded. α being the angle in the horizontal plane and β being the angle in the vertical plane. The 10th–90th percentiles of the data were used to set threshold levels for training. The median Fabs was 24 N (19 N – 30 N), 27 N (20 N – 33 N) and 29 N (23 N – 32 N) for the posterior, posterolateral and anterior compartment, respectively. The median α was - 29° (- 55° – 5°), - 23° (- 56° – -1°) and 4° (- 22° – -18°) for the posterior, posterolateral and anterior compartment, respectively. The median β was - 71° (- 80° – -65°), - 76° (- 86° – -69°) and - 75° (- 81° – -71°) for the posterior, posterolateral and anterior compartment, respectively. Expert data on force magnitude and force direction exerted on the Elbow during arthroscopic navigation in cadaveric specimens were collected. The proposed maximum allowable force of 30 N (smallest 90th percentile of Fabs) exerted on the Elbow tissue, and the 10th–90th percentile range of the force directions (α and β) for each compartment may be used to provide objective feedback during arthroscopic skills training.

  • review of poehling et al 1989 on Elbow Arthroscopy a new technique
    Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine, 2018
    Co-Authors: Denise Eygendaal, Nick F J Hilgersom, Michel P J Van Den Bekerom, Rik J Molenaars, Job N Doornberg
    Abstract:

    This classic discusses the original publication ‘Elbow Arthroscopy: A New Technique’ by Poehling et al, published in 1989 in The Journal of Arthroscopic and Related Surgery on the introduction of the prone position and the proximal medial portal to Elbow Arthroscopy. The first attempt to perform Elbow Arthroscopy was on a cadaveric specimen by Burman in 1931, after which it took approximately 50 years until the first reports on the successful clinical use of Elbow Arthroscopy were published. By then patients were commonly placed in the supine(-suspended) position, wherein access to the posterior compartment was somewhat difficult, and entry to the anterior compartment of the Elbow was commonly established using anteromedial and anterolateral portals, which were increasingly associated with nerve injury. In 1989, Poehling et al published on the successful clinical use of two new techniques: the prone position and the proximal medial portal. The proximal medial portal meant a first established safe and reproducible entry into the anterior compartment of the Elbow that is still commonly used today. With these techniques, Poehling et al improved visualisation of the Elbow joint and showed that Elbow Arthroscopy could be performed safely and reliably despite the closeness of neurovascular structures, transitioning Elbow Arthroscopy from being pioneer work into a safe surgical procedure that would become part of the common orthopaedic practice. This classic places the work of Poehling et al in a historic perspective, discusses its impact at the time and relates it to scientific developments up to the present day.

  • nerve injuries do occur in Elbow Arthroscopy
    Knee Surgery Sports Traumatology Arthroscopy, 2018
    Co-Authors: Nick F J Hilgersom, Denise Eygendaal, Derek F P Van Deurzen, Carina L E Gerritsma, Huub J L Van Der Heide, Martijn J A Malessy, Michel P J Van Den Bekerom
    Abstract:

    The purpose is to create more awareness as well as emphasize the risk of permanent nerve injury as a complication of Elbow Arthroscopy. Patients who underwent Elbow Arthroscopy complicated by permanent nerve injury were retrospectively collected. Patients were collected using two strategies: (1) by word-of-mouth throughout the Dutch Society of Shoulder and Elbow Surgery, and the Leiden University Nerve Centre, and (2) approaching two medical liability insurance companies. Medical records were reviewed to determine patient characteristics, disease history and postoperative course. Surgical records were reviewed to determine surgical details. A total of eight patients were collected, four men and four women, ageing 21–54 years. In five out of eight patients (62.5%), the ulnar nerve was affected; in the remaining three patients (37.5%), the radial nerve was involved. Possible causes for nerve injury varied among patients, such as portal placement and the use of motorized instruments. A case series on permanent nerve injury as a complication of Elbow Arthroscopy is presented. Reporting on this sequel in the literature is little, however, its risk is not to be underestimated. This study emphasizes that permanent nerve injury is a complication of Elbow Arthroscopy, concurrently increasing awareness and thereby possibly aiding to prevention. IV, case series.

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  • factors that increase the risk of infection after Elbow Arthroscopy analysis of patient demographics medical comorbidities and steroid injections in 2 704 medicare patients
    Arthroscopy, 2017
    Co-Authors: Christopher L. Camp, Ryan M. Degen, David W. Altchek, Joshua S. Dines, Jourdan M Cancienne, Brian C Werner
    Abstract:

    Purpose To use a national database to determine (1) the incidence of joint infection after Elbow Arthroscopy, (2) identify independent patient-related risk factors for infection, and (3) determine the influence of concomitant intra-articular corticosteroid injection on infection risk. Methods The 100% Medicare Standard Analytic Files were queried to identify patients who underwent Elbow Arthroscopy from 2005 to 2012. Postoperative Elbow infections occurring within 6 months of surgery were identified using both International Classification of Diseases, 9th Revision codes for postoperative infection and Current Procedural Terminology codes for the surgical treatment of a postoperative infection. Patients were excluded if their initial arthroscopic procedure was performed for infection. A multivariate binomial logistic regression analysis was then used to evaluate patient-related risk factors for postoperative infection. Results Of the 2,704 Elbow Arthroscopy cases identified, 42 (1.55%) developed a postoperative infection. The annual incidence of infections did not increase significantly over the course of the study ( P  = .374). A number of patient demographics and medical comorbidities significantly increased the risk of infection. The most notable factors included age ≥ 65 years (odds ratio [OR] 2.38, P  = .006), body mass index > 40 (OR 1.97, P  = .024), tobacco usage (OR 1.80, P  = .046), alcohol usage (OR 4.01, P P  = .015), inflammatory arthritis (OR 2.81, P P  = .015), and intra-articular corticosteroid injection at the time of Arthroscopy (OR 2.79, P  = .006). Conclusions The annual number of Elbow arthroscopies performed in the United States has increased steadily; however, the postoperative infection rate remained consistently low at 1.55%. There are a number of patient-specific risk factors that increase this risk with OR ranging from 1.97 to 4.01. Similarly, patients who receive an intra-articular corticosteroid injection at the time of surgery are nearly 3 times (OR 2.79) more likely to develop a postoperative infection. Level of Evidence Level III, case-control study.

  • basics of Elbow Arthroscopy part ii positioning and diagnostic Arthroscopy in the supine position
    Arthroscopy techniques, 2016
    Co-Authors: Christopher L. Camp, Ryan M. Degen, Joshua S. Dines, Joaquin Sanchezsotelo, David W. Altchek
    Abstract:

    The field of Elbow Arthroscopy has evolved significantly since the procedure was first introduced more than 30 years ago. As our knowledge and understanding grows, numerous technical modifications have been made to improve the safety and efficacy of Elbow Arthroscopy. One of the most significant modifications is the change from the supine hanging position to the supine-suspended position with the use of a mechanical arm holder. Currently, the supine-suspended and lateral decubitus positions are the 2 most commonly used techniques. In this work, we discuss the history of the supine position, provide key points for proper patient positioning, and detail the steps of diagnostic Elbow Arthroscopy. It is our hope that this work will serve as an up-to-date review and summary of the most critical components of this procedure for emerging Elbow arthroscopists.

  • basics of Elbow Arthroscopy part iii positioning and diagnostic Arthroscopy in the lateral decubitus position
    Arthroscopy techniques, 2016
    Co-Authors: Christopher L. Camp, Ryan M. Degen, David W. Altchek, Joshua S. Dines, Joaquin Sanchezsotelo
    Abstract:

    In recent years, Arthroscopy has gained popularity as a preferred treatment of a multitude of pathologies affecting the Elbow. Since its initial description in 1985, many modifications have been made as our knowledge and technology have advanced. Currently, the majority of arthroscopic procedures are performed in either the lateral decubitus or supine suspended position. In this work, we discuss the history, patient positioning, and key steps for performing Elbow Arthroscopy in the lateral decubitus position. In addition to key steps, a number of strengths and limitations of this set up are discussed in detail. When properly executed, Elbow Arthroscopy can be performed in a safe and efficient manner with minimal risk to patients.

  • Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk.
    Arthroscopy Techniques, 2016
    Co-Authors: Christopher L. Camp, Ryan M. Degen, Joaquin Sanchez-sotelo, David W. Altchek, Joshua S. Dines
    Abstract:

    As our knowledge and technology advance, the indications for Elbow Arthroscopy continue to grow rapidly. During this expansion, a number of new portals have been described and reported using variable nomenclature and location descriptions. Accordingly, a comprehensive review of these portals is warranted. Given the concern for potential iatrogenic injury to surrounding neurovascular structures, a discussion of these critical nerves and vessels is also timely. In this work, we review pertinent surface anatomy; portal nomenclature, locations, and utility; and review distances to the nearest structures at risk.

  • revision arthroscopic contracture release in the Elbow resulting in an ulnar nerve transection surgical technique
    Journal of Bone and Joint Surgery American Volume, 2011
    Co-Authors: Bradley S Raphael, Andrew J Weiland, David W. Altchek
    Abstract:

    Over the past several years, the indications for Elbow Arthroscopy have expanded. Currently, Elbow Arthroscopy is used for the removal of loose bodies, the treatment of lateral epicondylitis, synovectomy, the debridement of osteophytes, the evaluation of instability contracture release, and the treatment of osteochondritis dissecans1-5. Although Elbow Arthroscopy is a relatively safe procedure, the prevalence of neurovascular complications has been reported to range from 0% to 14%1,3,6-9. In the literature, there have been a few reports of complete nerve transections during Elbow Arthroscopy6-9. We recently reported the case of a patient who presented from an outside institution after undergoing a revision arthroscopic contracture release that resulted in a complete transaction of the ulnar nerve10. A thorough understanding of the Elbow anatomy and how it is affected by certain abnormalities can reduce the risk of complications associated with Elbow Arthroscopy. Elbows with a posttraumatic contracture have a decreased compliance of the capsule, resulting in limited displacement of neurovascular structures with insufflation. These effects should be thoroughly considered during portal placement and capsular debridement, especially because most reported complications have occurred in patients with posttraumatic contractures6-11. On the medial side of the Elbow, it is imperative that the location of the ulnar nerve be identified prior to the placement of medial-side portals. This can be done by means of direct palpation, ultrasonography, or open exposure12. Dodson et al. recommended avoiding an arthroscopic procedure if the patient has undergone a previous ulnar nerve transposition1. If there has been previous surgery on the lateral aspect of the Elbow, it has been suggested that an arthroscopic procedure not be attempted because of possible adherence of the radial nerve to …