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The Classic
Review of Poehling et al (1989) on elbow arthroscopy: a new technique
  1. Nick F J Hilgersom1,2,
  2. Rik J Molenaars2,
  3. Michel P J van den Bekerom3,
  4. Denise Eygendaal1,4,
  5. Job N Doornberg5
  1. 1Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  2. 2Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  4. 4Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
  5. 5Department of Orthopaedic Surgery, Royal Adelaide Hospital, Adelaide, Australia
  1. Correspondence to Nick F J Hilgersom, Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; nhilgersom{at}gmail.com

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.

  • elbow
  • arthroscopy
  • treatment / technique
  • upper extremity

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Footnotes

  • Contributors NFJH is responsible for critical analysis and interpretation of articles reviewed for the manuscript, manuscript preparation, design, creation of figure, editing and obtaining the expert opinions. RJM is responsible for critical analysis and interpretation of articles and manuscript editing. MPJB, DE and JND are responsible for manuscript preparation, editing and obtaining the expert opinions.

  • Competing interests NFJH, RJM, MPJB and DE have nothing to declare. JND was supported by an unrestricted research grant from the non-profit Marti-Keuning-Eckhardt foundation.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note All images within the article are created by N.F.J. Hilgersom. They are licensed under Creative Commons Attribution Non Commercial 4.0 (https://creativecommons.org/licenses/by-nc/4.0/deed.en).

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