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

Abstract

Importance Proper portal placement is imperative for a successful outcome in elbow arthroscopy. Discrepancies in the location of the placement of the anterolateral portal, with variable safety margins in regard to the radial nerve, exist in the current cadaveric literature.

Objective To systematically review and compare the placement of the anterolateral portal in elbow arthroscopy with regard to the radial nerve.

Evidence review A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines utilising the PubMed, Embase, Medline and Cochrane databases. Criteria included any original cadaveric study discussing the placement of the anterolateral portal in relation to the radial nerve. No restrictions were placed on publication date or language.

Findings Thirteen studies met final inclusion criteria as an original cadaveric work with regard to the location of the anterolateral portal and its relation to the radial nerve. Overall, nine distinct definitions of the anterolateral portal were identified in the literature, each with variable safety margins.

Conclusions and relevance There is really no consistency in the literature describing the locations of the lateral portals of the elbow. We have grouped those definitions into three categories: the distal, the direct and the proximal portals based on the location relative to the lateral epicondyle. Portal locations in the direct and proximal categories were consistently found to have an increased safety margin in reference to the radial nerve when compared with those of the distal anterolateral portal. Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin. The effects of these techniques are additive.

Level of evidence Level IV—Systematic Review of Cadaver studies

  • elbow
  • arthroscopy
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