Elbow arthroscopy is a minimally invasive procedure that involves introducing a tiny camera in the elbow joint and having a look around. It is used to diagnose and treat elbow problems. Elbow arthroscopy can improve elbow function with smaller incisions, quicker recovery and less postoperative pain.
The indications for elbow arthroscopy include:
• Arthroscopic treatment of tennis elbow
• Loose body removal
• Capsular release for elbow stiffness
• Osteophyte debridement for early arthritis
• Osteochondritis dissecans
• Debridement for septic arthritis
• Arthroscopic-assisted fracture fixation
Before elbow arthroscopy, you will typically undergo preoperative assessment. You will be asked about your health history in detail. You will be asked to bring along a full list of your medications. You may need to stop taking some of your medications a few days before surgery (especially blood thinners). Before the procedure, you may also need blood tests, a chest x-ray or an ECG (electrocardiogram), to make sure it’s safe to proceed with surgery. The anaesthetist will give you specific preoperative instructions, including how long before surgery to stop eating and drinking.
Elbow arthroscopy may last 60-90 minutes, depending on the complexity of the case. During elbow arthroscopy:
• You will lie in the lateral position (on your side) and a tourniquet will be applied on your upper arm.
• Your skin will be cleaned with an antiseptic solution.
• The surgeon will make a small incision (4mm) in the front of your elbow and insert a small camera, called arthroscope, which will project images of your elbow joint in a video screen.
• The arthroscope is essentially a slim telescope (4.5mm or 2.9mm) with a high-definition camera, surrounded by a fiber-optic tube that functions as a light source.
• In order to see inside the joint and to undertake any procedures, the joint needs to be ‘opened’ up. This is done by distending the joint with normal saline fluid.
• A specialized pump is used to control the pressure and rate of fluid going into the joint, to optimize visualization.
• The surgeon will make one or two more small incisions in the back of your elbow to insert tiny instruments in order to address all pathology found.
• Multiple arthroscopic instruments may be used during the procedure. These include probes, graspers, punches, rasps, elevators and suture cutters. Power instruments, such as shavers, burrs or radiofrequency probes may also be used.
• Small implants may be used during the procedure. Suture-anchors are the most common implant used during arthroscopic elbow surgery. A suture-anchor is essentially a small device made usually out of biocomposite material, loaded with sutures through a small eyelet. The anchor is placed flash with the bone and the suture is threaded through the tissue to repair.
• Once surgery is finished, all incisions will be closed, and a bandage will be placed on top.
• Your arm will be placed in a sling after surgery.
Recovery time depends on the underlying pathology and the type of procedure undertaken. Your doctor and physical therapist will build a rehabilitation plan customized for you. It is imperative that you start moving your elbow, as pain allows and as soon as possible, as the elbow joint is notorious for getting stiff if it does not move.
Elbow arthroscopy is a minimally invasive procedure. Its advantages compared to open traditional surgery include:
• Less postoperative pain
• Smaller incisions
• Quicker recovery
• the actual procedure can be undertaken more accurately (under magnification and with more accurate instruments)
However, you must consider that elbow arthroscopy has specific indications. Not all procedures in the elbow can be done arthroscopically and there are many situations for which open surgery is more appropriate. Dr Panagopoulos will discuss all options with you during your visit in the office. Elbow arthroscopy is a technically demanding procedure that should only be undertaken by an experienced appropriately trained upper limb surgeon.
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