Safe Arthroscopic Approaches for Epicodilitis: Topographic-Anatomical Study

Abstract

Background. Arthroscopic methods of diagnosis and treatment of elbow diseases have not yet become widespread due to the small volume of the joint, the close location to neurovascular bundles and the manipulation difficulty. The aim of the study was to determine the safe zones for the minimally invasive approaches to the elbow in patients with lateral and medial epicondylitis. Methods. A complex anatomical and clinical study was performed. The anatomical part was carried out on 30 non-fixed anatomical preparations of the upper limb. The features of the tendon-muscular and neurovascular structures surrounding the elbow were studied, depending on the angle of elbow flexion at three different levels: level I 5 cm above the articular gap, level II the articular gap, level III the neck of the radius. In the clinical part of the study, the these structures were studied by MRI in 30 patients. Results. The brachial artery at the level I is located from the bone at a distance 28.6 (28.4-28.7) mm at the elbow flexion to 90. The radial nerve at level II is located at a distance of 15.8 (15.6-16.0) mm from the nominal medial epicondylar line (NMEL). From the NMEL the median nerve is located at a distance of 17.5 (16.6-18.1) mm, the brachial artery 22.4 (20.5-22.8) mm. The anterior bundle of the medial collateral ligament has the following average width throughout: the proximal part 6.21.4 mm; the middle part 6.51.5 mm; the distal part 9.31.4 mm. The average area of the medial collateral ligament attachment to the medial condyle of the humerus was 45.59.3 mm2 and has a rounded shape. The average length of the radial collateral ligament was 20.51.9 mm; width 5.20.8 mm, the average area of its attachment to the humerus was 13.61.4 mm2. The average area of the extensor carpi radialis brevis on the lateral condyle of the humerus was 53.13.7 mm2. The average distance from the entrance of the deep branch of the radial nerve into the supinator canal to the articular gap 28 (25.5-29.6) mm. Conclusion. The results of the study make it possible to choose the safe arthroscopic approaches to the elbow with minimal risk of damage to neurovascular structures in the treatment of patients with lateral and medial epicondylitis.