title: Arthroscopic biceps ulnar release procedure (BURP): technique description and in vitro assessment of the association of visual control and surgeon experience to regional damage and tenotomy completeness.
abstract: OBJECTIVE
  (1) Describe arthroscopic BURP surgical technique, (2) assess association of visual control and surgeon experience to tenotomy completeness and regional iatrogenic tissue damage.
  
  
  METHODS
  Cadaveric study.
  
  
  METHODS
  Canine cadavers weighing >20 kg (n = 16; 32 elbows).
  
  
  METHODS
  Phase 1 = dissection/anatomic description/procedural refinement (n = 6). Phase 2 = technique description (n = 6). Phase 3 = association of surgeon experience and procedural visual control to tenotomy completion and regional iatrogenic damage (n = 20). Elbows were randomly assigned via coin toss to an experienced- or inexperienced-arthroscopist. Using conventional medial portals, surgeons sought to identify the medial collateral ligament (MCL) and ulnar insertion of the biceps tendon (uBT) before attempting complete tenotomy. Upon procedural completion, surgeons assigned a standardized "visual control score" (VCS) describing viewing that governed procedure and predicted % uBT release, MCL, and median nerve damage. Post-procedural dissection determined actual tenotomy completion and iatrogenic tissue damage.
  
  
  RESULTS
  Complete BURP was achieved in 16 of 19 elbows. VCS was associated with tenotomy completeness (P < .01). "Blind" BURP was incomplete in both elbows in which it was attempted. Perception of complete BURP was associated with complete release (P < .01). MCL damage occurred in 10% of elbows. Surgeon experience did not influence VCS, regional damage, or BURP completeness.
  
  
  CONCLUSIONS
  In canine cadavers, arthroscopic BURP can be consistently performed using conventional arthroscopic instruments and portals by both experienced and inexperienced arthroscopists when visual control guides the tenotomy into the distal aspect of the tendon.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado.
authors.forename: David M
authors.initials: DM
authors.lastname: Wilson
authors.forename: Clara S S
authors.initials: CS
authors.lastname: Goh
authors.forename: Ross H
authors.initials: RH
authors.lastname: Palmer
mesh_terms: D000818:Animals; D001182:Arthroscopy / Q000379:methods / Q000662:veterinary*; D002102:Cadaver; D002983:Clinical Competence; D017885:Collateral Ligaments / Q000601:surgery; D004285:Dogs / Q000293:injuries* / Q000601:surgery; D004551:Elbow Joint / Q000601:surgery; D006801:Humans; D018482:Muscle, Skeletal; D011897:Random Allocation; D013708:Tendon Injuries / Q000601:surgery / Q000662:veterinary*; D058971:Tenotomy / Q000662:veterinary*; D014457:Ulna; D000092464:Elbow Injuries