title: Portal placement in elbow arthroscopy by novice surgeons: cadaver study.
abstract: OBJECTIVE
  In this anatomical cadaver study, the distance between major nerves and ligaments at risk for injury and portal sites created by trainees was measured. Trainees, inexperienced in elbow arthroscopy, have received a didactic lecture and cadaver instruction prior to portal placement. The incidence of iatrogenic injury from novice portal placement was also determined.
  
  
  METHODS
  Anterolateral, direct lateral, and anteromedial arthroscopic portals were created in ten cadavers by ten inexperienced trainees in elbow arthroscopy. After creating each portal, the trajectory of the portal was marked with a guide pin. Subsequently, the cadavers were dissected and the distances between the guide pin in the anterolateral, direct lateral, and anteromedial portals and important ligaments and nerves were measured.
  
  
  RESULTS
  The difference between the distance of the direct lateral portal and the posterior antebrachial cutaneous nerve (PABCN) (22 mm, p < 0.001), the lateral antebrachial cutaneous nerve (4.0 mm, p < 0.001), and the radial nerve (25 mm, p < 0.001) was different from the average reported distances in the literature. A difference was found between the distance of the anterolateral portal and the PABCN (32 mm, p < 0.001) compared to previous studies. Three major iatrogenic complications were observed, including: laceration of the posterior bundle of the medial ulnar collateral ligament, lateral ulnar collateral ligament midsubstance laceration, and median nerve partial laceration.
  
  
  CONCLUSIONS
  Surgeons increasingly consider arthroscopic treatment as an option for elbow pathology. In the present study a surgical complication rate of 30 % was found with novice portal placement during elbow arthroscopy. Furthermore, as the results from this study have indicated, accurate, precise, and safe portal placement in elbow arthroscopy is not easily achieved by didactic lecture and cadaver instruction session alone. Level of evidence V.
authors.affiliation: Harvard Medical School, University of Amsterdam, Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. femke__claessen@hotmail.com.
authors.forename: Femke M A P
authors.initials: FMAP
authors.lastname: Claessen
authors.affiliation: Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.|Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amir R
authors.initials: AR
authors.lastname: Kachooei
authors.affiliation: Department of Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Kolovich
authors.affiliation: Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program (PGY3), Amsterdam, The Netherlands.
authors.forename: Geert A
authors.initials: GA
authors.lastname: Buijze
authors.affiliation: Sports Medicine Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Luke S
authors.initials: LS
authors.lastname: Oh
authors.affiliation: Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MPJ
authors.lastname: van den Bekerom
authors.affiliation: Orthotrauma Research Center Amsterdam Resident, University of Amsterdam Orthopaedic Residency Program (PGY6), Amsterdam, The Netherlands.
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D002983:Clinical Competence; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008022:Ligaments / Q000293:injuries; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000209:etiology; D012307:Risk Factors
keywords: Cadaver study; Elbow arthroscopy; Iatrogenic adverse events; Training