Arthroscopic Transfossa Approach for Osteocapsular Arthroplasty in Elbow Osteoarthritis

Loss of elbow motion due to trauma or arthritis is common and significantly compromises functional capacity of the upper extremity [1–3]. Arthroscopic osteocapsular arthroplasty (OCA) of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain [4]. This technique has become a more common procedure in recent years since it is generally believed to provide results that are at least comparable to those of traditional open procedures, but it allows better visualization of intra-articular lesions, a quicker recovery, and better cosmetic results. Although there is little doubt regarding the efficacy of arthroscopic contracture release, the procedure is technically challenging and there are serious concerns about the risk of nerve injury. However, arthroscopic OCA is technically dependent especially in advanced anterior capsular contracture into anterior compartment with risk of neurovascular structures [5–8]. Ulnar nerve subluxation and prior transposition increase the risk of ulnar nerve injury during the creation of anteromedial portal as the main viewing portal in arthroscopic OCA. In addition, less intuitive visualization compared with traditional open procedures contributes to a prolonged learning curve.