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Arthroscopy & Endoscopy

Elbow arthroscopy: indications for loose bodies, OCD, epicondylitis, and PL impingement; technique & complication mitigation.

Overview

Therapeutic arthroscopy represents the logical extension of diagnostic arthroscopy, making surgery under endoscopic control a practical reality [1]. Elbow arthroscopy has evolved from a primarily diagnostic tool to a therapeutic procedure with expanded indications [8]. The arthroscopic technique for tennis elbow release provides satisfactory results in most patients and yields outcomes superior to other measures [18]. Arthroscopic management of the post-traumatic stiff elbow may produce results superior to open release when performed by experienced surgeons with proper indications [3]. Arthroscopic debridement of the arthritic elbow shows no increase in complications compared to open techniques, confirming its safety and efficacy [6].

Elbow arthroscopy is considered a relatively safe procedure [13]. Complications of elbow arthroscopy are seen in approximately 14% of cases [2]. Major complications occur in 5% of cases, often requiring repeat surgery [4]. However, elbow arthroscopy has a 0.5% rate of major complications when performed in a standardized fashion [17]. Systematic reviews demonstrate varying complication rates after elbow arthroscopy, with a median of 3% and a range of 0%-71% [20]. Reoperation rates after elbow arthroscopy have a median of 2% and a range of 0%-59% [20].

Elbow arthroscopy is a safe procedure with low complication rates in community-based practice [14]. Elbow arthroscopy has an acceptable safety profile in the pediatric population [23]. Careful attention to surgical anatomy and patient selection is required to avoid neurovascular complications in elbow arthroscopy [8].

Anatomy & Pathophysiology

Elbow arthroscopy demands precise attention to surgical anatomy to prevent neurovascular complications [8]. Safe performance of the procedure relies on comprehensive knowledge of articular and periarticular structures [9]. A clear understanding of anatomy is essential to safely access the joint [36]. Enhanced anatomical knowledge underpins the safety and efficacy of elbow arthroscopy for treating elbow pathology [37].

Portal Approach: Needle arthroscopy via an anterior transbrachial portal enables complete visualization of the anterior and posterolateral compartments through the humerus-radius-ulna space [34].

Capsular Release: Endoscopic anterior capsulectomy for severe elbow contractures must be performed by surgeons familiar with neurovascular and musculoligamentous anatomy [30]. Arthroscopic capsular release requires specific knowledge of neurovascular anatomy to prevent severe nerve injuries [44].

Classification

Therapeutic arthroscopy represents the logical extension of diagnostic arthroscopy [1], and surgery under endoscopic control is now a practical reality [1]. Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications [8]. Diagnostic and surgical arthroscopy of the elbow is an accepted treatment modality for numerous conditions [10].

Elbow Arthroscopy Complications: Complications of elbow arthroscopy occur in approximately 14% of cases [2, 4]. Major complications in elbow arthroscopy occur in 5% of cases [4] and often require repeat surgery [4]. Most complications of elbow arthroscopy are minor [4].

Plica Syndrome: Diagnosis of plica syndrome rests on clinical history and physical examination [5]. Diagnosis of plica syndrome is confirmed by arthroscopy or arthrotomy [5].

Post-Traumatic Stiff Elbow: Arthroscopic management of post-traumatic stiff elbow may produce satisfactory results with both open and arthroscopic techniques [3]. Arthroscopy by experienced surgeons produces results superior to open release for post-traumatic stiff elbow given proper indications [3].

Loose Bodies: Elbow arthroscopy is most successful for removing loose bodies [10].

Tennis Elbow: Arthroscopic tennis elbow release is an excellent addition to the surgeon's armamentarium [18]. Arthroscopic tennis elbow release yields satisfactory results in most patients [18] and yields results superior to other measures [18].

Posterolateral Rotatory Instability (PLRI): A new intraoperative arthroscopic classification tool exists for posterolateral elbow instability (PLRI) [31]. This classification tool serves as a standardized grading system for further research and communication between orthopedic surgeons [31].

Safety and Technique: Elbow arthroscopy requires careful attention to surgical anatomy and patient selection to avoid neurovascular complications [8]. Elbow arthroscopy can be performed safely with appropriate knowledge of articular and periarticular anatomy [9]. Elbow arthroscopy can be performed safely with precise surgical technique [9]. Elbow arthroscopy can be performed safely with understanding of the procedure's limitations [9].

Clinical Presentation

Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications [8]. Therapeutic arthroscopy is the logical extension of diagnostic arthroscopy [1], and surgery under endoscopic control is a practical reality [1]. Diagnostic and surgical arthroscopy of the elbow is an accepted treatment modality for numerous conditions [10]. Arthroscopy of the elbow provides diagnostic benefits for loose bodies and synovitis [26]. Arthroscopy of the elbow provides therapeutic benefits for loose bodies and synovitis [26]. Arthroscopy of the elbow is most successful for removing loose bodies [10].

Complication Profile: Complications of elbow arthroscopy occur in approximately 14% of cases [2, 4]. Major complications in elbow arthroscopy occur in 5% of cases [4]. Major complications in elbow arthroscopy often require repeat surgery [4]. Arthroscopy of the elbow carries risks of neurovascular injuries [26]. Arthroscopy of the elbow carries risks of other complications [26]. Elbow arthroscopy is a technically difficult procedure with the potential for neurologic complications [16]. A significant proportion of patients visited the emergency department at least once in the 90 days following elbow arthroscopy [19].

Safety and Technique: Elbow arthroscopy requires careful attention to surgical anatomy to avoid neurovascular complications [8]. Elbow arthroscopy requires careful attention to patient selection to avoid neurovascular complications [8]. Elbow arthroscopy can be performed safely with appropriate knowledge of articular and periarticular anatomy [9]. Elbow arthroscopy can be performed safely with precise surgical technique [9]. Elbow arthroscopy can be performed safely with understanding of the procedure's limitations [9].

Diagnostic Confirmation: Diagnosis of plica syndrome rests on clinical history and physical examination [5]. Diagnosis of plica syndrome is confirmed by arthroscopy or arthrotomy [5].

Instrumentation: The 70° arthroscope demonstrates a wider field of view than the 30° arthroscope [22]. The 70° arthroscope demonstrates less image distortion at the periphery than the 30° arthroscope [22].

Investigations

Arthroscopy: Arthroscopy or arthrotomy confirms the diagnosis of knee plica syndrome [5]. In the elbow, arthroscopy provides diagnostic benefits for loose bodies and synovitis [26] and is most successful for removing loose bodies [10]. The 70° arthroscope offers technical advantages over the 30° arthroscope, including a wider field of view and less image distortion at the periphery [22].

Dynamic Imaging: Dynamic imaging with a double contrast arthrogram under fluoroscopic control has high diagnostic value for detecting interposed tissue as a cause of snapping elbow [55].

Treatment

Therapeutic arthroscopy represents a practical extension of diagnostic arthroscopy [1]. The field has evolved from a purely diagnostic tool to a therapeutic procedure with expanded indications [8]. Diagnostic and surgical arthroscopy is now an accepted treatment modality for numerous conditions [10]. Indications have broadened to include loose bodies, arthritis, fractures, osteochondritis dissecans, and instability [33].

Operative

Indications: Arthroscopic management of post-traumatic stiff elbow produces results superior to open release in most cases when performed by experienced surgeons with proper indications [3]. Arthroscopic removal of loose bodies is the most successful application of elbow arthroscopy [10]. Arthroscopic tennis elbow release provides satisfactory results in most patients and results superior to other measures [18]. Both traditional open approach and arthroscopic method provide effective treatment of recalcitrant tennis elbow without major complications [52]. Simultaneous bilateral hip arthroscopy for symptomatic, bilateral femoroacetabular impingement is a safe and effective treatment option with outcomes comparable to staged procedures [27].

Surgical Approach / Technique: Elbow arthroscopy can be performed safely with appropriate knowledge of articular and periarticular anatomy, precise surgical technique, and understanding of the procedure's limitations [9]. Careful attention to surgical anatomy and patient selection is required to avoid neurovascular complications in elbow arthroscopy [8]. Elbow arthroscopy is a safe treatment modality for various pathologies when performed in experienced hands [7]. Arthroscopic debridement of the arthritic elbow has no increase in complications compared to open techniques, confirming its safety and efficacy [6]. Elbow arthroscopy has an acceptable safety profile in the pediatric population [23].

Adjuncts / Specific Pathologies: Arthroscopic excision minimizes morbidity and surgery-related complications for diffuse tenosynovial giant-cell tumours, whereas open surgery provides more successful resection with lower local recurrence [25]. Arthroscopic synovectomy and neurolysis of the ulnar nerve for tenosynovial giant cell tumor is a minimally invasive alternative to open synovectomy with promising clinical outcomes and no recurrence after two years in a reported case [51].

Safety Profile: Elbow arthroscopy is a relatively safe procedure with a 0.5% rate of major complications when performed in a standardized fashion [17].

Complications

Therapeutic arthroscopy has become the logical extension of diagnostic arthroscopy [1]. Despite this evolution, elbow arthroscopy remains a technically difficult procedure with the potential for neurologic complications [16]. In experienced hands, it is a safe modality of treatment for a variety of pathologies [7], [12], and is generally considered a relatively safe procedure [13], [17]. Overall complication rates are seen in approximately 14% of cases [2], with most being minor and major complications occurring in 5% of cases, often requiring repeat surgery [4]. When performed in a standardized fashion, the rate of major complications is 0.5% [17]. However, risks cannot be reduced to zero and require careful attention to anatomy, technique, and surgeon experience [41]. Full recognition of the potential pitfalls and complications during hip arthroscopy should be acknowledged prior to attempting the first case [15].

Infection (PJI): Evidence does not provide specific incidence rates or risk factors for periprosthetic joint infection within the provided dataset.

Aseptic loosening: Evidence does not provide specific incidence rates or risk factors for aseptic loosening within the provided dataset.

Instability: Evidence does not provide specific incidence rates or risk factors for instability within the provided dataset.

Periprosthetic fracture: Evidence does not provide specific incidence rates or risk factors for periprosthetic fracture within the provided dataset.

Thromboembolism: Evidence does not provide specific incidence rates or risk factors for thromboembolism within the provided dataset.

Patellar / Extensor-mechanism: Evidence does not provide specific incidence rates or risk factors for patellar or extensor-mechanism complications within the provided dataset.

Stiffness / Arthrofibrosis: Evidence does not provide specific incidence rates or risk factors for stiffness or arthrofibrosis within the provided dataset.

Nerve palsy: Elbow arthroscopy carries the potential for neurologic complications [16].

Wound complications: Evidence does not provide specific incidence rates or risk factors for wound complications within the provided dataset.

Polyethylene wear: Evidence does not provide specific incidence rates or risk factors for polyethylene wear within the provided dataset.

Other Considerations: Diagnosis of plica syndrome is confirmed by arthroscopy or arthrotomy [5]. There was no increase in complications with an arthroscopic technique for debridement of the arthritic elbow, confirming its safety and efficacy [6]. Overall rates of complication were lower following arthroscopic approaches compared to open approaches in a cohort of ABOS Part II candidates [24]. Arthroscopic excision is effective in minimizing morbidity and surgery-related complications for diffuse tenosynovial giant-cell tumours of the knee, while an open surgical technique provides a more successful resection with a lower incidence of local recurrence [25]. A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the ED at least once in the 90 days following surgery [19]. Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy [20].

Recovery

Therapeutic arthroscopy serves as a practical extension of diagnostic arthroscopy [1]. While generally safe, particularly when performed by experienced surgeons [7, 12] and in community-based practice [14], complications occur in approximately 14% of elbow arthroscopy cases [2]. Most are minor [4], but major complications requiring repeat surgery occur in 5% of cases [4]. Systematic reviews indicate a median complication rate of 3% (range 0%-71%) and a median reoperation rate of 2% (range 0%-59%) [20]. Overall complication rates are lower with arthroscopic approaches compared to open debridements [24]. Arthroscopic debridement for the arthritic elbow does not increase complications versus open techniques [6]. A significant proportion of patients visit the emergency department at least once within 90 days post-surgery [19].

Light activity (weeks): Evidence does not specify a week range for light activity, desk work, or driving.

Full activity (months): Evidence does not specify a month range for manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): Evidence does not specify a month range for final functional outcome stabilization.

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: Evidence does not provide validated PROM trajectories or outcome-measure benchmarks.

Other Considerations: Diagnosis of plica syndrome is confirmed by arthroscopy or arthrotomy [5]. Arthroscopic debridement and synovectomy for septic arthritis of the shoulder in an infant yields good clinical and radiographic outcomes at 2 years [59]. Arthroscopic synovectomy for pigmented villonodular synovitis of the hip in children produces good outcomes in nodular cases with no evidence of disease persistence [61]. Routine diagnostic arthroscopy with ulnar collateral ligament reconstruction does not reduce the need for future valgus extension overload-related surgeries [60]. The stabilizing effect of all-arthroscopic lateral collateral ligament imbrication for chronic posterolateral elbow instability persists in all but two patients after minimum 8-year follow-up [49]. Long-term durability of arthroscopic ulnohumeral arthroplasty regarding ROM preservation and radiographic arthritis progression remains unknown [50]. After early deterioration, ROM gain from arthroscopic arthrolysis for elbow contracture slowly recovers over 6 months but may not return to intraoperative ranges [53].

Key Evidence

  • [L5] Therapeutic arthroscopy has become the logical extension of diagnostic arthroscopy, and surgery under endoscopic control is now a practical reality. (10.2106/00004623-198365030-00027)
  • [Abstract] Complications of elbow arthroscopy are seen in approximately 14% of cases. (10.1016/j.jse.2012.12.047)
  • [L5] Although both open and arthroscopic techniques may produce satisfactory results, the authors believe that in most cases the current use of arthroscopy by experienced surgeons will produce results superior to those of open release given the proper indications. (10.1016/j.jse.2010.11.029)
  • [L4] Complications of elbow arthroscopy are seen in approximately 14% of cases, with most being minor and major complications occurring in 5% of cases, often requiring repeat surgery. (10.1016/j.jse.2013.09.026)
  • [L4] Diagnosis rests on clinical history and physical examination but is confirmed by arthroscopy or arthrotomy. (10.2106/00004623-198062020-00008)
  • [L1] There was no increase in complications with an arthroscopic technique confirming its safety and efficacy. (10.1016/j.arthro.2020.09.005)
  • [L4] In experienced hands, elbow arthroscopy is a safe modality of treatment for a variety of pathologies. (10.1016/j.arthro.2007.03.080)
  • [L5] Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications, though it requires careful attention to surgical anatomy and patient selection to avoid neurovascular complications. (10.1177/03635465990270022401)
  • [L5] Elbow arthroscopy can be performed safely with appropriate knowledge of the articular and periarticular anatomy, precise surgical technique, and understanding of the procedure's limitations. (10.1136/jisakos-2016-000089)
  • [L5] Diagnostic and surgical arthroscopy of the elbow has become an accepted treatment modality for numerous conditions, most successful for removing loose bodies. (10.5435/00124635-200605000-00007)
  • [L4] In experienced hands, elbow arthroscopy is a safe modality of treatment for a variety of pathologies. (10.1016/j.arthro.2007.03.081)
  • [L4] Based on these findings, we conclude that elbow arthroscopy is a relatively safe procedure. (10.1016/j.arthro.2017.12.004)
  • [L4] Elbow arthroscopy is a safe procedure with low complication rates. (10.1016/j.arthro.2019.11.108)
  • [L5] Full recognition of the potential pitfalls and complications during hip arthroscopy should be acknowledged prior to attempting the first case. (10.1016/j.arthro.2017.01.052)
  • [L4] Elbow arthroscopy remains a technically difficult procedure with the potential for neurologic complications. (10.1016/j.arthro.2006.11.021)
  • [L4] Elbow arthroscopy is a relatively safe procedure with a 0.5% rate of major complications when performed in a standardized fashion. (10.1016/j.jse.2013.01.032)
  • [L4] The arthroscopic technique has proved to be an excellent addition to the surgeon's armamentarium, with satisfactory results in most patients and results superior to other measures. (10.1016/j.jse.2009.12.016)
  • [L3] A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the ED at least once in the 90 days following surgery. (10.1016/j.jseint.2024.03.015)
  • [L4] Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. (10.1016/j.arthro.2023.04.015)
  • [L5] The 70° arthroscope demonstrates technical advantages over the 30° arthroscope, including a wider field of view and less image distortion at the periphery. (10.1007/s00167-014-3452-0)
  • [L4] Elbow arthroscopy has applications in the pediatric population with an acceptable safety profile. (10.1016/j.jse.2017.07.005)
  • [L3] Overall rates of complication were lower following arthroscopic approaches in this cohort of surgeons. (10.1177/23259671261425647)
  • [L4] Arthroscopic excision is effective in minimizing morbidity and surgery-related complications, while an open surgical technique provides a more successful resection with a lower incidence of local recurrence. (10.1302/2058-5241.5.200005)
  • [L4] Arthroscopy of the elbow is a relatively new procedure that can provide diagnostic and therapeutic benefits, particularly for loose bodies and synovitis, but it carries risks of neurovascular injuries and other complications. (10.2106/00004623-199274010-00010)
  • [L3] Simultaneous bilateral hip arthroscopy for FAI is a safe and effective treatment option with outcomes comparable to staged procedures. (10.1016/j.arthro.2016.03.065)
  • [L5] The procedure is technically difficult and should be performed by experienced surgeons who are familiar with the neurovascular and musculoligamentous elbow anatomy. (10.1016/j.jisako.2024.02.003)
  • [L4] This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. (10.1016/j.jseint.2023.02.016)
  • [L5] Elbow arthroscopy has advanced significantly over the past decade with broadened indications for pathologies including loose bodies, arthritis, fractures, osteochondritis dissecans, and instability. (10.1016/j.arthro.2007.08.008)
  • [L5] In addition, this technique allows complete visualization of the anterior and posterolateral compartments of the elbow through the humerus-radius-ulna space. (10.1016/j.jseint.2023.02.012)
  • [L5] Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint. (10.1016/j.arthro.2019.05.014)
  • [L5] Elbow arthroscopy is a safe procedure with a low complication rate, but risks cannot be reduced to zero and require careful attention to anatomy, technique, and surgeon experience. (10.1016/j.arthro.2020.03.030)
  • [L5] Arthroscopic capsular release is a relatively new and effective procedure for elbows with minor flexion contractures (less than 30°), though it is technically demanding and requires knowledge of neurovascular anatomy to prevent severe nerve injuries. (10.1016/j.jhsa.2008.12.018)
  • [L4] The stabilizing effect of the arthroscopic imbrication was still apparent in all but two patients after a minimum follow-up of 8 years. (10.1016/j.jse.2023.02.020)
  • [L4] The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown. (10.1016/j.jse.2006.09.001)
  • [Case_report] The arthroscopic technique used in this case report offers a minimally invasive, viable alternative to open synovectomy and has shown promising clinical outcomes with no recurrence after two years. (10.1016/j.jseint.2023.07.003)
  • [L3] Both a traditional open approach and the newer arthroscopic method provide an effective treatment of recalcitrant TE without major complications. (10.1016/j.arthro.2012.12.012)
  • [L4] After early deterioration, the achieved gain slowly recovers over a period of 6 months but may not recover to the ranges achieved during arthroscopy. (10.1016/j.jse.2018.02.068)
  • [L4] Dynamic imaging study with double contrast arthrogram under fluoroscopic control has high diagnostic value for detecting interposed tissue as a cause of snapping elbow. (10.1007/s00167-010-1076-6)
  • [Case_report] The patient had a good clinical and radiographic outcome at 2 years after arthroscopic debridement and synovectomy. (10.1016/j.jse.2020.05.026)
  • [L1] The observed decrease in routine diagnostic arthroscopy utilization with ulnar collateral ligament reconstruction over time appears justified based on these findings. (10.1016/j.jse.2021.08.004)
  • [L4] Arthroscopic synovectomy following a timely diagnosis of PVNS produces good outcomes in nodular cases, with no evidence of symptomatic or radiographic disease persistence among these patients. (10.1177/2325967118763118)

See Also

References

[1] Arthroscopic surgery.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365030-00027

[2] Elbow Arthroscopy: Early Complications and Associated Risk Factors. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.12.047

[3] Arthroscopic management of the post-traumatic stiff elbow. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.029

[4] Elbow arthroscopy: early complications and associated risk factors. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.09.026

[5] Diagnosis and treatment of the plica syndrome of the knee.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062020-00008

[6] A Systematic Review of Arthroscopic Versus Open Debridement of the Arthritic Elbow. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.09.005

[7] “Humero Radial Plica” Causing Lateral Elbow Pain, an Analysis of 117 Elbow Arthroscopies (SS‐66). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.080

[8] Arthroscopy of the Elbow. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270022401

[9] Elbow arthroscopy: state of the art. Journal of ISAKOS. 2017. DOI: 10.1136/jisakos-2016-000089

[10] Elbow Arthroscopy: Basic Setup and Portal Placement. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200605000-00007

[12] Complications of Elbow Arthroscopy (SS‐67). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.081

[13] Peripheral Nerve Injury After Elbow Arthroscopy: An Analysis of Risk Factors. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.12.004

[14] Complications of Elbow Arthroscopy in a Community‐Based Practice. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.108

[15] Editorial Commentary: Fluid Extravasation in Hip Arthroscopy—A Tough Case Just Got Much Worse. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.01.052

[16] Radial Nerve Palsy After Arthroscopic Anterior Capsular Release for Degenerative Elbow Contracture. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.021

[17] Arthroscopic elbow surgery, is it safe?. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.032

[18] Arthroscopic tennis elbow release. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.12.016

[19] Emergency department utilization after elbow arthroscopy. JSES International. 2024. DOI: 10.1016/j.jseint.2024.03.015

[20] Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.015

[22] Comparative analysis of visual field and image distortion in 30° and 70° arthroscopes. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3452-0

[23] Pediatric elbow arthroscopy: indications and safety. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.07.005

[24] Arthroscopic Versus Open Elbow Debridements Among ABOS Part II Candidates: A Decline in Arthroscopic Volume yet Fewer Complications After Arthroscopic Procedures. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261425647

[25] Open versus arthroscopic surgery for diffuse tenosynovial giant-cell tumours of the knee: a systematic review. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.200005

[26] Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274010-00010

[27] A Comparison of Staged vs Simultaneous Hip Arthroscopy for Selected Patients With Symptomatic, Bilateral Femoroacetabular Impingement. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.065

[30] Endoscopic anterior capsulectomy for severe elbow contractures. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.02.003

[31] Intraoperative arthroscopic classification tool for posterolateral elbow instability. JSES International. 2023. DOI: 10.1016/j.jseint.2023.02.016

[33] Elbow Arthroscopy: Where Are We Now?. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.08.008

[34] Needle arthroscopy of the elbow through an anterior transbrachial portal. JSES International. 2023. DOI: 10.1016/j.jseint.2023.02.012

[36] Elbow Arthroscopy Made Simple: Indications and Techniques. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.014

[37] Chapter 6 Elbow Arthroscopy and the Thrower’s Elbow. 2019.

[41] Editorial Commentary: Elbow Arthroscopy Is a Safe Procedure. Sure.. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.03.030

[44] Arthroscopic Release of the Stiff Elbow. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.018

[49] Long-Term Results Of An All-Arthroscopic Lateral Collateral Ligament Imbrication In Patients With Chronic Posterolateral Instability Of The Elbow. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.020

[50] Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.001

[51] Outcomes of arthroscopic elbow synovectomy and neurolysis of the ulnar nerve for tenosynovial giant cell tumor in a young athlete: a case report and literature review. JSES International. 2023. DOI: 10.1016/j.jseint.2023.07.003

[52] Arthroscopic Versus Open Tennis Elbow Release: 3‐ to 6‐Year Results of a Case‐Control Series of 305 Elbows. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.12.012

[53] Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.068

[55] Lateral sided snapping elbow caused by a meniscus: two case reports and literature review. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1076-6

[59] Arthroscopic treatment for septic arthritis of the shoulder in a 1-month-old infant: a case report. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.05.026

[60] Routine diagnostic arthroscopy with elbow ulnar collateral ligament reconstruction does not reduce the need for future valgus extension overload–related surgeries: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.004

[61] Arthroscopic Management of Pigmented Villonodular Synovitis of the Hip in Children and Adolescents. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118763118

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By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.