Authors Preferred Technique

Arthroscopic treatment of VEO has evolved as arthro-scopic techniques and understanding of arthroscopic anatomy of the elbow have evolved.22-27 The primary advantages are the small incisions; direct visualization and access to the medial aspect of the olecranon fossa; and thorough evaluation of the entire elbow joint for additional abnormalities, such as aberrant loose bodies, and for evaluation of the UCL and medial compartment under stress. The procedure can be done with the patient placed either in the supine or prone position. The setup for surgery and the arthroscopic evaluation are described in Chapter 14.

The surgeon always should accomplish a general ar-throscopic examination of the elbow even when he or she believes that the abnormality is localized to a specific compartment. This examination ensures that no coexis tent abnormality is missed. For example, the surgeon needs to examine the UCL using the arthroscopic stress view in patients who have VEO and to document the presence or absence of laxity. The sequence of evaluation should be orderly and done in the same fashion each time.

After evaluating the elbow joint, the surgeon begins arthroscopic treatment of VEO. He or she initially uses the 3.5-mm, full-radius resector to debride the soft tissue and synovitis of the posterior compartment. This de-bridement facilitates visualization of the bony margins and osteophytes. The surgeon uses a ^-inch, straight os-teotome to remove posterior and posteromedial osteo-phytes (Fig. 10.5). Next, he or she smoothes the resected edges with a high-speed burr. The full-radius resector is reintroduced through the straight posterior portal, and any areas of chondromalacia (i.e., "kissing lesions") (Fig. 10.6) of the trochlea are debrided to a smooth surface. The elbow is put through its full range of motion to ensure that no further impingement or loose fragments of articular cartilage exist. An intraoperative lateral radiograph should be obtained at this point to visualize the resection (Fig. 10.7). The posterior compartment is irrigated copiously, and a medium hemovac drain is placed. The wounds are closed with sterile adhesive strips or butterfly-type bandages, and a soft, bulky dressing is applied.

A postoperative exercise protocol is outlined in Table 10.1. The exercises are very similar to those used in nonoperative management; however, Table 10.1 reflects the

FIGURE 10.5. (A) and (B) Osteophyte removal in a patient with valgus extension overload. (Adapted from Andrews JR and McKenzie PJ.23) (C) Arthroscopic view from the posterolateral portal. The spur has been debrided, and an os-teotome is in place to remove more of the spur. The osteotome is placed through the straight posterior portal. (Used with permission from Timmerman LA.27)

FIGURE 10.5. (A) and (B) Osteophyte removal in a patient with valgus extension overload. (Adapted from Andrews JR and McKenzie PJ.23) (C) Arthroscopic view from the posterolateral portal. The spur has been debrided, and an os-teotome is in place to remove more of the spur. The osteotome is placed through the straight posterior portal. (Used with permission from Timmerman LA.27)

FIGURE 10.6. Once the spur is removed, the area of corresponding chondromalacia of the trochlea, or the "kissing lesion," is seen. (Used with permission from Timmerman LA.27)

timing of progression to account for the initial period of recovery from surgery. The athlete should be prepared to embark on an aggressive rehabilitation program with the goal of beginning an interval throwing program 6 to 8 weeks after surgery.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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