Editorial Commentary: Avoiding Complications in Elbow Arthroscopy: Know the Indications, Learn the Anatomy, and Master a Safe Technique

Elbow arthroscopy enables surgeons to treat a vast range of elbow injuries and pathologies in a minimally invasive manner. It has a lower morbidity rate and is often followed by a faster recovery than traditional open surgery unless it is followed by a serious complication. Although most complications are minor and transient, the incidence of both minor and major complications is considerably higher than that after arthroscopy of other joints, specifically the risk of neurovascular injury including permanent nerve injury because of the proximity of neurovascular structures. A recent review of 114 studies reported a median 3% incidence of complications and 2% incidence of reoperation, with transient nerve palsies accounting for about one third. Surgeon experience may influence complication rates; a survey suggested that surgeons need to experience more than 200 cases to be considered expert. In addition, patient-related factors such as obesity, female gender, age over 65 years, elevated blood sugar levels, hypercoagulable disorder, tobacco or alcohol use or both, as well as history of previous surgery and perioperative corticosteroid injections are identified as risk factors for complications after elbow arthroscopy. Keys to avoiding complications include precise surgical indications and understanding the 3-dimensional anatomy—especially the relationship of the various nerves to the portals and joint capsule.