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A Simple New Technique for Arthroscopic Humeral Fenestration in Ulnohumeral Arthroplasty
Kimberly Spahn, MD; Leo T. Kroonen, MD
Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA

Introduction:  Degenerative arthritis of the elbow, though uncommon, usually affects middle-aged men who engage in repetitive activities of flexion and extension.   The disease process is characterized by pain at the extremes of flexion and extension and mechanical impingement.  Ulnohumeral arthroplasty with debridement of osteophytes is well recognized as a treatment option to decrease mechanical impingement of bony prominences.   We present a novel technique which simplifies the arthroscopic technique for ulnohumeral arthroplasty .

Method:  A new device has been introduced for use in arthroscopic knee surgery to drill tunnels in a retrograde fashion.  The device allows for antegrade drilling with a small diameter tip.  The leading tip of the device can then be rotated ninty degrees and locked into place.  By then spinning the device and pulling in a retrograde fashion, a larger diameter hole can safely be established.  Though the device was designed for retrograde drilling of tunnels in knee ligament reconstruction procedures, we have found it useful in creating the arthroscopic fenestration in ulnohumeral arthroplasty, and can quickly create a large diameter fenestration much in the same way a Cloward drill is used for an open procedure.

Results:  A case is presented of a young male with bilateral osteoarthritis of the elbow.  He initially underwent arthroscopic ulnohumeral arthroplasty and debridement through previously described techniques.  While that surgery was overall successful in improving his symptoms, the procedure was arduous due to the large amount of sclerotic bone that required debridement.  He underwent the same procedure on the contralateral side, this time using the retrograde drilling device, and the procedure was felt to be much simpler.  The patient subjectively also reported a much easier rehabilitation process with his second surgery.

Conclusion:  Arthroscopic ulnohumeral arthroplasty can be simplified through the use of a specialized retrograde drilling device.  Further investigations are warranted to refine this technique and determine its overall effect on surgical outcomes in elbow osteoarthritis.

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