Arthroscopy of the elbow

Elbow arthroscopy is exceptionally challenging, with a relatively high complication rate including a particular risk of iatrogenic injury as a result of the proximity of neurovascular structures. The superficial nervous structures traverse close to the portals and deep nerves are at risk as they are in close proximity to the intra-articular working field. Thorough knowledge of elbow arthroscopic anatomy is paramount in order to avoid nerve damage.Attention should be focused on the following surgical pearls of wisdom in order to lower the risk of complications during arthroscopy: 1) marking of anatomic landmarks, 2) pre-operative physical examination to rule out a subluxing or anteriorly transposed ulnar nerve, 3) patient placement with the elbow at 90°, 4) pre-operative joint distension and avoiding intra-operative suction in the proximity of nerves, especially in the posteromedial corner, and 5) becoming familiar with the advantages of, preferably, five portals.Although the indications for elbow arthroscopy depend on the experience of the arthroscopist, the most common indications with satisfactory outcomes include: 1) debridement or fixation of osteochondral defects, 2) treatment of posterior impingement, and 3) arthroscopic release of the posttraumatic stiff elbow. As our understanding of elbow pathoanatomy is improving, surgical indications will continue to evolve.