Page 22 - ISAKOS 2018 Winter Newsletter

CURRENT CONCEPTS
Radiocapitellar Arthritis
We therefore do not recommend using the low posterolateral portal for the introduction of the perforating device; instead, we recommend using a higher and more laterally placed percutaneous portal (Figs. 2 and 3). To find the correct portal position, we use a needle and aim for the steepest angle to the target articular surface. We recommend using the oscillating drill mode as it produces less heat compared with standard drilling.
After the drill has perforated the subchondral bone, the wire is withdrawn. To document extrusion of bone marrow fat into joint cavity, it is helpful to reduce pump pressure or to apply suction (Fig. 4). We make the holes 4 to 5 mm apart. Any loose debris will be removed with a shaver. This usually creates a clot over the defect, which evolves into fibrocartilage over a period of 1 – 2 months. During aftercare, free range of motion is allowed to prevent stiffness, but loading should be avoided for 6–8 weeks.
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An alternative method is to use an angled arthroscopic pick, which was designed for ankle arthroscopy (Arthrex). As it is angled, it can be positioned with greater precision, and, as it does not require power, it avoids the concerns regarding heat generation.
Open Debridement 03
Open debridement procedures can also be performed, but at the cost of more intensive soft-tissue dissection. If radiohumeral arthritis continues to be symptomatic, radial head resection may be required. However, resection of the radial head removes a critical stabilizer against valgus and longitudinal forces and should be avoided in the athlete, other than as a last resort. Potential complications of resection include medial instability with valgus deformity and changes to the radioulnar variance with proximalization of the radius.
As an alternative, resection interposition arthroplasty has been advocated, but that procedure is based on strict patient selection as instability is a contraindication. If there is associated elbow instability, then prosthetic arthroplasty should be performed. However, prosthetic replacement is associated with specific problems.
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20 ISAKOS NEWSLETTER 2018: VOLUME I