Patient Positioning and Arthroscopic Portals

Patient positioning must allow the surgeon safe access to all joint compartments and ensure stable positioning. In addition, the joint must be freely movable for extension and flexion as well as for pronation and supination. In principle, the patient can be positioned on the lateral, prone, or supine. The lateral position allows the surgeon optimal working conditions for the ventral and dorsal joint compartments; however, the reverse anatomy may be disadvantageous for arthroscopic beginners. The prone position offers the surgeon the same advantages in terms of access and work options as the lateral position. The supine position is technically simple and offers easy access options, particularly to the ventral joint compartments, but requires stable fixation of the hanging arm. The hanging position of the arm limits the range of motion and makes dorsal access difficult. The less experienced arthroscopist benefits from the familiar anatomical orientation in the supine position. However, changing to an open approach is only possible with certain measures, especially for the dorsal joint area. When initiating elbow arthroscopy, the joint should be filled with irrigation fluid before portal establishment to achieve distension of the joint capsule protecting the surrounding neurovascular structures. The joint can be filled via the “soft spot” or optionally transtricipitally. Patient positioning, standard portals, relevant anatomical structures, and systematic guidance through diagnostic elbow arthroscopy are provided in this chapter.