ARTHROSCOPIC ASSESSMENT OF THE MEDIAL COLLATERAL LIGAMENT COMPLEX OF THE ELBOW

The extent that the medial collateral ligament complex could be visual ized by arthroscopy was determined in 10 fresh cadaveric elbows from 1 0 individuals. We carefully exposed the medial collateral ligament com plex through a muscle-splitting incision before performing arthroscopy . The anterior and posterior bundles were identified and marked by pla cing 4.0 nylon sutures deep to the bundles to aid in arthroscopic visu alization. A portion of the anterior bundle was visible in only one el bow and in that elbow only the most anterior 25% of the anterior bundl e was seen. Attempts to visualize the anterior bundle through addition al portals were unsuccessful. Varying the flexion angle of the cadaver ic elbow from 0 degrees to 130 degrees also failed to improve visualiz ation. Conversely, the entire posterior bundle, including humeral and ulnar insertion sites, could be seen in all 10 specimens using the pos terior portals. We also noted that direct pressure was placed on the u lnar nerve in all specimens when the arthroscope or any arthroscopic i nstrument was advanced into the posteromedial gutter in contact with t he posterior bundle because of its proximity immediately adjacent to t he ulnar nerve. The inability to reliably see the anterior bundle and the humeral or ulnar insertion sites of this ligament may limit the va lue of the arthroscope when assessing medial collateral ligament injur ies. Additionally, great care should be taken when using the arthrosco pe or other instruments in the posteromedial gutter because the ulnar nerve lies immediately adjacent to the thin posterior bundle and capsu le.