Indications
- Loose body removal
- Osteochondritis dissecans of the capitellum
- Valgus extension overload and olecranon osteophytes
- Posterolateral impingement and plica
- Arthrofibrosis and contracture release
- Synovectomy and septic arthritis washout
- Refractory lateral epicondylitis
Position
- Lateral decubitus with the arm over a bolster, elbow flexed 90°
- Prone with the shoulder abducted 90° and the forearm hanging
- Supine with the arm suspended in traction
- Tourniquet, then mark epicondyles, olecranon, radial head and ulnar nerve
- Distend the joint with about 20 mL saline through the soft spot to move the neurovascular structures away
Operative Steps
- Incise skin only and spread the deeper tissue with a blunt haemostat for every portal
- Make a proximal anteromedial portal 2 cm proximal and 1 cm anterior to the medial epicondyle
- Make a proximal anterolateral portal 1 to 2 cm proximal and 1 cm anterior to the lateral epicondyle
- Inspect the coronoid, trochlea, capitellum and radial head
- Make a posterior portal 3 cm proximal to the olecranon tip through triceps
- Make a posterolateral portal at the lateral triceps border for the olecranon fossa and posterior gutter
Postoperative Care
- Compressive dressing and early active range of motion
- Monitor neurological function once the block resolves
Complications
- Transient nerve palsy, most often ulnar, with higher risk in rheumatoid arthritis and contracture
- Ulnar nerve injury at medial portals, with extra risk after prior transposition
- Median nerve and medial antebrachial cutaneous nerve injury at the anteromedial portal
- Radial nerve and posterior interosseous nerve injury at anterolateral portals, safer when proximal
- Prolonged portal drainage, the most common minor complication in the largest series
- Infection
- Compartment syndrome from fluid extravasation
- Stiffness
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 12 October 2026.