The importance of elbow arthroscopy has been increasing during recent years. The knowledge gained from the deployment of improved technical tools has contributed to a comprehensive understanding of the underlying pathologies of this small and complex joint. In particular, the understanding of elbow instabilities
gained significantly from the diagnostic procedure of elbow arthroscopy. This has meant that the treatment concept for complex instabilities can be defined more effectively and more reproducibly. Elbow arthroscopy enables the severity and direction of new and chronic instabilities to be defined and any necessary treatment strategy to be derived. This includes screening for new capsule syndesmorrhaphy or syndesmoplasty in cases of chronic instability.

The therapeutic options offered by elbow arthroscopy cover the spectrum of arthrolysis in primary and secondary arthroses, and the treatment of post-traumatic arthrofibrosis.
Meanwhile, improved function results have been obtained involving lower morbidity with the right screening, by comparison with open arthrolysis. In the hands of a trained and experienced surgeon, the level of complications is low despite the close proximity to the pathways of blood vessels and nerves, provided that a standardized technique is used and the relevant landmarks are respected. A complex arthrolysis can involve the removal of arthroliths floatdie ing in the joint, ablation of osteophytes, intraarticular debridement of soft tissue with synovectomy, cartilage smoothing, release of triceps muscle and complete
ventral capsulotomy.
If patients are suffering from rheumatism, the arthroscopic synovectomy of the elbow has a defined status within the treatment concept alongside basic drug
therapy directed toward reducing aggressive development patterns.

Other indications for elbow arthroscopy are osteochondrosis dissecans with the relevant cartilage therapy required depending on the stage reached. They include procedures for direct and indirect drilling, and
microfracturing and chrondroplasty with debridement. The defect in the dissected bed is generally filled with a cartilage-bone cylinder or artificial bone using an open procedure. Initial experience has already
been provided in the arthroscopic technique. In special cases, the facture can also be treated with arthroscopic assistance, the cartilage damage and joint stages can be assessed more precisely and hence achieve better results in reinstating injured joints, and/or the extent of the injury can be more precisely identified.

Another important indication of elbow arthroscopy lies in identifying the surgical treatment concept for radial epicondylitis. Several studies have indicated a causal link between posterolateral rotation instability and chronic radial epicondylitis. Furthermore, intraarticular pathologies, such as a major inflammatory plica synovialis and free arthroliths, have been identified as causes for chronic radial epicondylitis.

Intraarticular diseases causing radial epicondylitis can often only be identified and treated arthroscopically. If there are significant posterolateral rotation instabilities, syndesmoplasty of the LUCL complex (Lateral Ulnar Collateral Ligament) would also be indicated in addition to open intervention, which involves debridement with denervation and reinsertion of the extensors. Syndesmoplasty with a triceps tendon transplant has proved effective.

We recommend commencing arthroscopy of the elbow from a dorsal position. Initially, the joint is filled with around 20 ml of irrigation fluid through the dorsoradial soft spot. An anteroradial trocar is then inserted into the ventral compartment. Afterward, the continuous water supply is connected to this trocar. A proximal dorsoradial portal is then created at the level of the olecranon tip. A Wissinger rod is inserted into the olecranon fossa for this purpose. The camera trocar is inserted into the dorsal compartment through the Wissinger rod. A transtriceptal port can also be created as an additional working portal. After dorsal arthroscopy has been completed, the camera is swiveled from the proximal dorsoradial portal over the dorsoradial recess to the soft spot. Another working portal is then created here. The plica synovialis is resected through this portal and the joint surfaces of the radius head, the dorsal capitulum of the humerus, and humeroulnar joint can be assessed. Furthermore, the posterolateral rotation instability is assessed with the Wissinger rod through this port.

After the dorsoradial compartment has been dealt with, the camera is then inserted into the ventral compartment through the anteroradial trocar. If pathology requiring treatment is identified here, an inside-out technique is used to create an anteromedial portal with the Wissinger rod. The camera is then placed in the anteroradial portal and the working instrument is inserted in the anteromedial portal. In each case, shuttle techniques should be used to change instruments under controlled conditions. The camera must be placed in the anteromedial portal to complete a ventral capsulotomy or to gain an improved overview of the anteroradial area. A complete arthrolysis generally requires between four and five standard portals.

Elbow arthroscopy has achieved a central position in the treatment of the elbow. Although knowledge of shoulder and knee arthroscopy can be transferred to the elbow, practical implementation generally requires
training in cadaver workshops or tutorial sessions due to the extremely demanding technical and anatomical conditions.