Arthroscopic assessment for lateral collateral ligament complex deficiency of the elbow: a cadaveric study.

PURPOSE: To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy. METHODS: Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow. RESULTS: The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157). CONCLUSION: Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.

Arthroscopic Assessment of Temporomandibular Joint Pathologies-Is It Possible for Non-Specialists in Arthroscopy? Analysis of Variability and Reliability of Dental Students' Ratings after a Comprehensive One-Semester Introduction.

Background: Arthroscopy of the temporomandibular joint (TMJ) plays a long-established role in the diagnostics and therapy of patients suffering from arthrogenic temporomandibular disorders (TMDs), which do not respond adequately to conservative/non-invasive therapy. However, the interpretation of arthroscopic findings remains challenging. This study investigates the reliability and variability of assessing arthroscopic views of pathologies in patients with TMDs by non-specialists in arthroscopy and whether a standardized assessment tool may improve correctness. Methods: Following a comprehensive one-semester lecture, dental students in the clinical stage of education were asked to rate 25 arthroscopic views (freeze images and corresponding video clips) regarding the severity of synovitis, adhesions, and degenerative changes on a scale of 0-10 (T1). The results were compared to ratings stated by two European-board-qualified academic OMF surgeons. In a second round (T2), the students were asked to repeat the ratings using a 10-point rating scheme. Results: With regard to all three subcategories, congruency with the surgeons' results at T1 was at a low level (p < 0.05 in 19/75 cases) and even decreased at T2 after the implementation of the TMDs-SevS (p < 0.05 in 38/75 cases). For both T1 and T2, therefore, the inter-rater agreement was at a low level, showing only a slight agreement for all three subcategories (Fleiss' Kappa (κ) between 0.014 and 0.099). Conclusions: The judgement of the arthroscopic pathologies of the TMJ remains an area of temporomandibular surgery that requires wide experience and training in TMDs to achieve expertise in TMJ arthroscopic assessments, which cannot be transferred by theoretical instruction alone.