Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals

The purpose of this anatomic cadaveric study was to determine with trocars in situ the relationships of 12 shoulder arthroscopic portals frequently used with the adjacent musculotendinous and neurovascular structures.

Twelve shoulders of embalmed cadavers installed in a beach-chair position were dissected. Twelve different portals were established by using their authors' description: posterior "soft point," central posterior, anterior central, anterior inferior, anterior superior, 5 o'clock portal, Neviaser, superolateral, transrotator cuff approach, Port of Wilmington, anterolateral, and posterolateral. Six of these portals were placed on each shoulder so that each portal was studied 6 times. Dissections were conduced with trocars in situ to take into account their volume. The distance to the adjacent relevant neurovascular structures at risk (axillar and suprascapular nerves, axillar and suprascapular arteries, and cephalic vein) were measured, arm at side, by using a calliper. Musculotendinous structures crossed by portals were noticed.

The cephalic vein was injured twice by anterior portals. The 5 o'clock portal is at most risk of neurovascular injury. It is located at mean distances to the axillar artery and nerve of 13 and 15 mm, respectively. Other anterior, posterior, superior, and lateral portals are safe with mean distances higher than 20 mm. No musculotendinous rupture nor large injury occurred.

The present study shows that the trocars placement of the studied portals did not create, except for the cephalic vein, any lesion of the neurovascular adjacent structures.

This study suggests, except for the 5 o'clock portal, the safety of the shoulder arthroscopic portals tested regarding to the neurovascular adjacent structures.