Cadaveric Feasibility Study Describing Transarticular Drilling of the Canine Anconeal Process through a Cranial...

The aims of this study were to describe a cranial arthroscopic portal to the supratrochlear foramen and to assess the feasibility and accuracy of retrograde transarticular drilling of the anconeal process in canine cadaveric elbows.

Cadaver elbows (n = 8) were instrumented through a cranial portal in the distal humerus using a NanoScope. The scope was manoeuvred through the supratrochlear foramen to inspect the anconeal process. A 2.0-mm tunnel simulating the pilot hole for an ununited anconeal process repair was performed using a C guide, cannulated drill bits and NanoScope guidance. Experimental measures included arthroscopic anconeal process identification, surgical time, computed tomography and gross dissection to assess for critical structure damage and drill tunnel aperture location and trajectory. The first two elbows were used for technique development; the remaining six elbows have reported outcome measures.

Mean surgery time was 16.6 (standard deviation 3.0) minutes. All six tunnels drilled had acceptable trajectories based on computed tomography and gross dissection. Major damage to critical structures was not observed in any specimen; however, tunnels were directly adjacent to transcubital vessels and a musculocutaneous nerve branch.

This technique was feasible, provided visualization of the anconeal process, and allowed accurate drilling of the anconeal process in a cadaveric model. Clinical feasibility and safety require validation in a clinical study.