Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment

Arthroscopy of the shoulder, elbow, hip, and knee has become increasingly utilized due to continued advancements in technique, training, and instrumentation. In addition, arthroscopy is generally safe and effective in the utilization of joint preservation surgical techniques. The arthroscopist must utilize a thorough understanding of the surgical anatomy, detailed care with patient positioning, and safe instrumentation portals to prevent associated neurological injury. In the event of postoperative neurological complications, the physician must carefully document the patient history and physical examination while considering the utilization of additional imaging, testing, or surgical nerve exploration with a specialized team depending upon the severity of neurological injury. In this review, we discuss the prevention, evaluation, and treatment of neurological complications related for arthroscopic procedures of the shoulder, elbow, hip, and knee.

[1]  Shipra Tandon,et al.  Combined pericapsular nerve group and lateral femoral cutaneous nerve blocks for surgical anaesthesia in hip arthroscopy , 2020, Indian journal of anaesthesia.

[2]  R. Mirzayan,et al.  Complications of Elbow Arthroscopy in a Community Based Practice. , 2019, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  O. Mei-Dan,et al.  Effects of Hip Arthroscopy Without a Perineal Post on Venous Blood Flow, Muscle Damage, Peripheral Nerve Conduction, and Perineal Injury: A Prospective Study , 2019, The American journal of sports medicine.

[4]  J. Lubowitz,et al.  Hip Arthroscopy Complications Are Rare, but There Is Room for Improvement. , 2019, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[5]  David E. Ruchelsman,et al.  Ulnar Nerve Complications After Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review , 2019, The American journal of sports medicine.

[6]  P. Randelli,et al.  The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm. , 2019, Journal of shoulder and elbow surgery.

[7]  Adam J. Popchak,et al.  Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database , 2018, Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews.

[8]  W. Stetson,et al.  Avoiding Neurological Complications of Elbow Arthroscopy , 2018, Arthroscopy techniques.

[9]  J. Somerson,et al.  Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction: A Meta-Regression and Systematic Review , 2018, JBJS reviews.

[10]  Alexander H. Jinnah,et al.  Peripheral Nerve Injury After Elbow Arthroscopy: An Analysis of Risk Factors. , 2018, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[11]  F. Gwathmey,et al.  Hip Arthroscopy: Common Problems and Solutions. , 2018, Clinics in sports medicine.

[12]  V. Khanduja,et al.  What Is the Risk Posed to the Lateral Femoral Cutaneous Nerve During the Use of the Anterior Portal of Supine Hip Arthroscopy and the Minimally Invasive Anterior Approach for Total Hip Arthroplasty? , 2018, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[13]  C. Tudisco,et al.  Transient Common Peroneal and Tibial Nerve Palsy Following Knee Arthroscopy for the Treatment of Discoid Lateral Meniscus , 2017, Joints.

[14]  Christopher L. Camp,et al.  Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk. , 2016, Arthroscopy techniques.

[15]  D. Ruch,et al.  Major Peripheral Nerve Injuries After Elbow Arthroscopy. , 2016, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[16]  K. Tomaszewski,et al.  The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis , 2016, Hernia.

[17]  Chad Poage,et al.  Peroneal Nerve Palsy: Evaluation and Management , 2016, The Journal of the American Academy of Orthopaedic Surgeons.

[18]  Alan L. Zhang,et al.  Age-Related Trends in Hip Arthroscopy: A Large Cross-Sectional Analysis. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[19]  I. García-Alonso,et al.  The Effect of Knee Flexion Angle on the Neurovascular Safety of All-Inside Lateral Meniscus Repair: A Cadaveric Study. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[20]  M. Hutchinson,et al.  A Systematic Review of Ulnar Collateral Ligament Reconstruction Techniques , 2014, The American journal of sports medicine.

[21]  D. Ruch,et al.  Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study. , 2014, The Journal of hand surgery.

[22]  S. Krishnan,et al.  Complications of Shoulder Arthroscopy , 2014, The Journal of the American Academy of Orthopaedic Surgeons.

[23]  J. Irrgang,et al.  Complications After Arthroscopic Knee Surgery , 2014, The American journal of sports medicine.

[24]  P. Hölmich,et al.  Symptoms of nerve dysfunction after hip arthroscopy: an under-reported complication? , 2014, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[25]  David J. Wilson,et al.  Iatrogenic Nerve Injuries in Shoulder Surgery , 2013, The Journal of the American Academy of Orthopaedic Surgeons.

[26]  R. Brophy,et al.  Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy , 2013, The Journal of the American Academy of Orthopaedic Surgeons.

[27]  D. Eygendaal,et al.  Arthroscopic elbow surgery, is it safe? , 2013, Journal of shoulder and elbow surgery.

[28]  K. Yamaguchi,et al.  Elbow arthroscopy: early complications and associated risk factors. , 2013, Journal of shoulder and elbow surgery.

[29]  C. Spross,et al.  The first 100 elbow arthroscopies of one surgeon: analysis of complications. , 2013, Journal of shoulder and elbow surgery.

[30]  Samuel A. Taylor,et al.  Peripheral nerve injuries in sports-related surgery: presentation, evaluation, and management: AAOS exhibit selection. , 2012, The Journal of bone and joint surgery. American volume.

[31]  J. Giuffre,et al.  Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma , 2012, Clinical orthopaedics and related research.

[32]  Roberto Aldegheri,et al.  Surgical anatomy of the axillary nerve and its implication in the transdeltoid approaches to the shoulder. , 2010, Journal of shoulder and elbow surgery.

[33]  J. Simpson,et al.  Hip arthroscopy technique and complications. , 2010, Orthopaedics & traumatology, surgery & research : OTSR.

[34]  D. Hak,et al.  Traction Table‐related Complications in Orthopaedic Surgery , 2010, The Journal of the American Academy of Orthopaedic Surgeons.

[35]  Emerson Kiyoshi Honda,et al.  Do complications in hip arthroscopy change with experience? , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[36]  Robert Spinner,et al.  Shoulder tendon transfer options for adult patients with brachial plexus injury. , 2010, The Journal of hand surgery.

[37]  R. Frank,et al.  Avoiding Complications in Shoulder Arthroscopy: Pearls for Lateral Decubitus and Beach Chair Positioning , 2010 .

[38]  Steven B Cohen,et al.  Shoulder arthroscopy positioning: lateral decubitus versus beach chair. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[39]  O. Sherman,et al.  Risk of Iatrogenic Injury to the Peroneal Nerve during Posterolateral Femoral Tunnel Placement in Double-Bundle Anterior Cruciate Ligament Reconstruction , 2009, The American journal of sports medicine.

[40]  W. Robertson,et al.  The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. , 2008, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[41]  M. Medvecky,et al.  Beginning hip arthroscopy: indications, positioning, portals, basic techniques, and complications. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[42]  S. Steinmann,et al.  Elbow arthroscopy: where are we now? , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[43]  P. Hardy,et al.  Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[44]  A. Cosgarea,et al.  Posterior knee arthroscopy: anatomy, technique, application. , 2006, The Journal of bone and joint surgery. American volume.

[45]  G. McGwin,et al.  The Posterolateral Corner of the Knee , 2005, The American journal of sports medicine.

[46]  Charles P. Ho,et al.  Shoulder , 2005, Encyclopedic Dictionary of Archaeology.

[47]  I. Lo,et al.  Surgery about the coracoid: neurovascular structures at risk. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[48]  Daniel H. Kim,et al.  MANAGEMENT AND OUTCOMES IN 318 OPERATIVE COMMON PERONEAL NERVE LESIONS AT THE LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER , 2004, Neurosurgery.

[49]  R. Žic,et al.  Lesion of the common peroneal nerve during arthroscopy. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[50]  B. Morrey,et al.  Complications of Elbow Arthroscopy , 2001, The Journal of bone and joint surgery. American volume.

[51]  L. Adolfsson,et al.  Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[52]  A. Deutsch,et al.  Evaluation of the Anatomy of the Common Peroneal Nerve , 1999, The American journal of sports medicine.

[53]  G. Pierer,et al.  Transsection of the peroneal nerve complicating knee arthroscopy: case report and cadaver study. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[54]  D. Peterson,et al.  Shoulder arthroscopy and nerve injury: pitfalls and prevention. , 1995, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[55]  R. A. Forster,et al.  Neurological complications due to arthroscopy. , 1993, The Journal of bone and joint surgery. American volume.

[56]  E. Devereaux.  Community-based practice. , 1991, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[57]  P. Mccann,et al.  An anatomical study of the suprascapular nerve. , 1990, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[58]  E. M. Wolf.  Anterior portals in shoulder arthroscopy. , 1989, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[59]  E. April,et al.  An anatomic study of the musculocutaneous nerve and its relationship to the coracoid process. , 1989, Clinical orthopaedics and related research.

[60]  Neal C. Small,et al.  Complications in arthroscopy: the knee and other joints. Committee on Complications of the Arthroscopy Association of North America. , 1986, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[61]  H. Tullos,et al.  The axillary nerve and its relationship to common sports medicine shoulder procedures , 1986, The American journal of sports medicine.

[62]  M. Friedman,et al.  Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases. , 1986, The Journal of bone and joint surgery. American volume.

[63]  J. Andrews,et al.  Arthroscopy of the shoulder: Technique and normal anatomy , 1984, The American journal of sports medicine.

[64]  L. Engebretsen,et al.  Outcomes of an anatomic posterolateral knee reconstruction. , 2010, The Journal of bone and joint surgery. American volume.

[65]  R. LaPrade,et al.  Common Peroneal Nerve Neuropraxia After Arthroscopic Inside-Out Lateral Meniscus Repair , 2009, The journal of knee surgery.

[66]  Freddie H. Fu,et al.  Measurement of brachial plexus strain in arthroscopy of the shoulder. , 1987, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.