Feasibility of shoulder joint visualization using the 0° Arthrex Nanoscope: a cadaveric study on twenty specimens

PURPOSE: Nanoscopic technology is increasingly employed in minimally invasive orthopedic procedures, offering enhanced access to tight compartments with reduced soft-tissue disruption. This study assessed the feasibility of visualizing key anatomical structures of the shoulder joint using a 0° nanoscope in cadaveric specimens. METHODS: Twenty fresh-frozen human cadaveric shoulders (10 left, 10 right) were examined by two orthopedic surgeons with different experience levels using a 1.9 mm 0° nanoscope. Standard posterior, anterior, and lateral portals were used to assess glenohumeral and subacromial compartments. Predefined landmarks were graded on a 5-point Likert scale. The primary outcome was feasibility of identifying each structure; secondary outcomes included mean visibility scores and inter-observer variability. RESULTS: All predefined landmarks were identified in all 20 specimens. The senior surgeon reported an overall mean visibility score of 4.45 (SD ± 0.18), and the resident 4.18 (SD ± 0.21). Highest scores were observed for the long head of the biceps tendon and superior labrum. Lower scores occurred in the subacromial space, particularly in bursal-side rotator cuff assessment, reflecting challenges inherent to the 0° field of view. Inter-observer agreement was good (mean differences ≤ 0.3). CONCLUSION: Nanoscopic visualization of the shoulder using a 0° device is feasible and yields high visibility scores for most landmarks. Surgeon experience may influence interpretation in anatomically complex regions such as the subacromial space. These findings support a potential diagnostic and adjunctive therapeutic role for shoulder nanoscopy. LEVEL OF EVIDENCE VI: Descriptive laboratory study.