Coronoid reconstruction using osteochondral grafts: a biomechanical study

Bellato, Enrico; Kim, Young Bok; Fitzsimmons, James S.; Berglund, Lawrence J.; Hooke, Alexander W.; Bachman, Daniel R.; O’Driscoll, Shawn W.

doi:10.1016/j.jse.2017.05.010

Cited by 20 publications

(18 citation statements)

References 42 publications

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“…No specimen demonstrated a flexion contracture of more than 10 , a pronation-supination rotation arc less than 140 , or any radiologic evidence of arthritis or deformity under C-arm fluoroscopy. 10 Each specimen was carefully dissected to remove the skin and subcutaneous fat from the mid-humerus to 5 cm distal of the elbow joint. The biceps, brachialis, and triceps muscle bellies were removed, while their tendon insertions were preserved and prepared with locking Krackow stitches using 36-kg-test braided polyester fishing line.…”

Section: Specimen Preparationmentioning

confidence: 99%

“…The biceps, brachialis, and triceps muscle bellies were removed, while their tendon insertions were preserved and prepared with locking Krackow stitches using 36-kg-test braided polyester fishing line. 10 The humeral origins of the flexor-pronator and the extensor-supinator muscles were preserved. To permit placement of the pressure transducer, the anterior capsule was excised, taking care not to injure the collateral or annular ligaments.…”

Section: Specimen Preparationmentioning

confidence: 99%

“…Any specimen with cartilage erosion to the subchondral bone was excluded, but we did not discard specimens exhibiting shallow erosion with fibrillation and fissuring with normal joint contact. 10 Any specimen with ligament insufficiency was excluded using the posterolateral rotatory drawer test or the direct observation of ligaments. The proximal humeral end of the specimen was then potted into a cylindrical metal sleeve in parallel to its long-axis using a polyurethane resin (Smooth-Cast 65D, Techno-Industrial Products, Inc., Hartland, WI 53029-8302) to fix and load the specimen onto the testing machine.…”

Section: Specimen Preparationmentioning

confidence: 99%

“…The thin-film Tekscan sensor has been validated for measuring pressure in rounded contact areas 11 and has been used in earlier reports of joint contact pressures, 12,13 specifically including use within the elbow. 10,[14][15][16][17] Each 5051 sensor has one 56 Â 56 mm matrix (3136 mm 2 ), comprising of 1936 sensels (individual detection units of pressure) located on conductive ink grids. The Tekscan 5051 thin-film pressure transducers (Tekscan, South Boston, MA) with a saturation pressure of 8.3 MPa (84.4 kg/cm 2 ) were prepared, preconditioned, and calibrated according to the manufacturer's recommendations.…”

Section: Pressure Transducermentioning

confidence: 99%

“…The Tekscan sensors were inserted between the joint surfaces from anterior to posterior as previously reported. 10,[15][16][17] The osteotomized lateral humeral condyle was fixed with three screws as stated above and the sensor was secured in place by fixing to two proximal screws in the proximal posterior aspect of ulna. The Tekscan contact pressure data were captured at a frequency of 100 Hz.…”

Section: Pressure Transducermentioning

confidence: 99%

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Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures

et al. 2019

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Background Over-lengthening of the radial neck has been shown to affect ulnohumeral kinematics and has been proposed to affect radiocapitellar pressures. We hypothesized that an incremental increase in radial neck height increases the capitellar contact pressure and reduces the coronoid contact pressure. Knowledge of the effects of over-lengthening is clinically important in preventing pain and degenerative changes due to overstuffing. Methods Six human cadaveric elbows were prepared on a custom-designed apparatus simulating muscle loads and passive flexion from 0° to 90° under gravity valgus torque while measuring joint contact pressures in this biomechanical study. Each elbow was tested sequentially starting with the intact specimen followed by insertion of a radial head prosthesis with 0, +2, and +4 mm of radial neck height, respectively. Results Capitellar mean contact pressures significantly increased after insertion of +2 and +4 mm radial head prostheses (p < 0.03). The capitellar mean contact pressure with a 0 mm radial head prosthesis was 97 KPa. Insertion of +2 mm and +4 mm radial heads increased mean contact pressures to 391 KPa (p = 0.001) and 619 KPa (p = 0.001), respectively, with 90° of elbow flexion. Discussion Increasing radial prosthesis height by 2 mm significantly increases capitellar contact pressures and reduces coronoid contact pressures.

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Section: Specimen Preparationmentioning

confidence: 99%

Section: Specimen Preparationmentioning

confidence: 99%

Section: Specimen Preparationmentioning

confidence: 99%

Section: Pressure Transducermentioning

confidence: 99%

Section: Pressure Transducermentioning

confidence: 99%

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Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures

et al. 2019

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Ellenbogenluxation

Geyer¹,

Lenich²,

Siebenlist³

2020

Orthopädie Und Unfallchirurgie

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Coronoidaufbau mittels Beckenkammspan über einen medialen Zugang zur Therapie von chronischen Coronoiddefekten mit posteromedialer Rotationsinstabilität

Schneider

Zimmermann

Hollinger³

et al. 2022

Oper Orthop Traumatol

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Zusammenfassung Operationsziel Ziel ist die Wiederherstellung der ulnohumeralen Gelenkkongruenz mit Neutralisierung der posteromedialen Instabilität (PMRI) und der damit einhergehenden chronischen Fehlstellung des Ellenbogens. Indikationen Neben akuten Defekten, auf die im Artikel nicht näher eingegangen werden soll, besteht die Indikation zum Coronoidaufbau bei chronischen Defekten der anteromedialen Facette des Coronoids mit PMRI. Kontraindikationen Gegen die Durchführung der Operation sprechen fortgeschrittene Knorpelschäden des Ellenbogens sowie allgemeine Kontraindikationen (akuter Infekt, Schwangerschaft, fehlende Operabilität des Patienten etc.) Operationstechnik Über einen medialen Zugang wird zunächst das Coronoidbett präpariert. Im Anschluss wird ein autologer Beckenkammspan auf den Defekt aufgebracht, an die Gelenkfläche anpasst und mittels Schrauben- oder Plattenosteosynthese dauerhaft fixiert. Additiv wird eine Rekonstruktion des anterioren Bündels des medialen Kollateralbandes durchgeführt und die Kapsel bzw. Flexoren werden zum Ende der Operation verschlossen respektive rekonstruiert. Weiterbehandlung Postoperativ wird eine Bewegungsorthese angepasst, die für 6 Wochen getragen werden sollte. Der Ellenbogen kann unmittelbar nach Operation schmerzadaptiert frei funktionell beübt werden. Die Therapie wird durch einen CPM-Ellenbogenstuhl unterstützt. Ergebnisse Zwischen 04/2015 und 11/2017 wurden 10 Patienten mit chronischen Coronoiddefekten mit dieser Technik operiert. Acht der 10 Patienten standen 86 Wochen postoperativ für ein Follow-up zur Verfügung. Die durchschnittlich 41,4 Jahre alten Patienten wiesen postoperativ alle einen gesteigerten Bewegungsumfang, regelrechte radiologische Stellungskontrollen ohne Subluxationen und Verbesserungen in Funktionsscores auf. Ein Patient wurde ausgeschlossen, weil eine Konversion in eine Ellenbogenprothese notwendig wurde. Mit der beschriebenen Technik ließ sich eine objektive wie subjektive Verbesserung der chronischen PMRI erreichen.

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Coronoid reconstruction using osteochondral grafts: a biomechanical study

Cited by 20 publications

References 42 publications

Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures

Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures

Ellenbogenluxation

Coronoidaufbau mittels Beckenkammspan über einen medialen Zugang zur Therapie von chronischen Coronoiddefekten mit posteromedialer Rotationsinstabilität

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