Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow

Wegmann, Kilian; Burkhart, Klaus J.; Bingoel, Alperen S.; Ries, Christian; Neiss, Wolfram F.; Müller, Lars Peter

doi:10.1007/s00167-014-3091-5

Cited by 13 publications

(10 citation statements)

References 12 publications

(13 reference statements)

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“…The lateral 25% of the radial head is overlaid by the LUCL, up to a maximum of 40%. [97] INSTABILITY Arthroscopic treatment mainly focusses on the LUCL. It should be noted that in a normal elbow, arthroscopic visualization of the MCL is limited.…”

Section: Tennis Elbow (Lateral Epicondylitis)mentioning

confidence: 99%

Advances and future trends in elbow arthroscopy

Robinson¹

2020

JASSM

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Elbow arthroscopy has evolved since its inception and is now a commonly used technique in the diagnosis and treatment of elbow pathology. It has many indications, from the removal of intra-articular loose bodies to the management of elbow osteoarthritis and fractures. In this paper, we will discuss the full spectrum of elbow arthroscopy covering recent evidence, surgical techniques, advances, and future trends.

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Section: Tennis Elbow (Lateral Epicondylitis)mentioning

confidence: 99%

Advances and future trends in elbow arthroscopy

Robinson¹

2020

JASSM

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“…Both tendinous and ligamentous structures convey the lateral stability of the elbow: the collateral ligament (LCL) complex is a reinforcement of the lateral capsule, which consists of three components, including the ulnar band (U-LCL), the radial band (R-LCL) and the annular ligament [1][2][3][4]. Superficial to this structure, the wrist extensors contribute as dynamic stabilizers to lateral elbow stability.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

Arrigoni

Cucchi

Luceri

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.

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“…The lateral collateral ligament (LCL) complex is a reinforcement of the lateral capsule, and it consists of 3 components: the ulnar (U-LCL), radial (R-LCL), and annular ligaments. 6,8,18,21,26,33 Ruptures of the U-LCL may follow acute dislocations or repetitive microtrauma and can result in overt acute or chronic posterolateral rotatory instability. 16 This injury pattern has been described in detail and associated with specific U-LCL alterations, such as proximal or distal avulsions, midsubstance tears, or bony avulsions from the humeral epicondyle or the crista supinatoris.…”

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confidence: 99%

mentioning

confidence: 99%

Lateral Elbow Laxity Is Affected by the Integrity of the Radial Band of the Lateral Collateral Ligament Complex: A Cadaveric Model With Sequential Releases and Varus Stress Simulating Everyday Activities

et al. 2021

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Background: An elongation of the radial lateral collateral complex (R-LCL) can provoke symptomatic minor instability of the lateral elbow leading to lateral elbow pain. Biomechanical models investigating the effects of elongation and partial or complete lesions of the R-LCL on lateral elbow stability are lacking. Purpose: To evaluate how partial and complete R-LCL release affects radiocapitellar joint stability in a setting of controlled varus load and progressive soft tissue release. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric specimens were obtained and mounted on a custom-made support to control elbow flexion and extension and to allow for controlled varus loading. Stress tests were performed on all intact specimens under gravity load alone, a 0.5-kg load applied to the hand, and a 1-kg load applied to the hand. After load application, anteroposterior radiographs were obtained. The following release sequence was applied to all specimens: release of the anterior half of the common extensor origin, pie crusting of the R-LCL, and R-LCL release. After each release, stress tests and radiographs were performed. The varus joint angulation of the elbow (α) was measured by 2 examiners as the main outcome parameter. Results: Significant changes in α from the initial condition occurred after each release, and a significant effect of varus load on α was documented for all release steps. A significant effect of the releases on α could be documented for all identical varus load conditions. A linear regression model was generated to describe the effect of varus load on α. Conclusion: Varus loads simulating everyday activities produce changes in the varus joint angulation of the elbow already in the intact specimen, which are linearly dependent on the applied moment and persist after release of the lateral stabilizing structures. With progressive load, a pie crusting of the R-LCL is the minimal procedure able to provoke a significant change in the varus joint angulation, and a complete R-LCL release produces additional increase in the varus joint angulation in all testing conditions. Clinical Relevance: These findings confirm the role of the R-LCL as static lateral stabilizer, supporting a pathological model based on its insufficiency and culminating with a symptomatic minor instability of the lateral elbow.

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Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow

Abstract: Experimental study.

Cited by 13 publications

References 12 publications

Advances and future trends in elbow arthroscopy

Advances and future trends in elbow arthroscopy

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

Lateral Elbow Laxity Is Affected by the Integrity of the Radial Band of the Lateral Collateral Ligament Complex: A Cadaveric Model With Sequential Releases and Varus Stress Simulating Everyday Activities

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