Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE)

Arrigoni, Paolo; Cucchi, Davide; D’Ambrosi, Riccardo; Butt, Usman Ismat; Safran, Marc R.; Denard, Patrick J.; Randelli, Pietro

doi:10.1007/s00167-017-4530-x

Cited by 49 publications

(52 citation statements)

References 63 publications

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“…However, in a study published by Anakwe et al 15 of the 110 patients managed with conservative treatment for a simple dislocation, followed for a mean of 88 months, 56% suffered from residual stiffness and 62% showed residual pain. In 2017, Arrigoni et al 16 reported that over 85% of patients suffering from recalcitrant lateral epicondylitis demonstrate at least one pathologic intra-articular finding, and almost 50% presented with at least one sign of lateral ligamentous patholaxity. O'Brien et al 8 argued that acute or subacute arthroscopic repair of the LUCL is a safe and effective treatment after elbow dislocation in high-demand patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture

Seo

Kim

et al. 2020

J Orthop Surg (Hong Kong)

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Background: The pathoanatomy and biomechanics of elbow instability have been previously reported; however, few researchers have dealt with the operative management and clinical consequence of recurrent elbow instability. Recent studies on arthroscopic lateral collateral ligament (LCL) complex repair have reported successful outcomes similar to those achieved by open repair. We aimed to determine the validity of arthroscopic repair of the LCL complex in elbows with unstable dislocation with or without intra-articular fracture. Methods: Eighteen consecutive patients who had undergone arthroscopic repair of the LCL complex for unstable dislocation of the elbow with or without intra-articular fracture and who were followed for at least 12 months were included in the study. Ligament injury combined with coronoid and/or radial head fractures were treated with arthroscopic technique. Pain, range of motion, clinical outcomes based on the Mayo Elbow Performance Score (MEPS), and surgical complications were evaluated. Results: At 12 months follow-up, all 18 patients demonstrated complete settlement of the instability and mean (and standard deviation) extension of 1.7 + 3.8 , flexion of 138.3 + 3.8 , supination of 88.6 + 5.3 , and pronation of 88.2 + 5.6 . The average MEPS was 97.7 + 3.9 points and according to this validated outcome score. However, slight widening (2 mm) of the radiocapitellar joint space was accompanied in one patient, although the varus stress test and pivot shift test were not observed. One patient showed delayed union of the anteromedial facet fracture, and two patients showed pin site irritation, which was a complication of arthroscopic coronoid fracture fixation and was fully resolved after pin removal. Conclusion: In patients with unstable elbow dislocation, with or without an intra-articular fracture, arthroscopic repair of the LCL complex is an effective and alternative treatment option that can restore elbow stability and have satisfactory clinical and radiographic results.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture

Seo

Kim

et al. 2020

J Orthop Surg (Hong Kong)

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“…The focus on a likely correlation between recalcitrant pathologies and cases of articular micro-instability has increased the attention on this topic over the last years, especially in case of patients showing a high predisposition for pain perception and a negative outcome after testing articular macro-instability. These patients have shown an increased incidence of intra-articular reactions that can be easily related to a pathological laxity, which can be defined "elbow lateral (micro) instability", especially in case of recalcitrant elbow lateral pain, even though it was originally defined as LET (20). Further authors (20,21) have also highlighted signs of intra-articular pain, after arthroscopy (i.e.…”

Section: New Pathoanatomical Acquisitionsmentioning

confidence: 99%

“…These patients have shown an increased incidence of intra-articular reactions that can be easily related to a pathological laxity, which can be defined "elbow lateral (micro) instability", especially in case of recalcitrant elbow lateral pain, even though it was originally defined as LET (20). Further authors (20,21) have also highlighted signs of intra-articular pain, after arthroscopy (i.e. synovitis, radio-ulnar ballottement, radiocapitellar chondromalachia combined with a pathological laxity of both radial-lateral collateral ligaments (RLCL) and orbicular ligaments.…”

Section: New Pathoanatomical Acquisitionsmentioning

confidence: 99%

Research proposal of a new clinic model for the interpretation of Lateral Elbow Pain: is it time to change?

Filippo

Pennella

Maselli

et al. 2020

Muscle Ligaments and Tendons J

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Background. Lateral Elbow Tendinopathy (aka Tennis Elbow or Lateral Elbow Pain), is characterized by a specific pain located in the lateral epicondyle and referred to the dorsal compartment of the forearm. Manual labour and forceful gripping activities can exacerbate pain, by restricting a patient's ability to work, train and perform simple daily tasks. In the framework of an aetiopathogenic complexity, a multimodal approach based upon the exclusive involvement of the common extensor tendon seems to be rather obsolete. This method does not consider any intra-articular pain resulting from micro-instabilities requiring a different approach together with a detection performed in a limited time span, in order to avoid any impairment of the psychosocial condition following the failure of all the proposed conservative treatments. Objectives. The primary objective of this debate was to have elaborated a decisional algorithm called Integrated Approach of Lateral Elbow Pain (I-APPLEp), which could allow the detection of a time-optimized plan for a diagnostic, therapeutic framing. Discussion. Following the above-mentioned research proposal, this clinical approach based upon an evaluative and therapeutic management of patients with LEP allows us to draw some conclusions: 1) using the expression Lateral Elbow Pain (LEP) to refer to this musculoskeletal condition should be preferable, owing to its aetiological and pathophysiological complexity. Moreover, the expression Non-specific Lateral Elbow Pain (NSLEP) in case of suffering of the extra-articular structures (i.e. Tendinopathy) and Specific Lateral Elbow Pain (SLEP) is recommended, within the framework of arthropathy or intra-articular pathology (e.g.: Smile Symptomatic MInor Instabilities of the Lateral Elbpw); 2) an early surgical treatment can be a feasible option in the management of articular micro-instabilities, recalcitrant pathologies and psychosocial profiles with a high risk of unfavorable prognosis. Conclusions. We recommend testing brand-new diagnostic, therapeutic proposals on sampling patients, who must be adequately chosen, in order to estimate the real impact in the short, medium and long term.

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“…Nirschl et al described the pathology as an angiofibroblastic tendinosis [ 17 ]. More recently, postero-lateral micro-instability has been suggested as a possible etiology for TE [ 18 ].…”

Section: Lateral Epicondylitismentioning

confidence: 99%

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

Kwapisz

Prabhakar

Compagnoni

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of ReviewPlatelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies.Recent FindingsThe response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.SummaryRegarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.

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Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE)

Abstract: III.

Cited by 49 publications

References 63 publications

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture

Research proposal of a new clinic model for the interpretation of Lateral Elbow Pain: is it time to change?

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

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