Relationship Between the Lateral Collateral Ligament of the Elbow and the Kocher Approach: A Cadaver Study

Bellato, Enrico; Castoldi, Filippo; Marmotti, Antonio; Greco, Valentina; Pautasso, Andrea; Blonna, Davide

doi:10.1016/j.jhsa.2020.09.013

Cited by 6 publications

(10 citation statements)

References 33 publications

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“…The results of the present and other cadaveric studies suggest that PLRI consistently develops following the Kocher approach; however, clinical reports do not describe similar rates of instability 13 . This discrepancy may be the result of a minimum threshold of clinically relevant instability, below which a small degree of PLRI is not appreciable.…”

Section: Discussioncontrasting

confidence: 71%

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Posterolateral Rotatory Instability Develops Following the Modified Kocher Approach and Does Not Resolve Following Interval Repair

Daniels,

France,

Peek

et al. 2023

Journal of Bone and Joint Surgery

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Background: The modified Kocher and extensor digitorum communis (EDC)-splitting intervals are commonly utilized to approach the lateral elbow. Iatrogenic injury to the lateral ulnar collateral ligament may result in posterolateral rotatory instability (PLRI). in the present cadaveric study, we (1) evaluated lateral elbow stability following the use of these approaches and (2) assessed the accuracy of static lateral elbow radiographs as a diagnostic tool for PLRI. Methods: Ten matched-pair cadaveric upper-extremity specimens (n = 20) were randomly assigned to Kocher or EDC-splitting approaches. Specimens underwent evaluation pre-dissection, post-dissection, and following repair of the surgical interval. Clinical evaluation of lateral elbow stability was performed with the lateral pivot-shift maneuver. Radiographic radiocapitellar displacement was evaluated with the fully extended hanging arm test and on lateral elbow 30° flexion radiographs. Paired Wilcoxon signed-rank tests with Bonferroni correction were utilized to compare groups. Results: All Kocher group specimens (10 of 10) developed PLRI on the pivot-shift maneuver following dissection. No EDC-splitting group specimens (0 of 10) developed instability with pivot-shift testing. The fully extended hanging arm test showed no difference in radiocapitellar displacement between groups (p > 0.008). Lateral elbow 30° flexion radiographs in the Kocher group showed an increased radiocapitellar displacement difference (mean, 8.46 mm) following dissection compared with the pre-dissection baseline (p < 0.008). Following repair of the Kocher interval, the radiocapitellar displacement (mean, 6.43 mm) remained greater than pre-dissection (mean, 2.26 mm; p < 0.008). In the EDC-splitting group, no differences were detected in radiocapitellar displacement on lateral elbow radiographs with either the fully extended hanging arm or lateral elbow 30° flexion positions. Conclusions: The Kocher approach produced PLRI that did not return to baseline conditions following repair of the surgical interval. The EDC-splitting approach did not cause elbow instability clinically or radiographically. The hanging arm test was not reliable for the detection of PLRI. Clinical Relevance: The Kocher interval for lateral elbow exposure results in iatrogenic PLRI that is not detectable on the hanging arm test and that does not return to baseline stability following repair of the surgical interval.

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Section: Discussioncontrasting

confidence: 71%

“…Hall and McKee evaluated 42 patients with radial head fractures without associated dislocation treated with radial head resection, and reported that 17% (7) developed symptomatic PLRI 27 . In a cadaveric study, Bellato et al reported that 75% of specimens (15 of 20) developed elbow instability attributable to the Kocher approach 13 .…”

Section: Discussionmentioning

confidence: 99%

Posterolateral Rotatory Instability Develops Following the Modified Kocher Approach and Does Not Resolve Following Interval Repair

Daniels,

France,

Peek

et al. 2023

Journal of Bone and Joint Surgery

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“…Then, a deep lateral approach is usually sufficient. The Kocher interval is developed [ 46 ] and, if the lateral ulnar collateral ligament (LUCL) is intact, the capsule between the extensor carpi ulnaris and the anconeus should be incised as far anterior as possible, in order to preserve the LUCL integrity [ 47 ]. When the fracture line extends toward the trochlea, an extended Kocher approach might be preferred [ 48 ]— starting the incision at the supracondylar ridge and detaching the origins of the wrist extensors and brachioradialis from the lateral condyle.…”

Section: Treatment Options and Resultsmentioning

confidence: 99%

Coronal Shear Fractures of the Distal Humerus

Bellato

Via

Bachman

et al. 2022

JFMK

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Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

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“…However, this approach affords excellent visualization of the radial head, LUCL, and coronoid that may need to be addressed in cases of complex elbow trauma. 1 , 3 , 4 , 7 , 11 Therefore, we evaluated whether a TED-based estimate could more accurately and reliably localize the PIN if the dissection was performed with an EDC-splitting approach on FF cadavers (method A) instead of the tissue-sparing dissection performed on embalmed cadavers as previously described. When we achieved similar results, we developed a different methodology (method B) that was more representative of the surgical setting and more accurate than previous investigations, including our own.…”

Section: Discussionmentioning

confidence: 99%

“…The posterolateral Kocher approach is near the lateral ulnar collateral ligament (LUCL) but avoids the posterior interosseus nerve (PIN). 1 The more anterior Kaplan and EDC-splitting approaches avoid the LUCL and offer improved visualization of the radial head and the coronoid for terrible triads but also require careful identification of the nearby PIN in cases necessitating exposure of the proximal third of the radial shaft. 3 , 4 …”

mentioning

confidence: 99%

Estimating the location of the posterior interosseus nerve during an extensor digitorum communis-splitting approach: a comparison of methods using the transepicondylar distance

et al. 2023

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Relationship Between the Lateral Collateral Ligament of the Elbow and the Kocher Approach: A Cadaver Study

Cited by 6 publications

References 33 publications

Posterolateral Rotatory Instability Develops Following the Modified Kocher Approach and Does Not Resolve Following Interval Repair

Posterolateral Rotatory Instability Develops Following the Modified Kocher Approach and Does Not Resolve Following Interval Repair

Coronal Shear Fractures of the Distal Humerus

Estimating the location of the posterior interosseus nerve during an extensor digitorum communis-splitting approach: a comparison of methods using the transepicondylar distance

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