Reliability of Magnetic Resonance Imaging Signs of Posterolateral Rotatory Instability of the Elbow

Hackl, Michael; Wegmann, Kilian; Ries, Christian; Leschinger, Tim; Burkhart, Klaus J.; Müller, Lars Peter

doi:10.1016/j.jhsa.2015.04.029

Cited by 52 publications

(24 citation statements)

References 19 publications

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“…Sanchez-Sotelo et al in 2005 reported that, if the clinical diagnosis is in doubt, a fluoroscopic examination should be performed and occasionally an examination under anesthesia, but other imaging studies such as MRI are usually not needed in simple elbow dislocations [ 35 ]. In contrast, Hackl et al and our study group could show, that it is important to detect possible warning signs of instability on MRI after acute simple elbow dislocation [ 9 , 36 ]. Our study group could show that the presence of a warning sign of instability (drop sign or joint incongruence) is associated with more complications (Odds ratio 15.9) and higher revision rates (Odds ratio 10.3) after non-operative treatment of simple elbow dislocations [ 9 ].…”

Section: Discussioncontrasting

confidence: 76%

Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation

Schnetzke

Schüler

Hoffend

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe primary objective of this study was to assess the interobserver and intraobserver agreement on ligamentous injuries on conventional magnetic resonance imaging (MRI) in acute simple elbow dislocation. The secondary objectives were to determine the interobserver agreement on the assessment of joint congruity, joint effusion, loose bodies and chondral lesions on conventional MRI.MethodsConventional MRIs (1.5 Tesla, elbow specific surface coil) of 30 patients (40.7 years; range 14–72) with simple elbow dislocations were evaluated by four blinded examiners. An analysis of the interobserver agreement of all raters and for several subgroups (radiologists, orthopaedics, experienced, non-experienced) was performed. The examiners assessed the integrity (intact, partial tear, complete tear) of the lateral collateral ligament (LCL), medial collateral ligament (MCL), extensor and flexor tendons, as well as the presence of joint congruity, joint effusion, loose bodies and chondral lesions. Agreement strength, correlation and proportion of exact agreement were determined for interobserver agreement, and intraobserver agreement analyses.ResultsInterobserver agreement of all examiners was fair to moderate for collateral ligaments (LCL: 0.441, MCL: 0.275). Exact agreement of all raters was found in 33.3% for the LCL and in 26.7% for the MCL. The both experienced examiners showed highest agreement strength for the LCL (0.619) and the radiologists showed highest agreement strength for the MCL (0.627), the proportion of exact agreement was 60.0% in both categories. A high proportion of exact agreement regarding joint congruity (90%), joint effusion (100%), loose bodies (96.7%) and chondral lesion (80%) was found among the radiologists. The evaluation of the intraobserver agreement revealed slight to substantial agreement (0.227 to 0.718) for the collateral ligaments.ConclusionsThis study shows difficulties in the evaluation of ligaments by conventional MRI technique as demonstrated by a weak inter- and intraobserver agreement. This should be the basis to develop new MRI quality standards with special focus on coronal oblique reconstructions to improve the evaluation of ligament injuries after simple elbow dislocations.

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Section: Discussioncontrasting

confidence: 76%

Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation

Schnetzke

Schüler

Hoffend

et al. 2017

BMC Musculoskelet Disord

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“…10 With regard to PLRI, studies have not confirmed the effectiveness of CT imaging, despite the potential ability to characterize joint incongruity in PLRI. 21 …”

Section: Testingmentioning

confidence: 99%

“…Hackl et al 21 demonstrated that posterior translation of the radial head greater than 2 mm and axial ulnohumeral incongruity greater than 1 mm was highly suspicious for PLRI. The LCL complex cannot be easily seen on a single MRI view.…”

Section: Testingmentioning

confidence: 99%

Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing

Karbach

Elfar

2017

The Journal of Hand Surgery

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The elbow comprises a complex of bony and ligamentous stabilizers that provide both primary and secondary constraints to elbow instability. Through trauma and overuse, classic instability patterns arise by loss of these important stabilizers. The diagnosis of elbow instability can made using specific examination maneuvers and testing to diagnose the clinical pattern. This article reviews the elbow’s unique anatomy and biomechanical characteristics and these are applied when reviewing the maneuvers and testing used to diagnose elbow instability.

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“…Associated subluxation of the radial head posterolateral to the capitellum is best appreciated on sagittal images (Fig 20). Posterolateral translation of the radial head of more than 1.2 mm (sensitivity 67%, specificity 70%) and axial ulnohumeral incongruity of more than 0.7 mm (sensitivity 63%, specificity 70%) are cutoffs that can be used as screening tools to aid the diagnosis of elbow instability (74).…”

Section: Figure 19mentioning

confidence: 99%

Elbow Imaging in Sport: Sports Imaging Series

2016

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Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.

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Reliability of Magnetic Resonance Imaging Signs of Posterolateral Rotatory Instability of the Elbow

Cited by 52 publications

References 19 publications

Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation

Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation

Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing

Elbow Imaging in Sport: Sports Imaging Series

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