Valgus stability of the elbow

Hotchkiss, Robert N.; Weiland, Andrew J.

doi:10.1002/jor.1100050309

Cited by 340 publications

(122 citation statements)

References 4 publications

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“…In order to gain a clearer understanding of the consequences of radial head resections (1,18,32,59,71,84) (elbow instability, radiocapitellar joint contact loss, proximal migration of the radius) in comminuted radial head fractures, research was carried out on human cadaver elbows in order to examine the function of the radial head (31,51,63,64,66) and the role of the anterior band of the medial collateral ligament (aMCL), the interosseous membrane (MI) and the triangular fibrocartilaginous complex (TFCC) (20,37,38,66,70,74,75).…”

Section: Biomechanicsmentioning

confidence: 99%

“…In extension however, the role of the anterior capsule, the bony contours of the joint and the medial collateral ligament appeared to be equivalent. Morrey and An (66) and Hotchkiss (38) pointed out that the aMCL is the primary stabilizer resisting valgus stresses, and that the radial head takes over this function in case of a failing aMCL ligament.…”

Section: Biomechanicsmentioning

confidence: 99%

“…Rigid radial head prostheses (metal, ceramic, ultra-high molecular weight polyethylene) give better load transfers at the RC joint than silicone radial head prostheses (12,29,38,51,52). Moreover, silicone implants are not only unable to resist axial forces without showing deformations (12,29,52), they are also incapable of providing valgus stability in MCL deficient elbows (51) .…”

Section: Biomechanicsmentioning

confidence: 99%

“…On the other hand, there is a potential danger of stress-shielding (29), overstuffing (29,77), altered load transfers (29), induction of cartilage lesions on the capitellum (29,38,51,77) and osteoarthritic changes (12) when rigid radial head prostheses are used. A number of these complications may result from incorrect length and orientation in reconstruction of the radial head (12,51,77), and further experimental research is necessary to assess the importance of these factors.…”

Section: Biomechanicsmentioning

confidence: 99%

“…It can be concluded that the radial head as well as different ligamentous structures are extremely important for normal functioning of the elbow (17,22,29,37,38,51,61,62,63,66,89). (73,74).…”

Section: Biomechanicsmentioning

confidence: 99%

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Current Concepts Review

Harcke¹,

Kumar²

1991

Journal of Pediatric Orthopaedics

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The treatment of simple radial head fractures type Mason-Hotchkiss 1 and 2 is unequivocal. In the case of a displacement of less than 2 mm (MasonHotchkiss 1), functional conservative treatment is indicated. If the displacement is more than 2 mm (Mason-Hotchkiss 2) internal fixation is indicated, combined with treatment of the soft-tissue injuries. The treatment of comminuted radial head fractures Mason-Hotchkiss type 3 is more controversial, as they are usually associated with ligament injuries. Conservative treatment appears to have unsatisfactory results. Opinions differ on surgical treatment, i.e. 1) excision of the radial head ; 2) reconstruction by means of internal fixation ; 3) excision and reconstruction with a prosthesis. Basic experimental research on human cadaver elbows shows the importance of the conservation of the radial head, especially in case of associated soft tissue injuries. In most cases a stable osteosynthesis is impossible, and in case of associated ligament disruptions, resection and reconstruction by means of a rigid radial head prosthesis should be considered. Experimental research demonstrates promising results for rigid radial head prostheses in human cadaver elbows with a resected radial head and failing medial collateral ligament. Short-term clinical studies seem to confirm this, but long-term results are as yet unknown.

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Section: Biomechanicsmentioning

confidence: 99%

Section: Biomechanicsmentioning

confidence: 99%

Section: Biomechanicsmentioning

confidence: 99%

Section: Biomechanicsmentioning

confidence: 99%

Section: Biomechanicsmentioning

confidence: 99%

See 3 more Smart Citations

Current Concepts Review

Harcke¹,

Kumar²

1991

Journal of Pediatric Orthopaedics

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Anatomy of the ulnar part of the lateral collateral ligament of the elbow

et al. 1992

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The lateral ulnar collateral ligament (LUCL) of the elbow has been illustrated variably in anatomy texts. The purpose of this investigation was to determine the percentage of specimens in which this structure is present, and to describe its anatomy and function. The LUCL was identified as part of the lateral capsulo-ligamentous complex in 17 of 17 fresh frozen cadaver elbows (P <.Owl). The LUCL originates on the lateral epicondyle, blends with the fibers of the annular ligament as it arches superficial to it, then curves to insert on the tubercle of the supinator crest of the ulna. It is distinct at its insertion, but not at its origin where its fibers blend with those of the common extensor origin. The insertion is exposed in the interval created between (the deep surface of) the fascia of the supinator and its muscle fibers. The insertion can be palpated by applying a varus stress to the elbow. Cutting the ulnar fibers permitted posterolateral rotatory subluxation of the ulno-humeral joint and varus subluxation of the elbow. o 1992 wiley-Liss, Inc.

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Initial repair strengths of two methods for acute medial collateral ligament injuries of the elbow

Pichora¹,

Furukawa²,

Ferreira³

et al. 2007

Journal Orthopaedic Research

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The purposes of this study were to compare the initial repair strength of the medial collateral ligament (MCL) of the elbow using trans-osseous sutures and suture anchor methods and to determine the effect of repair pretensioning. Twelve, fresh-frozen upper extremities (66 AE 5 years) were mounted in a valgus-loading system. MCL repairs were performed using trans-osseous suture and suture anchor methods with 20 N or 40 N pretensioning. A cyclic (0.5 Hz), valgus 40 N load was applied 12 cm distal to the elbow axis of flexion. The load was increased by 10 N every 200 cycles until a length increase of 5 mm or catastrophic failure of the repair occurred. Repairs pretensioned with 40 N endured a significantly higher number of cycles and failed at higher loads than those pretensioned with 20 N (p < 0.05). No difference was found in the cycles or load to failure between trans-osseous sutures and suture anchors (p > 0.05). A higher magnitude of pretensioning of MCL repairs was found to increase initial repair strength suggesting that pretensioning should be performed clinically. Despite the comparable failure loads of the trans-osseous suture and suture anchor methods, the failure mechanism differed between the two techniques. The suture anchors usually failed catastrophically when the sutures broke as they passed through the anchor eyelet, while the trans-osseous sutures gradually elongated to the defined failure length by stretching and sliding through the ligament. The use of different suture anchors, suture sizes, or suture materials would likely influence the findings of this study and should be considered when applying these findings clinically. ß

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Valgus stability of the elbow

Cited by 340 publications

References 4 publications

Current Concepts Review

Current Concepts Review

Anatomy of the ulnar part of the lateral collateral ligament of the elbow

Initial repair strengths of two methods for acute medial collateral ligament injuries of the elbow

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