Varus Posteromedial Instability

Ramirez, Miguel A.; Stein, Jason; Murthi, Anand M.

doi:10.1016/j.hcl.2015.06.005

Cited by 28 publications

(13 citation statements)

References 12 publications

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“…Owing to the absence of the medial buttress of the LCL and coronoid, the varus stress causes mechanical symptoms by loading the medial ulnohumeral joint. 18 Pollock et al 19 evaluated multiple simulated examination maneuvers in LCL and anteromedial facet deficient–elbows; and the gravity-assisted varus stress test proved the most sensitive and specific maneuver (Fig. 6).…”

Section: Diagnostic Maneuversmentioning

confidence: 99%

“…Varus stress radiographs under anesthesia are the gold standard with widening seen at the ulnohumeral joint. 18 …”

Section: Testingmentioning

confidence: 99%

“…The coronoid fracture seen in VPMI is best evaluated with CT, and this assists in preoperative planning. 18 In valgus instability, CT arthrograms improve detection of partial thickness MCL tears and are between 71% and 86% sensitive and 91% specific. 10 With regard to PLRI, studies have not confirmed the effectiveness of CT imaging, despite the potential ability to characterize joint incongruity in PLRI.…”

Section: Testingmentioning

confidence: 99%

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

Karbach

Elfar

2017

The Journal of Hand Surgery

100

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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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Section: Diagnostic Maneuversmentioning

confidence: 99%

“…Varus stress radiographs under anesthesia are the gold standard with widening seen at the ulnohumeral joint. 18 …”

Section: Testingmentioning

confidence: 99%

Section: Testingmentioning

confidence: 99%

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

Karbach

Elfar

2017

The Journal of Hand Surgery

100

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“…Secondly, the osteotomies performed by Golan and Gluck teams on the radius prejudiced the normal elbow kinematics due to the alteration not only of the radio-humeral contact force in compressive stress, but also of the action of the annular ligament and the radial collateral ligament. This latter provides a predominant support in the varus stress 33 while the annular ligament stabilizes the radio-ulnar joint and therefore doesn't directly contribute to the ulno-humeral stability. Moreover, the radial head is an important secondary varus-valgus stabilizer, and an increasing joint instability was reported in settings of radial head fracture with a MCL insufficiency 34 .…”

Section: Resultsmentioning

confidence: 99%

“…The added coronoid resection increased the elbow instability even at lower flexion angles a confirming the PMRI occurrence in the setting of a concomitant coronoid fracture 35 . In fact, the coronoid facet lengthens the ar- ticular surface of the elbow preventing varus instability and resisting to posteromedial rotatory forces 33 .…”

Section: Muscles Ligaments and Tendonsmentioning

confidence: 99%

Multibody modelling of ligamentous and bony stabilizers in the human elbow

Terzini

Zanetti

Audenino

et al. 2019

Muscle Ligaments and Tendons J

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The elbow ligamentous and bony structures play essential roles in the joint stability. Nevertheless, the contribution of different structures to joint stability is not yet clear and a comprehensive experimental investigation into the ligament and osseous constraints changes in relation to joint motions would be uphill and somehow unattainable, due to the impossibility of obtaining all the possible configurations on the same specimen. Therefore, a predictive tool of the joint behavior after the loss of retentive structures would be helpful in designing reconstructive surgeries and in pre-operative planning. In this work, a multibody model consisting of bones and non-linear ligamentous structures is presented and validated through comparison with experimental data. An accurate geometrical model was equipped with non-linear ligaments bundles between optimized origin and insertion points. The joint function was simulated according to maneuvers accomplished in published experimental studies which explored the posteromedial rotatory in-stability (PMRI) in coronoid and posterior medial collateral ligament (PB) deficient elbows. Moreover, a complete design of experiments (DOE) was explored, investigating the influence of the elbow flexion degree, of the coronoid process and of the medial collateral ligaments (MCL) structures (anterior and posterior bundles) in the elbow joint opening. The implemented computational model accurately predicted the joint behavior with intact and deficient stabilizing structures at each flexion degree, and highlighted the statistically significant influence of the MCL structures (P<0.05) on the elbow stability. The predictive ability of this multibody elbow joint model let foresee that future investigations under different loading scenarios and injured or surgically reconstructed states could be effectively simulated, helping the ligaments reconstruction optimization in terms of bone tunnel localizations and grafts pre-loading. Level of evidence: V.

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Varus Posteromedial Rotatory Instability

Chan

Athwal

2016

The Unstable Elbow

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Varus Posteromedial Instability

Cited by 28 publications

References 12 publications

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

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

Multibody modelling of ligamentous and bony stabilizers in the human elbow

Varus Posteromedial Rotatory Instability

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