Acute reconstruction of the medial collateral ligament of the elbow for severe valgus instability after anterior elbow dislocation

Background The present report describes subluxation and dislocation of the elbow with articular fracture of the distal humerus and injury to the medial collateral ligament, a type of elbow fracture-dislocation about which little is available in the literature. Methods Twenty-two patients with subluxation or dislocation of the elbow (with injury to the medial collateral ligament) and a fracture of the distal humerus articular surface (capitellum/trochlea) were identified. Seventeen patients had a minimum of 12 months follow-up and eight patients returned for a long-term follow-up at a median of 36 months (range 12 months to 154 months) after injury. Results Nine patients had one or more subsequent surgeries. Seven patients had surgery to address complications and two had a planned implant removal. The final median arc of elbow flexion was 120° (range 100° to 145°) and the median arc of forearm rotation was 175° (range 150° to 180°). The median Broberg and Morrey score was 88 points (range 63 points to 100 points) and the median Disabilities of the Arm Shoulder and Hand score was 9 points (range 1 point to 43 points). Discussion Some elbow dislocations and subluxations are associated with osteochondral fractures of the distal humeral articular surface.

Download Full-text

Valgus Instability of the Elbow Due to Medial Epicondyle Nonunion: Treatment by Fragment Excision and Medial Collateral Ligament Reconstruction

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500125 ◽

2017 ◽

Vol 22 (01) ◽

pp. 70-74 ◽

Cited By ~ 1

Author(s):

Yasunori Kaneshiro ◽

Noriaki Hidaka ◽

Koichi Yano ◽

Makoto Fukuda ◽

Hideki Sakanaka

Keyword(s):

Range Of Motion ◽

Medial Collateral Ligament ◽

Ligament Reconstruction ◽

Signs And Symptoms ◽

Medial Epicondyle ◽

Collateral Ligament ◽

Valgus Instability ◽

Bone Fragments ◽

The Mean ◽

Fragment Excision

Background: The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion. Methods: A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury. Results: All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients. Conclusions: By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.

Download Full-text

Medial Collateral Ligament Reconstruction of the Elbow using the Docking Technique

The American Journal of Sports Medicine ◽

10.1177/03635465020300041401 ◽

2002 ◽

Vol 30 (4) ◽

pp. 541-548 ◽

Cited By ~ 280

Author(s):

Joel T. Rohrbough ◽

David W. Altchek ◽

Jon Hyman ◽

Riley J. Williams ◽

Jonathan D. Botts

Keyword(s):

Medial Collateral Ligament ◽

Collegiate Athletes ◽

Tendon Graft ◽

Collateral Ligament ◽

Associated Lesions ◽

Competition Level ◽

Medial Collateral Ligament Reconstruction ◽

Valgus Instability ◽

Graft Reconstruction

Background Medial collateral ligament insufficiency of the elbow with resultant valgus instability in throwing athletes is typically treated with free tendon graft reconstruction as described by Jobe. Hypothesis Improved results could be obtained with the use of the docking technique. Study Design Uncontrolled retrospective review. Methods The study group consisted of 36 athletes who had symptomatic insufficiency of the medial collateral ligament confirmed by magnetic resonance imaging and by surgical findings. Average follow-up was 3.3 years. Key elements of the docking technique included a muscle-splitting approach without routine transposition of the ulnar nerve, routine arthroscopic assessment, treatment of associated lesions, and docking the two ends of the tendon graft into a single humeral tunnel. Results Thirty-three of 36 patients (92%) returned to or exceeded their previous level of competition for at least 1 year, meeting the Conway-Jobe classification criteria of “excellent.” All 22 professional or collegiate athletes returned to or exceeded their previous competition level. Conclusions The docking technique allowed simplified graft tensioning and improved graft fixation.

Download Full-text

Elbow Dislocation With Intra-Articular Fracture: The Results of Operative Treatment Without Repair of the Medial Collateral Ligament

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2007.06.019 ◽

2007 ◽

Vol 32 (8) ◽

pp. 1200-1209 ◽

Cited By ~ 144

Author(s):

Christopher Forthman ◽

Marjolijn Henket ◽

David C. Ring

Keyword(s):

Operative Treatment ◽

Medial Collateral Ligament ◽

Elbow Dislocation ◽

Collateral Ligament ◽

Articular Fracture

Download Full-text

Development of 3D Finite Element Model of Human Elbow to Study Elbow Dislocation and Instability

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206282 ◽

2009 ◽

Cited By ~ 4

Author(s):

Samer Khodor Al Kork ◽

Farid Amirouche ◽

Edward Abraham ◽

Mark Gonzalez

Keyword(s):

Finite Element ◽

Medial Collateral Ligament ◽

Inverse Dynamics ◽

Elbow Dislocation ◽

Lateral Collateral Ligament ◽

Element Model ◽

Fe Model ◽

Collateral Ligament ◽

Coronoid Fracture ◽

Flexion Extension

The mechanics of elbow dislocation and its stages of dislocation are complex and not well understood. Reconstructing a fall where someone lands on their hand is one of the most challenging problem in biomechanics. Current models which attempt to reconstruct falls usually focus on experimental kinematical conditions that cause the fall coupled with inverse dynamics to determine the joint and muscles forces [1,2] to provide on insight into the joint instability. Our hypothesis based on our experimental investigation is that the mechanism of posterior elbow dislocation is initiated at radial head where the ulna and coronoid fracture followed by anterior tearing of the joint capsule, lateral collateral ligament will then rupture followed by posterior medial collateral ligament rupture and then the medial collateral ligament peeling off the ulna. In this study we developed a quasi-static three-dimensional finite element of human elbow joint, and conducted several cadaveric studies to study elbow dislocation. The FE model is used to investigate how the ligaments, cartilages behave under different flexion, extension of the elbow. Dislocation is investigated as function of different loads and moments applied to the radius-ulna with arm being flexed and configured into a supination or pronation.

Download Full-text

Surgical Treatment of Subacute and Chronic Valgus Instability in Multiligament-Injured Knees With Superficial Medial Collateral Ligament Reconstruction Using Achilles Allografts

The American Journal of Sports Medicine ◽

10.1177/0363546513479016 ◽

2013 ◽

Vol 41 (5) ◽

pp. 1044-1050 ◽

Cited By ~ 31

Author(s):

Xin Liu ◽

Hua Feng ◽

Hui Zhang ◽

Lei Hong ◽

Xue Song Wang ◽

...

Keyword(s):

Surgical Treatment ◽

Medial Collateral Ligament ◽

Ligament Reconstruction ◽

Collateral Ligament ◽

Superficial Medial Collateral Ligament ◽

Medial Collateral Ligament Reconstruction ◽

Valgus Instability

Download Full-text

Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique

Acta Orthopaedica Belgica ◽

10.52628/87.2.23 ◽

2021 ◽

Vol 87 (2) ◽

pp. 359-365

Author(s):

Hamidreza Yazdi ◽

John Y. Kwon ◽

Mohammad Ghorbanhoseini ◽

Alireza Yousof Gomrokchi ◽

Paniz Motaghi

Keyword(s):

Medial Collateral Ligament ◽

Lysholm Score ◽

Hardware Removal ◽

Anatomic Reconstruction ◽

Collateral Ligament ◽

Knee Motion ◽

Knee Ligament ◽

Second Surgery ◽

Subjective Score ◽

Valgus Instability

Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised. Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded. Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity. In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion.

Download Full-text

Severe traumatic valgus instability of the elbow: pathoanatomy and outcomes of primary operation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1374-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Lei Zhang ◽

Laixu Wang ◽

Shiyang Yu ◽

Zhanhui Lv ◽

Peng Zhang ◽

...

Keyword(s):

Clinical Outcomes ◽

Medial Collateral Ligament ◽

Radial Head ◽

Dash Score ◽

Collateral Ligament ◽

Anterior Capsule ◽

Radial Head Fractures ◽

Primary Operation ◽

Valgus Instability

Abstract Background The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation. Methods Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Twenty patients with disruption of the flexor-pronator tendon (FPT) and 14 patients with tears of the anterior capsule had primary repair of the FPT and anterior capsule simultaneously. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS), modified hospital for special surgery assessment scale (HSS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The median follow-up was 37.3 months (range, 15–53 months). Radial head fractures and complete avulsion of the medial collateral ligament (MCL) from its humeral footprint were confirmed in all patients intraoperatively. Intraoperative findings indicated disruption of the FPT in 20 patients and tears of the anterior capsule in 14 patients. Twenty-nine of 31 patients returned to previous activity and work levels within 6 months after surgery. The MEPS, modified HSS, and DASH score were 94 ± 4, 91 ± 5, and 8 ± 2 at the latest follow-up. Conclusions Radial head fractures with avulsion of the MCL can lead to severe valgus instability of the elbow. Primary operation to repair these disrupted structures, especially repair of the AMCL, can effectively restore valgus stability.

Download Full-text