Assessment of medial elbow laxity by gravity stress radiography: comparison of valgus stress radiography with gravity and a Telos stress device

2014 ◽  
Vol 23 (4) ◽  
pp. 561-566 ◽  
Author(s):  
Mikio Harada ◽  
Masatoshi Takahara ◽  
Masahiro Maruyama ◽  
Tadanobu Nemoto ◽  
Kazuhiko Koseki ◽  
...  
Keyword(s):  
Stress Radiography ◽  
Valgus Stress ◽  
Telos Stress Device

scholarly journals Elbow valgus stability of the transverse bundle of the ulnar collateral ligament

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Hirotake Yokota ◽  
Ryo Hirabayashi ◽  
Chie Sekine ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Load Condition ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Limb Position ◽  
Intact State ◽  
Significant Difference ◽  
Telos Stress Device

Abstract Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.

Valgus Stress Radiography in Normal Ankles

1997 ◽  
Vol 18 (10) ◽  
pp. 654-657 ◽  
Author(s):  
Jordan Michael Leith ◽  
J.P. McConkey ◽  
David Li ◽  
Bassam Masri
Keyword(s):  
Diagnostic Test ◽  
Ankle Injury ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Complete Rupture ◽  
Talar Tilt ◽  
Standardized Method ◽  
Deltoid Ligament Injury

Deltoid ligament injury is thought to be rare. Signs of complete rupture of the deltoid ligament may be subtle or interpreted as another injury condition and thus are often missed acutely. No standardized method has been created to evaluate medial ligament insufficiency in acute or chronic laxity. To establish a diagnostic test for suspected isolated ruptures of the deltoid ligament, 32 subjects with no previous ankle injury underwent valgus stress radiography and nonstressed radiography of both ankles. Stress radiography in this study showed that there is a measurable but minimal range of talar tilt on valgus stress in previously uninjured ankles. This study provides the basis for diagnosis of the rare isolated rupture of the deltoid ligament of the ankle.

scholarly journals Assessment of valgus laxity after release of the medial structure in medial open-wedge high tibial osteotomy: an in vivo biomechanical study using quantitative valgus stress radiography

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Dai Sato ◽  
Eiji Kondo ◽  
Koji Yabuuchi ◽  
Jun Onodera ◽  
Tomohiro Onodera ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Biomechanical Study ◽  
Trial Registration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Plate Removal ◽  
Wedge High Tibial Osteotomy

Abstract Background To perform medial open-wedge high tibial osteotomy (OWHTO), surgeons expose the medial-proximal tibia by releasing or cutting the superficial layer of the medial collateral ligament (sMCL). Biomechanically, the sMCL provides primary restraint against valgus forces. Therefore, any release of the sMCL can cause valgus instability of the knee joint. The purpose of this study was to assess valgus laxity after release of the medial structure of the knee during OWHTO. Methods Between 2009 and 2015, 84 consecutive patients (93 knees) who underwent OWHTO using a locking plate were enrolled in this study. All patients underwent radiological examinations before surgery, during surgery, 1 year after surgery, and after plate removal to objectively assess valgus laxity. The medial joint space (MJS) and the joint line convergence angle (JLCA) of the knee were evaluated using quantitative valgus stress radiography. Clinical evaluation was performed 2 years after surgery. Results The mean functional knee score improved significantly, from 65.5 to 91.1 points (p < 0.0001). The mechanical axis percentage shifted to pass through a point 69.7% lateral from the medial edge of the tibial plateau. The MJS and JLCA increased significantly during OWHTO surgery (11.0 mm, 7.4 °, p < 0.0001). However, no significant differences were noted in the MJS and JLCA among preoperative, 1-year postoperative periods and after plate removal. Conclusion Valgus laxity was significantly greater after release of the sMCL. However, no significant differences were noted in valgus laxity in preoperative, 1-year postoperative periods and after plate removal. Complete release of the sMCL did not cause postoperative valgus laxity after OWHTO surgery. Trial registration Trial registration number: No.012–0360.

The lateral joint space width can be measured reliably with Telos valgus stress radiography in medial knee osteoarthritis

2018 ◽  
Vol 48 (7) ◽  
pp. 1069-1077 ◽  
Author(s):  
Daan Koppens ◽  
Ole Gade Sørensen ◽  
Stig Munk ◽  
Søren Rytter ◽  
Solveig Kärk Abildtrup Larsen ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Joint Space Width ◽  
Joint Space ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Space Width

Simultaneous Reconstruction of the Medial and Lateral Collateral Ligaments for Chronic Combined Ligament Injuries of the Ankle

2017 ◽  
Vol 45 (9) ◽  
pp. 2052-2060 ◽  
Author(s):  
Toshito Yasuda ◽  
Hiroaki Shima ◽  
Katsunori Mori ◽  
Seiya Tsujinaka ◽  
Masashi Neo
Keyword(s):  
Arthroscopic Surgery ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Sports Participation ◽  
Stress Radiography ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Anterior Displacement ◽  
Simultaneous Surgery

Background: Objective data on chronic injuries of the medial collateral ligament (MCL) of the ankle are scarce. Chronic MCL injuries are frequently associated with lateral collateral ligament (LCL) injuries. For patients with chronic combined MCL and LCL injuries, the authors have performed simultaneous surgery of the 2 ligaments. Hypothesis: Simultaneous surgery of the 2 ligaments may be effectively used to treat chronic combined MCL and LCL injuries. Study Design: Case series; Level of evidence, 4. Methods: Surgical outcomes were evaluated in 29 consecutive patients presenting with chronic MCL and LCL injuries (30 ankles; 15 men and 14 women; mean age, 31 years; 13 competitive and 10 recreational athletes). Preoperative and postoperative clinical outcomes were measured with the Karlsson score and the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score. The patients underwent preoperative and postoperative functional measurements and a radiological examination. In addition, preoperative magnetic resonance imaging (MRI) results, arthroscopic findings, and histology of the MCL were evaluated. Results: Preoperatively, the deep fibers of the MCL did not appear striated in 29 ankles, and high-intensity signal changes were observed in 23 ankles on T2-weighted or gradient echo MRI. MCL ruptures were confirmed with arthroscopic surgery. Medial impingement lesions and focal chondral lesions were confirmed in 10 and 21 ankles, respectively. Histology of the reconstructed MCL showed dense collagen fibers with vessels. The mean postoperative follow-up period was 30 months (range, 24-52 months). There was a significant change between preoperative and postoperative Karlsson scores (69.0 vs 96.1 points, respectively; P < .0001) and JSSF scores (69.8 vs 94.5 points, respectively; P < .0001). On varus and valgus stress radiography, the postoperative talar tilt angle was significantly lower than the preoperative angle. Postoperative anterior displacement on stress radiography was significantly lower than preoperative anterior displacement. Postoperatively, all 23 athletes returned to their preinjury level of sports participation. Conclusion: MCL insufficiency resulted from medial ankle instability and medial impingement lesions. Outcomes in the patients indicated that MCL reconstruction or resection of medial impingement lesions, performed in addition to LCL reconstruction, is effective for treating chronic combined MCL and LCL injuries of the ankle.

Valgus Stress Radiography in Normal Ankles

1997 ◽  
Vol 7 (3) ◽  
pp. 240
Author(s):  
J. P. McConkey ◽  
J. Leith ◽  
O. K. Lee ◽  
K. Stothers
Keyword(s):  
Stress Radiography ◽  
Valgus Stress

Medial Elbow Joint Laxity in Professional Baseball Pitchers

1998 ◽  
Vol 26 (3) ◽  
pp. 420-424 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Angelo J. Mattalino ◽  
Erik A. Elam ◽  
Roger A. Caplinger
Keyword(s):  
Elbow Joint ◽  
Joint Space Width ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Professional Baseball ◽  
Stress Radiography ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Baseball Pitchers ◽  
Space Width

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 0.97 mm, while the nondominant elbow opened 0.88 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

Elbow Valgus Stress Radiography in an Uninjured Population

1998 ◽  
Vol 26 (3) ◽  
pp. 425-427 ◽  
Author(s):  
Guy A. Lee ◽  
Stephen D. Katz ◽  
Mark D. Lazarus
Keyword(s):  
False Positive ◽  
False Positive Rate ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Stress Radiographs ◽  
Significant Difference ◽  
Positive Rate ◽  
Positive Assessment ◽  
Valgus Instability ◽  
The Difference

Valgus instability of the elbow joint is a clinical diagnosis. However, many authors describe valgus stress radiographs as an aid in making this diagnosis. We studied valgus stress radiographs of 20 men (40 elbows) and 20 women (40 elbows), none with a history of elbow trauma or instability. The medial ulnohumeral distance was measured with no stress, valgus stress by gravity, and an applied valgus stress of 25 N (approximately 5 pounds). Measurements were made with the elbow positioned in extension and in 30° of flexion. The increase in medial ulnohumeral gapping with either gravity or 5 pounds of stress was statistically significant at both extension and 30° of flexion compared with the unstressed condition. The difference in ulnohumeral gapping between gravity stress and 5 pounds of valgus stress in extension and in 30° of flexion was also significant. We found no differences with regard to hand dominance or sex. We conclude that uninjured elbows have significant medial ulnohumeral gapping on valgus stress radiography. Although this is an important tool in diagnosing valgus instability of the elbow, it may yield a false-positive assessment of valgus instability. Valgus stress radiographs comparing contralateral elbows may reduce the false-positive rate since there appears to be no significant difference in medial ulnohumeral gapping between the two elbows.

scholarly journals Influence of Continuous Elbow Valgus Stress on the Medial Elbow Joint Space

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110459
Author(s):  
Tomoya Ikuta ◽  
Kanta Yoshioka ◽  
Kanta Matsuzawa ◽  
Sae Maruyama ◽  
Mutsuaki Edama
Keyword(s):  
Elbow Joint ◽  
External Rotation ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Ultrasound Images ◽  
Valgus Stress ◽  
Pronator Teres ◽  
Post Hoc ◽  
Male University Students ◽  
Telos Stress Device

Background: To investigate the effect of ulnar collateral ligament stretching due to the "creep phenomenon," the effect of accumulating elbow valgus stress on ligaments must be clarified. Purpose: To evaluate the effect of continuous elbow valgus stress on the medial elbow joint space (JS). Study Design: Controlled laboratory study. Methods: The authors measured the JS of the nondominant elbow joints of 20 healthy male university students (age, 21.4 ± 0.5 years; height, 171.4 ± 6.5 cm; weight, 65.7 ± 9.1 kg). The participants were seated with their shoulder at 90° of abduction and external rotation and their elbow at 30° of flexion, and elbow valgus stress was maintained at loads of 30 and 60 N using a Telos stress device. The JS was measured on ultrasound images of the medial elbow joint with the elbow in the start limb position (0 N) and then immediately (0 seconds) and at 60, 120, 180, 240, and 300 seconds after loading. In addition, muscle activity of the pronator teres muscle during JS measurement was monitored to examine the presence or absence of defensive contraction due to pain. Analysis of variance and the Bonferroni method for post hoc testing were used for statistical analysis. Results: No participants showed defensive contractions of the pronator teres. At 30 N, JS was significantly larger 60 seconds after loading compared with immediately after loading ( P = .007). At 60 N, JS was significantly larger after 120 seconds, as the loading time of valgus stress increased, compared with immediately after loading ( P = .002). Conclusion: JS was significantly larger immediately after loading of valgus stress, with an increase in continuous elbow valgus stress after 60 seconds at 30 N and after 120 seconds at 60 N. These results suggest that a creep phenomenon may develop around the soft tissue of the elbow when loaded by a continuous valgus stress. Clinical Relevance: JS is significantly increased by continuous elbow valgus stress.

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