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

2017 ◽  
Vol 22 (01) ◽  
pp. 70-74 ◽  
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.

scholarly journals Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770392 ◽  
Author(s):  
Antonios N. Varelas ◽  
Brandon J. Erickson ◽  
Gregory L. Cvetanovich ◽  
Bernard R. Bach
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Medial Collateral Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Ikdc Score

Background: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion z tests. Results: Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; P < .001), (2) improving the patient’s objective IKDC score (1.2% vs 88.4%; P < .001), (3) improving the patient’s subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; P < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; P < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; P < .001). Normal or nearly normal range of motion was obtained by 88% of all patients. Conclusion: The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.

scholarly journals A novel Medial Patellofemoral Ligament Reconstruction Technique; Preliminary Clinical Results

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007
Author(s):  
Hasan Basri Sezer ◽  
Raffi Armağan ◽  
Muharrem Kanar ◽  
Osman Tuğrul Eren
Keyword(s):  
Range Of Motion ◽  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Full Range ◽  
Lateral Collateral Ligament ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Ligament Rupture ◽  
Patella Luxation ◽  
The Mean

Medial Patellofemoral ligament(MPFL) is the main passive stabilizer of the patellofemoral joint. MPFL is injured in the 2/3 rds of the patients after patella luxation. In this study we present a novel aproach to the anatomical MPFL reconstruction and preliminary results of the technique. We operated 7 patients(4 female and female and 3 male) who applied to our clinic after a patella luxation episode. The mean age was 27,1 years(16-42). The mean follow up time was 23,5 months(24-35). We evaluated the patients clinically and radiologically for concommitant pathologies. 1 patient had patellar cartilage demage and patella alta, 1 patient had medial collateral ligament rupture, 1 patient had lateral collateral ligament and anterior cruciate ligament rupture and these pathologies were treated as well. The operation was done in the supine position on a radiolucent table and under the image intensifier control. The semitendinosus autograft was prepared. The femoral tunnel was drilled and double strand graft was introduced in the femoral tunnel and secured with ToggleLoc femoral fixation device(Biomet). The graft was advanced over the facia to the patellar side and passed through the 2 patellar tunnels and tied to each other. After exercising the knee the graft tension was rechecked at 30 degrees of knee flexion. Early postoperatively range of motion and quadriceps strenghtening exercises were carried out and patients were allowed to bear weight. All of the patients had full range of motion and free of pain. Postoperative x-ray and MRI examinations revealed the correction of patellar tilt and lateral shift of the patella in all patients. The only complication was a fissure of patella in 1 patient in the 6th week of rehabilitation due to anteriorly located patellar tunnel and heavy exercise. We immobilsed the patient in a brace and the patient returned to rehabilitation after 6 weeks when the fissure healed. All the patients returned to the previous functional level. Our anatomical MPFL technique uses ToggleLoc for the femoral side but implant free at the patellar side. The technique provided excellent preliminiary result in all of the patients. The technique allows graft retensioning again and again from both the femoral and the patellar side. The double bundle reconstruction seems to immitate the natural behaviour of the MPFL. However patellar tunnels carry a substantial risk of patella fracture and must be placed with great attention.

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