scholarly journals Quantitative and Qualitative Analyses of the Lateral Ligamentous Complex and Extensor Tendon Origins of the Elbow: An Anatomic Study

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096137
Author(s):  
David L. Bernholt ◽  
Samuel I. Rosenberg ◽  
Alex W. Brady ◽  
Hunter W. Storaci ◽  
Randall W. Viola ◽  
...  
Keyword(s):  
Lateral Collateral Ligament ◽  
Joint Line ◽  
Anatomic Reconstruction ◽  
Annular Ligament ◽  
Lateral Side ◽  
Collateral Ligament ◽  
Measuring Device ◽  
Lateral Epicondyle ◽  
Radial Collateral Ligament ◽  
Bony Landmarks

Background: The lateral collateral ligament complex of the elbow is important in preventing posterolateral rotary instability of the elbow. Understanding the quantitative anatomy of this ligamentous complex and the overlying extensor musculature can aid in the surgical treatment of problems affecting the lateral side of the elbow. Purpose: To perform qualitative and quantitative anatomic evaluations of the lateral elbow ligamentous complex and common extensor muscle origins with specific attention to pertinent osseous landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 nonpaired, fresh-frozen human cadaveric elbows (mean age, 42.2 years; all male) were utilized. Quantitative analysis was performed using a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks, tendons, and ligament footprints of the lateral side of the elbow. Results: The extensor carpi radialis brevis was the only humeral footprint found to cross the radiocapitellar joint line, extending a mean 5.9 mm (95% CI, 4.7-7.0) distal to the joint line. With the elbow in full extension, the lateral ulnar collateral ligament (LUCL) humeral footprint was found 7.1 mm (95% CI, 4.7-9.4) anterior and 9.8 mm (95% CI, 8.4-11.2) distal to the lateral epicondyle and 8.6 mm (95% CI, 7.5-9.7) proximal to the radiocapitellar joint line, while the radial collateral ligament humeral footprint was found 6.6 mm (95% CI, 5.5-7.8) anterior and 5.6 mm (95% CI, 4.0-7.2) distal to the lateral epicondyle and 12.7 mm (95% CI, 11.4-14.0) proximal to the radiocapitellar joint line. The center of the ulnar attachment of the LUCL was found 1.4 mm (95% CI, 0.7-2.1) anterior and 2.4 mm (95% CI, 1.2-6.0) proximal to the supinator tubercle and 24.4 mm (95% CI, 22.7-26.1) distal to the radiocapitellar joint line. The center of the ulnar attachment of the annular ligament was found to be 17.3 mm proximal to the supinator tubercle. Conclusion: The current study provides measured distances of LUCL and radial collateral ligament attachments in reference to clinically relevant landmarks, which can potentially aid surgeons in performing more anatomic reconstruction or repair of the lateral ligamentous complex of the elbow.

scholarly journals Stress And Strain At The Lateral Collateral Ligament Complex Of The Elbow Joint

2007 ◽  
Author(s):  
G O Mbaka ◽  
A B Ejiwunmi ◽  
V U Chukwuma ◽  
O O Odusote
Keyword(s):  
Elbow Joint ◽  
Lateral Collateral Ligament ◽  
Qualitative Assessment ◽  
Annular Ligament ◽  
Stress And Strain ◽  
Collateral Ligament ◽  
Lateral Aspect ◽  
Full Extension ◽  
Radial Collateral Ligament ◽  
The Impact

Background: The radial collateral ligament was previously believed to be the only ligament existing at the lateral aspect of the elbow joint until Morrey and An (1976) classified the ligaments to include radial collateral (RCL) and lateral ulnar collateral ligaments (LUCL). There is therefore the need to assess the impact these ligaments in elbow joint stability. Objective: To investigate how the RCL and LUCL are affected by stress and strain in both routine and forceful movements of the limb. Materials and Methods: Eight (8) embalmed upper extremities were used for this investigation. The elbow joint was dissected with care taken to preserve the lateral ulnar collateral ligament seen in seven of the limbs. Qualitative assessment of ligament tension was made under valgus and varus stresses. The angles at which stress was applied were 450, 700, 750, 900, 1100, 1200 and full extension. These angles were chosen partly because most movements during racket sporting activities take place at higher angles (Regan et al 1991). The angles were determined by hand held goniometer while the arm was firmly held in a retort stand. Results: The RCL is more able to absorb stress and strain because of its greater flexibility enhanced by its attachment at the annular ligament. However, LUCL a thickened mass, in both valgus and varus stresses was taut throughout most of the entire arc of flexion. It is a much stronger ligament that effectively stabilizes elbow joint in both routine and forceful movement. Conclusion: This study has been able to establish that LUCL is more prone to stress and strain. Being attached from bone to bone, it equally provides greater stability at the lateral aspect of elbow joint. KEY WORDS: Elbow joint; Ulna and Radial Collateral Ligament; stress and strain.

scholarly journals Surgical Treatment for Malunion of the Lateral Humeral Epicondyle with Posterior Subluxation of the Radial Head: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Koichi Yano ◽  
Yasunori Kaneshiro ◽  
Hideki Sakanaka
Keyword(s):  
Lateral Collateral Ligament ◽  
High Energy ◽  
Limited Range ◽  
Forearm Rotation ◽  
Collateral Ligament ◽  
Lateral Epicondyle ◽  
Limited Range Of Motion ◽  
Contracture Release ◽  
Normal Congruence ◽  
The Right

A 24-year-old right-handed man suffered right olecranon and lateral epicondylar fracture from high energy trauma. Fixation of olecranon was performed by a previous doctor. Three months after operation, he presented with limited range of motion (ROM) of the right elbow caused by malunion of the lateral epicondylar fracture and subluxation of the radiohumeral joint. Preoperative ROM of the right elbow was flexion 110° and extension −75°. Forearm rotation was pronation 85° and supination 65°. Fragment excision of the lateral epicondyle, which was 27 mm in length, and lateral collateral ligament repair using anchors were performed. Fourteen months postoperatively, contracture release of the elbow was performed. Twenty-four months postoperatively, radiograph of the elbow showed normal congruence without osteoarthritic changes and the ROM of the right elbow was flexion 120° and extension −35°. Forearm rotation was pronation 90° and supination 70°. In the surgical setting, in case of the size of the lateral epicondylar fragment is relatively large, the fragment should be fixed or lateral collateral ligament should be repaired when the instability of the elbow is found.

scholarly journals PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Tyler J. Stavinoha ◽  
Peter C. Cannamela ◽  
Theodore J. Ganley ◽  
Kevin G. Shea
Keyword(s):  
Sports Medicine ◽  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Longitudinal Axis ◽  
Joint Surface ◽  
Annular Ligament ◽  
Collateral Ligament ◽  
Reconstructive Procedures ◽  
Lateral Epicondyle ◽  
The Sublime

Background: The medial and lateral ligamentous complexes of the elbow provide static restraint to the elbow and serve as important components of posteromedial and posterolateral rotatory instability. Many collateral ligament and medial epicondylar injuries require surgical repair in those with open physes. Little is known about the anatomy of the pediatric elbow and the relationship between these ligaments and physes. Purpose: To evaluate the anterior bundle of the medial collateral ligament complex, lateral ulnar collateral ligament, annular ligament, and relationships to the joint surfaces and physes. Methods: Two cadaveric elbows from a 3 year-old donor were dissected. Collateral and annular ligaments were isolated and left intact at their osseous attachment. Pins were placed at the origins and insertions and CT scans were used to establish precise anatomic relationships. All dissections and measurements were performed by a single orthopedic surgeon with specialization in pediatric sports medicine. Results: The MUCL origin was a mean 4.10 mm distal and anterior to the medial epicondyle, 10.09 mm from the distal humeral articular surface, and 9.01 mm distal to the medial physis. The distal insertion of the MUCL spanned a mean 3.09 mm and was posterior and medial to the sublime tubercle. In the longitudinal axis, the MUCL insertion footprint spanned the tubercle. The origin was a mean 1.20 mm proximal to the sublime tubercle and the distal extent averaged 2.53 mm distal to the tubercle. The center of the MUCL insertional footprint was 0.38 mm distal to the tubercle. The center of the MUCL was 3.87 mm from the olecranon articular surface. The annular ligament had consistent medial and lateral attachments to the ulna. Distance from the annular ligament attachments to the tip of the coronoid averaged 4.6 mm (4.46 & 4.74 lateral and medial for left; 4.80 & 5.27 lateral and medial for right). The LUCL origin was distal and anterior to the lateral epicondyle. It was 3.43 mm from the lateral epicondyle, 7.51 mm from the articular surface and 0.74 mm distal to the physis. Conclusions: This study is the first to describe anatomy of the elbow collateral and annular ligaments in pediatric cadaveric specimens, through a reliable, CT-based identification method. Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. A better understanding of these relationships may assist with surgical planning that preserves adjacent physeal growth regions.

scholarly journals Topographic and Histologic Analysis of the Collateral Ligament Complex around the Elbow

2021 ◽  
Vol 26 (3) ◽  
pp. 152-160
Author(s):  
Jong-Pil Kim ◽  
Ji-Kang Park ◽  
Joon-Young Yoo ◽  
Won-Jeong Shin ◽  
Jeong-Sang Kim ◽  
...  
Keyword(s):  
Polarized Light ◽  
Lateral Collateral Ligament ◽  
Ulnar Collateral Ligament ◽  
Anatomic Reconstruction ◽  
Type I ◽  
Micro Ct ◽  
Micro Computed Tomography ◽  
Collateral Ligament ◽  
Proximal Ulna ◽  
Maximal Diameter

Purpose: The purpose of this study was to evaluate topographic anatomy of the footprints of key ligaments of the elbow and assess their relationships with bony parameters using micro-computed tomography (micro-CT). Additionally, the ratios of type I/III collagen at the medial collateral ligament (MCL) and lateral collateral ligament (LCL) of elbow were investigated.Methods: Eleven cadaveric elbows attached by both the MCL and LCL were scanned using micro-CT and reconstructed three-dimensionally. Additionally, the ligaments were examined under polarized light microscopy to determine the histological characteristics of collagen patterns. Results: Areas of footprints of the MCL and LCL attaching onto the humerus were 133.2±25.8 mm² and 128.3±23.2 mm², respectively. Footprint sizes of anterior and posterior bundles of the MCL in the proximal ulna and lateral ulnar collateral ligament (LUCL) attaching to the proximal ulna averaged to 109.9 mm², 89.2 mm², and 89.7 mm², respectively. There were a positive correlation between footprint size of the MCL and LUCL at the humeral side and a negative correlation between the footprint size of the MCL at humeral side and maximal diameter of the radial head. The collagen I/III ratio of the humeral attachment of the MCL was higher than distal attachment of the MCL. Conclusion: This study provides a better understanding of the pathologies of the MCL and LCL complex of the elbow and their relationships with osseous anatomy and may assist the clinician with an anatomic reconstruction of the ligaments.

Surgical stabilization of traumatic elbow joint luxation and proximal ulnar fracture in a silvery langur (Trachypithecus cristatus)

2021 ◽  
pp. 1-5
Author(s):  
Isabel A. Jimenez ◽  
Daniel I. Spector ◽  
Sarah B. Chaney ◽  
Robert Moore ◽  
Jean A. Paré
Keyword(s):  
Range Of Motion ◽  
Group Dynamics ◽  
Elbow Joint ◽  
Lateral Collateral Ligament ◽  
Annular Ligament ◽  
Monteggia Fracture ◽  
Type Ii ◽  
Collateral Ligament ◽  
Left Elbow ◽  
Ulnar Fracture

Abstract CASE DESCRIPTION A 3-year-old 5-kg sexually intact female silvery langur housed in a single-species group at a zoological institution was presented because of acute trauma to the left forelimb. CLINICAL FINDINGS Radiography of the left forelimb revealed a type II Monteggia fracture (proximal ulnar fracture with cranial displacement and caudal luxation of the radial head). During surgery, disruption of the annular ligament and rupture of the lateral collateral ligament were noted. TREATMENT AND OUTCOME The langur underwent open reduction and internal fixation of the ulnar fracture and placement of a radioulnar positional screw, a prosthetic lateral collateral ligament, and a temporary hinged type 1A external skeletal fixator. The langur was returned to group housing, underwent behavioral training, and was periodically anesthetized for physical therapy sessions to improve range of motion of the left elbow joint. The external skeletal fixator was removed 4 weeks after surgery, and the radioulnar positional screw was removed 6 weeks after surgery. Three months after surgery, the range of motion of the langur’s left elbow joint was considered normal, and the animal returned to normal activity. CLINICAL RELEVANCE For the captive silvery langur of the present report, surgical stabilization and postoperative management of a type II Monteggia fracture of the left forelimb were successful with recovery of elbow joint function. These techniques may be applied to other captive nonhuman primates, including those that brachiate or are members of social species that must be housed with conspecifics in the postoperative period to maintain group dynamics.

Functional Anatomy of the Lateral Collateral Ligament Complex of the Elbow: Morphology and Strain

2005 ◽  
Vol 30 (2) ◽  
pp. 143-147 ◽  
Author(s):  
N. TAKIGAWA ◽  
J. RYU ◽  
V. L. KISH ◽  
M. KINOSHITA ◽  
M. ABE
Keyword(s):  
Functional Anatomy ◽  
Lateral Collateral Ligament ◽  
Ulnar Collateral Ligament ◽  
Annular Ligament ◽  
Forearm Rotation ◽  
Collateral Ligament ◽  
Lateral Ulnar Collateral Ligament ◽  
Fibre Strain ◽  
Fresh Frozen

The anatomy of the lateral ulnar collateral ligament (LUCL) of the elbow was investigated in 26 fresh frozen cadavers. Two types of insertion of the LUCL were originally described but we found another type which is characterized by a broad single expansion along with a thin membranous fibre. Strain on the LUCL was measured in situ during extension and flexion with the forearm in supination, pronation and neutral. Strain in the proximal fibres started to occur at around 32° flexion and peaked at between 50° and 60° flexion. Strains measured in the distal fibres were smaller in magnitude. Forearm rotation had little effect on strain during extension to flexion. Based on these results, we conclude that the LUCL functions in unison with the annular ligament.

Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs

1992 ◽  
Vol 05 (04) ◽  
pp. 158-162 ◽  
Author(s):  
D. Blackketter ◽  
J Harari ◽  
J. Dupuis
Keyword(s):  
Mechanical Properties ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Biomechanical Properties ◽  
Fibular Head ◽  
Joint Stability ◽  
Collateral Ligament ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.

scholarly journals Repair of a Divergent Elbow Dislocation with Distal Ulnar Fracture in a Dog Using TightRope and External Skeletal Fixation

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e58-e64
Author(s):  
Marcos Garcia ◽  
Camille Bismuth ◽  
Claire Deroy-Bordenave
Keyword(s):  
Elbow Dislocation ◽  
Lateral Collateral Ligament ◽  
Normal Activity ◽  
Long Term Results ◽  
Collateral Ligament ◽  
Elbow Luxation ◽  
Ulnar Fracture ◽  
Fixation System

AbstractThe aim of this study was to report the outcome in a 6-year-old male English Setter dog that suffered a combination of divergent elbow dislocation and open distal ulnar fracture. This study is a case report. After surgical reduction in the elbow luxation, the dog was treated with the TightRope fixation system used as replacement of the lateral collateral ligament, a radioulnar positional screw, and external skeletal fixation. Removal of all implants was performed 3 months postoperatively. The 6-month follow-up visit found the dog without lameness, displaying normal activity, and with normal elbow range of motion and normal Campbell's test. Successful surgical management was achieved with good long-term results using TightRope, a positional screw, and an external skeletal fixator.

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