scholarly journals Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110489
Author(s):  
Jae-Man Kwak ◽  
Dani Rotman ◽  
Jorge Rojas Lievano ◽  
James S. Fitzsimmons ◽  
Shawn W. O’Driscoll
Keyword(s):  
Radial Head ◽  
Tennis Elbow ◽  
Lateral Collateral Ligament ◽  
Elbow Flexion ◽  
Safe Zone ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Custom Made ◽  
Varus Stress ◽  
Extensor Carpi Radialis

Background: There is no consensus how to determine the varus laxity due to the LCL injury using the ultrasonography. There is a risk of lateral collateral ligament injury during or after arthroscopic extensor carpi radialis brevis release for tennis elbow. The equator of the radial head has been suggested as a landmark for the safe zone to not increase this risk; however, the safe zone from the intra-articular space has not been established. Hypothesis: Increased elbow varus laxity due to lateral collateral ligament–capsular complex (LCL-cc) injury could be assessed reliably via ultrasound. Study Design: Descriptive laboratory study. Methods: Eight cadaveric elbows were evaluated using a custom-made machine allowing passive elbow flexion under gravity varus stress. The radiocapitellar joint (RCJ) space was measured via ultrasound at 30° and 90° of flexion during 4 stages: intact elbow (stage 0), release of the anterior one-third of the LCL-cc (stage 1), release of the anterior two-thirds (stage 2), and release of the entire LCL-cc (stage 3). Two observers conducted the measurements separately, and the mean RCJ space in the 3 LCL-cc injury models (stages 1-3) at both flexion angles was compared with that of the intact elbow (stage 0). We also compared the measurements at 30° versus 90° of flexion. Results: At 30° of elbow flexion, the RCJ space increased 2 mm between stages 0 and 2 (95% confidence interval [CI], 1-3 mm; P < .01) and 4 mm between stages 0 and 3 (95% CI, 2-5 mm; P < .01). At 90° of elbow flexion, the RCJ space increased 1 mm between stages 0 and 2 (95% CI, 1-2 mm; P < .01) and 2 mm between stages 0 and 3 (95% CI, 2-3 mm; P < .01). Conclusion: Elbow varus laxity under gravity stress can be reliably assessed via ultrasound by measuring the RCJ space. Clinical Relevance: Because ultrasonographic measurement of the RCJ space can distinguish the increasing varus laxity seen with release of two-thirds or more of the LCL-cc, the anterior one-third of the LCL-cc, based on the diameter of the radial head, can be considered the safe zone in arthroscopic extensor carpi radialis brevis release for tennis elbow.

scholarly journals Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? Mid-Term Postoperative Outcomes Following a Standardized Protocol

2020 ◽  
Vol 9 (11) ◽  
pp. 3500
Author(s):  
Beom-Soo Kim ◽  
Du-Han Kim ◽  
Seok-Ho Byun ◽  
Chul-Hyun Cho
Keyword(s):  
Operative Treatment ◽  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Type I ◽  
Dash Score ◽  
Terrible Triad ◽  
Collateral Ligament ◽  
Recurrent Instability ◽  
Standardized Protocol ◽  
Coronoid Fractures

The purpose of this study was to investigate mid-term outcomes and complications after operative treatment according to a standardized protocol for terrible triad injuries. Twenty-four patients that were treated by a single surgeon with a standardized surgical protocol were retrospectively reviewed. After the complete reconstruction of radial head and/or lateral collateral ligament (LCL) complex through a lateral approach, coronoid process, and/or medial collateral ligament (MCL) complex through a medial approach were fixed if the elbow is unstable. For coronoid fractures, only type III were fixed in four cases (16.7%). Twenty-two LCL (91.7%) and five MCL (20.8%) complexes were repaired. At the final follow-up, the mean MEPS and Quick-DASH score were 91.5 and 17.3, respectively. There was no recurrent instability after operation in all cases. This study revealed that operative treatment that was based on our standardized protocol for terrible triad injuries yielded satisfactory mid-term clinical and radiographic outcomes without any recurrent instability. These results suggest that Type I and II coronoid fractures in terrible triad injuries do not need to be fixed if the radial head and ligamentous complex are completely reconstructed.

scholarly journals Use of Suture Anchors for Coronoid Fractures in the Terrible Triad of the Elbow

2009 ◽  
Vol 17 (1) ◽  
pp. 31-35 ◽  
Author(s):  
V Pai ◽  
V Pai
Keyword(s):  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Lateral Condyle ◽  
Type I ◽  
Suture Anchors ◽  
Terrible Triad ◽  
Collateral Ligament ◽  
Range Of Movement ◽  
Flexion Extension ◽  
The Mean

Purpose. To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol. Methods. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs. Results. After a mean follow-up of 2.2 (range, 1–3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome. Conclusion. Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terible triad of the elbow.

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