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.

Anatomic and Biomechanical Evaluation of Ulnar Tunnel Position in Medial Ulnar Collateral Ligament Reconstruction

2019 ◽  
Vol 47 (14) ◽  
pp. 3491-3497 ◽  
Author(s):  
Pascual H. Dutton ◽  
Michael B. Banffy ◽  
Trevor J. Nelson ◽  
Melodie F. Metzger
Keyword(s):  
Motion Tracking ◽  
Full Range ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Joint Line ◽  
Collateral Ligament ◽  
Proximal Ulna ◽  
Tunnel Position ◽  
Fresh Frozen ◽  
Ulnar Tunnel

Background: Although numerous techniques of reconstruction of the medial ulnar collateral ligament (mUCL) have been described, limited evidence exists on the biomechanical implication of changing the ulnar tunnel position despite the fact that more recent literature has clarified that the ulnar footprint extends more distally than was appreciated in the past. Purpose: To evaluate the size and location of the native ulnar footprint and assess valgus stability of the medial elbow after UCL reconstruction at 3 ulnar tunnel locations. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. The anatomic footprint of the ulnar attachment of the mUCL was measured with a digitizing probe. The area of the ulnar footprint and midpoint relative to the joint line were determined. Medial elbow stability was tested with the mUCL in an intact, deficient, and reconstructed state after the docking technique, with ulnar tunnels placed at 5, 10, or 15 mm from the ulnotrochlear joint line. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion-tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: The mean ± SD length of the mUCL ulnar footprint was 27.4 ± 3.3 mm. The midpoint of the anatomic footprint was located between the 10- and 15-mm tunnels across all specimens at a mean 13.6 mm from the joint line. Sectioning of the mUCL increased elbow valgus rotation throughout all flexion angles and was statistically significant from 30° to 100° of flexion as compared with the intact elbow ( P < .05). mUCL reconstruction at all 3 tunnel locations restored stability to near intact levels with no significant differences among the 3 ulnar tunnel locations at any flexion angle. Conclusion: Positioning the ulnar graft fixation site up to 15 mm from the ulnotrochlear joint line does not significantly increase valgus rotation in the elbow. Clinical Relevance: A more distal ulnar tunnel may be a viable option to accommodate individual variation in morphology of the proximal ulna or in a revision setting.

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.

Reefing Procedure for Lateral Collateral Ligament Attenuation during Ligamentous Repair for Elbow Trauma

2012 ◽  
Vol 4 (4) ◽  
pp. 277-281
Author(s):  
Benjamin W. Sears ◽  
Grant E. Garrigues ◽  
Dan Witmer ◽  
Matthew L Ramsey
Keyword(s):  
Surgical Repair ◽  
Lateral Collateral Ligament ◽  
Ulnar Collateral Ligament ◽  
Current Procedural Terminology ◽  
Collateral Ligament ◽  
Elbow Trauma ◽  
Code Search ◽  
Lateral Ulnar Collateral Ligament ◽  
Humeral Condyle ◽  
A Current

Background Injury to the lateral soft tissue structures is common after complex elbow trauma and instability. Typically, this consists of lateral collateral ligamentous complex avulsion from the lateral distal humeral condyle. However, in some cases, attenuation of the ligament midsubstance may also occur, potentially resulting in residual ligamentous laxity after repair. Methods From 2007 to 2011, 37 patients were identified through a current procedural terminology code search as having undergone lateral ulnar collateral ligament (LUCL) repair during surgery for trauma to their elbow and were retrospectively reviewed. Results Attenuation of the ligament midsubstance was found in 19% (seven of 37) patients who underwent surgical repair of the LUCL for injuries to the elbow. In these patients, direct repair of the ligament with additional reefing of the ligament midsubstance was performed. Retrospective review of this population revealed no postsurgical instability or need for subsequent stabilizing procedures. Conclusions These findings demonstrate that, in select patients, repair with reefing of an attenuated LUCL ligament promotes stability to the elbow.

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.

scholarly journals Morphological Features of the Ulnar Collateral Ligament of the Elbow and Common Tendon of Flexor-Pronator Muscles

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095241
Author(s):  
Masahiro Ikezu ◽  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Fumiya Kaneko ◽  
Sohei Shimizu ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Capsule ◽  
Morphological Features ◽  
Single Bundle ◽  
Type I ◽  
Type Ii ◽  
Collateral Ligament ◽  
Functional Roles ◽  
Independent Form ◽  
Length Width

Background: The anterior bundle (AB) of the ulnar collateral ligament is the most important structure for valgus stabilization of the elbow. However, anatomic relationships among the AB, posterior bundle (PB) of the ulnar collateral ligament, and common tendon (CT) of the flexor-pronator muscles have not been fully clarified. Purpose: To classify the AB, PB, and CT and to clarify their morphological features. Study Design: Descriptive laboratory study. Methods: This investigation examined 56 arms from 31 embalmed Japanese cadavers. The CT investigation examined 34 arms from 23 embalmed Japanese cadavers with CTs remaining. Type classification was performed by focusing on positional relationships with surrounding structures. Morphological features measured were length, width, thickness, and footprint for the AB and PB and attachment length, thickness, and footprint for the CT. Results: The AB was classified as type I (44 elbows; 78.6%), can be separated as a single bundle, or type II (12 elbows; 21.4%), cannot be separated from the PB and joint capsule. The PB was classified as type I (28 elbows; 50.0%), can be separated as a single bundle; type IIa (6 elbows; 10.7%), posterior edge cannot be separated; type IIb (7 elbows; 12.5%), anterior edge cannot be separated; or type III (15 elbows; 26.8%), cannot be separated from the joint capsule. The CT was classified as type I (18 elbows; 52.9%), can be separated from the AB, or type II (16 elbows; 47.1%), cannot be separated from the AB. Significant differences in frequencies of AB, PB, and CT types were identified between men and women. Morphological features were measured only for type I of each structure, and reliability was almost perfect. Conclusion: These results suggest that the AB, PB, and CT each can be classified into an independent form and an unclear form. Presence of the unclear form was suggested as one factor contributing to morphological variation. Clinical Relevance: This study may provide basic information for clarifying functional roles of the AB, PB, and CT.

Finite Element Analysis of the Ulnar Tunnel in Ulnar Collateral Ligament Reconstruction

2010 ◽  
Author(s):  
Harold A. Cook ◽  
Sam Akhavan ◽  
Patrick J. DeMeo ◽  
Mark Carl Miller
Keyword(s):  
Ligament Reconstruction ◽  
Failure Load ◽  
Ulnar Collateral Ligament ◽  
Medial Epicondyle ◽  
Collateral Ligament ◽  
Element Analysis ◽  
Proximal Ulna ◽  
The Sublime ◽  
Throwing Motion ◽  
Ulnar Collateral Ligament Reconstruction

The ulnar collateral ligament (UCL) of the elbow originates on the medial epicondyle of the humerus and inserts on the sublime tubercle of the proximal ulna. This ligament is classically composed of three distinct structures: the anterior bundle, the posterior bundle, and the transverse bundle. Of these three, the anterior bundle has been shown to be the primary stabilizer to valgus load between 20° and 120° of flexion [1]. Injuries to the anterior bundle of the UCL are commonly seen in baseball pitchers, where the valgus load on the elbow during the throwing motion approaches the failure load of the ligament [2].

Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint vs Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

2021 ◽  
pp. 036354652110544
Author(s):  
Edward S. Chang ◽  
Anthony H. Le ◽  
Austin M. Looney ◽  
MAJ Donald F. Colantonio ◽  
CPT William B. Roach ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Anatomic Reconstruction ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Time Zero ◽  
Initial Fixation ◽  
Valgus Angle ◽  
Starting Point ◽  
Bone Tunnels

Background: Current techniques for ulnar collateral ligament (UCL) reconstruction do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better re-create the anatomy of the UCL and to compare the biomechanical profile at time zero among this technique, the native UCL, and the traditional docking technique. Hypothesis: The biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. Study Design: Controlled laboratory study. Methods: Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included (1) native UCL testing performed at 90° of flexion with 0.5 N·m of valgus moment preload, (2) cyclic loading from 0.5 to 5 N·m of valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with 1 elbow of each pair receiving the classic docking technique using either anatomic (proximal to distal) or traditional (anterior to posterior) tunnel locations. Specimen testing was then repeated as described. Results: There were no differences in maximum load at failure between the anatomic and traditional tunnel location techniques (mean ± SD, 34.90 ± 10.65 vs 37.28 ± 14.26 N·m; P = .644) or when including the native UCL (45.83 ± 17.03 N·m; P = .099). Additionally, there were no differences in valgus angle after 1000 cycles across the anatomic technique (4.58°± 1.47°), traditional technique (4.08°± 1.28°), and native UCL (4.07°± 1.99°). The anatomic group and the native UCL had similar valgus angles at failure (24.13°± 5.86° vs 20.13°± 5.70°; P = .083), while the traditional group had a higher valgus angle at failure when compared with the native UCL (24.88°± 6.18° vs 19.44°± 5.86°; P = .015). Conclusion: In this cadaveric model, UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels better restored the ulnar footprint while providing valgus stability comparable with reconstruction with the docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties to the traditional method at the time of initial fixation (ie, not accounting for healing after reconstruction in vivo) while keeping the ulnar tunnels farther from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes than traditional reconstruction techniques. Clinical Relevance: Current UCL reconstruction techniques do not accurately re-create the ulnar UCL footprint. The UCL is a dynamic constraint to valgus loads at the elbow, and a more anatomic reconstruction may afford more natural joint kinematics. This more anatomic technique performs similarly to the traditional docking technique at time zero, and the results of this study may offer a starting point for future in vivo studies.

scholarly journals Quantitative Analysis of the Anatomy of Mesial Roots of Mandibular First Molars with Vertucci Type I Root Canal Configuration by Means of Micro-Computed Tomography

2020 ◽  
Vol 10 (1) ◽  
pp. 17-21
Author(s):  
Ali Keleş ◽  
Cangül Keskin
Keyword(s):  
Computed Tomography ◽  
Quantitative Analysis ◽  
Root Canal ◽  
Visual Analysis ◽  
Descriptive Analysis ◽  
Type I ◽  
Micro Ct ◽  
Micro Computed Tomography ◽  
Cross Sectional ◽  
Root Canals

Aim:  This study aimed to evaluate root canal morphology of Vertucci type I root canal configuration detected in mesial roots of mandibular first molar teeth using micro-computed tomography (Micro-CT). Methodology: Micro-CT datasets of 269 specimens were evaluated for the detection of specimens with Vertucci type I root canal configuration for further analysis. Major and minor diameter, area, perimeter and roundness of root canal cross-sections at the beginning and midline of each root thirds were measured and recorded. The presence of apical delta, accessory canals, and deviation of major apical foramen from anatomical apex were investigated. Data was analyzed using descriptive analysis, ANOVA-Tukey and Kruskal-Wallis H-Wilcoxon signed-rank tests. Results: Vertucci type I canal configuration was present in the 4.46% of the specimens. The specimens often showed accessory root canals (50%) and apical deltas (41,6%). From the visual analysis of the 3D and 2D images, significant differences were detected among coronal, middle and apical thirds of the specimens regarding major and minor diameter, area, perimeter and roundness (P < 0.05). Conclusion: Three- and two-dimensional analyses of mesial roots with Vertucci type I canal configuration indicated that this type of configuration presents large buccolingual diameters with long oval shape and has isthmus at coronal and middle thirds. At the apical third the root canals often terminate in an oval cross sectional shape.   How to cite this article: Keles A, Keskin C. Quantitative analysis of the anatomy of mesial roots of mandibular first molars with Vertucci type I root canal configuration by means of micro-computed tomography. Int Dent Res 2020;10(1):17-21. https://doi.org/10.5577/intdentres.2020.vol10.no1.4   Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

scholarly journals The Ulnar Collateral Ligament is Always Torn in the Posterolateral Elbow Dislocation: A Suggestion on the new Mechanism of Dislocation Using MRI Findings

1970 ◽  
Vol 14 (2) ◽  
pp. 193-198
Author(s):  
In Hyeok Rhyou ◽  
Ji Ho Lee ◽  
Kyung Jun Park ◽  
Hyun Suk Kang ◽  
Kang Wook Kim
Keyword(s):  
Magnetic Resonance Image ◽  
Elbow Dislocation ◽  
Lateral Collateral Ligament ◽  
Ulnar Collateral Ligament ◽  
The Novel ◽  
Collateral Ligament ◽  
Mri Findings ◽  
Surrounding Soft Tissue ◽  
Bone Contusion ◽  
The Status

PURPOSE: From the status of ulnar collateral ligament of elbow with magnetic resonance image which suffered with posterolateral dislocation. We would propose the novel mechanism of posterolateral elbow dislocation.MATERIALS AND METHODS: Between November 2005 and October 2009, we prospectively collected 12 cases of simple posterolateral elbow dislocation. The location of bone contusion and the status of collateral ligament were evaluated with MRI. Collateral ligament was divided in 2 subgroups (distraction type, stripping type). We also defined the disengagement as escaping of conoid process from trochlear notch totally.RESULTS: From 12 cases, we could found 11 cases of bone contusion in radial head or capitellum. Trochlea and conoid process were always intact without bone contusion. All ulnar collateral ligament ruptures were distraction type instead of all lateral collateral ligament ruptures were stripping type. Translations of all cases were shown those of the ulnar collateral ligament were longer than those of lateral collateral ligament (p<0.05).CONCLUSION: We carefully conclude that UCL and surrounding soft tissue has responsibility for the initiation of simple posterolateral elbow dislocation.

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