nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

27.07.2019 | ELBOW

LUCL internal bracing restores posterolateral rotatory stability of the elbow

verfasst von: Bastian Scheiderer, Florian B. Imhoff, Cameron Kia, James Aglio, Daichi Morikawa, Elifho Obopilwe, Mark P. Cote, Lucca Lacheta, Andreas B. Imhoff, Augustus D. Mazzocca, Sebastian Siebenlist

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Posterolateral rotatory instability (PLRI) of the elbow occurs from an insufficient lateral collateral ligament complex (LCLC). For subacute LCLC injuries, lateral ulnar collateral ligament (LUCL) internal bracing rather than reconstruction may be a viable option. The purpose of the study was to compare the stabilizing effects of LUCL internal bracing to triceps tendon graft reconstruction in simulated PLRI.

Methods

Sixteen cadaveric elbows were assigned for either LUCL internal bracing (n = 8) or reconstruction with triceps tendon graft (n = 8). Specimen were mounted and a valgus rotational torque was applied to the ulna to test posterolateral rotatory stability. Posterolateral rotation was measured at 0°, 30°, 60°, 90° and 120° of elbow flexion. Cyclic loading was performed for 1000 cycles at 90° of elbow flexion. Three conditions were compared in each specimen: intact elbow, LUCL and radial collateral ligament (RCL) transected, and then either LUCL internal bracing or reconstruction with triceps tendon graft.

Results

Transection of the LUCL and RCL significantly increased posterolateral rotation in all degrees of elbow flexion compared to the intact condition (P < 0.05). Both LUCL internal bracing and reconstruction restored posterolateral rotatory stability to the native state between 0° and 120° of elbow flexion, with no significant difference in improvement between groups. Similarly, LUCL internal bracing and reconstruction groups showed no significant difference in posterolateral rotation compared to the intact condition during cyclic loading.

Conclusions

At time zero, both LUCL internal bracing and reconstruction with triceps tendon graft restored posterolateral rotatory stability. As such, this study supports the use of internal bracing as an adjunct to primary ligament repair in subacute PLRI.

Anakwenze OA, Kancherla VK, Iyengar J, Ahmad CS, Levine WN (2014) Posterolateral rotatory instability of the elbow. Am J Sports Med 42:485–491PubMed

Anakwenze OA, Khanna K, Levine WN, Ahmad CS (2014) Characterization of the supinator tubercle for lateral ulnar collateral ligament reconstruction. Orthop J Sports Med 2:2325967114530969PubMedPubMedCentral

Baghdadi YM, Morrey BF, O’Driscoll SW, Steinmann SP, Sanchez-Sotelo J (2014) Revision allograft reconstruction of the lateral collateral ligament complex in elbows with previous failed reconstruction and persistent posterolateral rotatory instability. Clin Orthop Relat Res 472:2061–2067PubMedPubMedCentral

Bodendorfer BM, Looney AM, Lipkin SL, Nolton EC, Li J, Najarian RG et al (2018) Biomechanical comparison of ulnar collateral ligament reconstruction with the docking technique versus repair with internal bracing. Am J Sports Med 46:3495–3501PubMed

Bottlang M, O’Rourke MR, Madey SM, Steyers CM, Marsh JL, Brown TD (2000) Radiographic determinants of the elbow rotation axis: experimental identification and quantitative validation. J Orthop Res 18:821–828PubMed

Braun S, Beitzel K, Buchmann S, Imhoff AB (2015) Arthroscopically assisted treatment of acute dislocations of the acromioclavicular joint. Arthrosc Tech 4:e681–685PubMedPubMedCentral

Charalambous CP, Stanley JK (2008) Posterolateral rotatory instability of the elbow. J Bone Jt Surg Br 90:272–279

Cohen MS, Hastings H 2nd (1997) Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Jt Surg Am 79:225–233

Conti Mica M, Caekebeke P, van Riet R (2016) Lateral collateral ligament injuries of the elbow—chronic posterolateral rotatory instability (PLRI). EFORT Open Rev 1:461–468PubMedPubMedCentral

10.

Daluiski A, Schrumpf MA, Schreiber JJ, Nguyen JT, Hotchkiss RN (2014) Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions. J Hand Surg Am 39:1125–1129PubMed

11.

Dargel J, Boomkamp E, Wegmann K, Eysel P, Muller LP, Hackl M (2017) Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study. Knee Surg Sports Traumatol Arthrosc 25:943–948PubMed

12.

Dargel J, Burkhart K, Pennig D, Stein G, Eysel P, Muller LP (2013) Percutaneous lateral ulnar collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:450–455PubMed

13.

Dehlinger F, Franke S, Hollinger B (2012) Therapeutic options for acute and chronic elbow instability. Eur J Trauma Emerg Surg 38:585–592PubMed

14.

Dehlinger FI, Ries C, Hollinger B (2014) LUCL reconstruction using a triceps tendon graft to treat posterolateral rotatory instability of the elbow. Oper Orthop Traumatol 26(414–427):429

15.

Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE (2016) Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified jobe reconstruction. Am J Sports Med 44:735–741PubMed

16.

Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 83-A:1823–1828

17.

Eygendaal D (2004) Ligamentous reconstruction around the elbow using triceps tendon. Acta Orthop Scand 75:516–523PubMed

18.

Golan EJ, Shukla DR, Nasser P, Hausman M (2016) Isolated ligamentous injury can cause posteromedial elbow instability: a cadaveric study. J Shoulder Elbow Surg 25:2019–2024PubMed

19.

Goren D, Budoff JE, Hipp JA (2010) Isometric placement of lateral ulnar collateral ligament reconstructions: a biomechanical study. Am J Sports Med 38:153–159PubMed

20.

Greiner S, Koch M, Kerschbaum M, Bhide PP (2019) Repair and augmentation of the lateral collateral ligament complex using internal bracing in dislocations and fracture dislocations of the elbow restores stability and allows early rehabilitation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05402-9 CrossRefPubMed

21.

Hackl M, Bercher M, Wegmann K, Muller LP, Dargel J (2016) Functional anatomy of the lateral collateral ligament of the elbow. Arch Orthop Trauma Surg 136:1031–1037PubMed

22.

Hackl M, Heinze N, Wegmann K, Lappen S, Leschinger T, Burkhart KJ et al (2016) The circumferential graft technique for treatment of multidirectional elbow instability: a comparative biomechanical evaluation. J Shoulder Elbow Surg 25:127–135PubMed

23.

Hackl M, Leschinger T, Ries C, Neiss WF, Muller LP, Wegmann K (2016) Lateral ulnar collateral ligament reconstruction: a biomechanical analysis of posterolateral rotatory instability of the elbow. Orthopade 45:895–900PubMed

24.

Heo YM, Yi JW, Lee JB, Lee DH, Park WK, Kim SJ (2015) Unstable simple elbow dislocation treated with the repair of lateral collateral ligament complex. Clin Orthop Surg 7:241–247PubMedPubMedCentral

25.

Jones CM, Beason DP, Dugas JR (2018) Ulnar collateral ligament reconstruction versus repair with internal bracing: comparison of cyclic fatigue mechanics. Orthop J Sports Med 6:2325967118755991PubMedPubMedCentral

26.

Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW et al (2012) The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg 21:389–395PubMed

27.

Kalainov DM, Cohen MS (2005) Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Jt Surg Am 87:1120–1125

28.

Kim BS, Park KH, Song HS, Park SY (2013) Ligamentous repair of acute lateral collateral ligament rupture of the elbow. J Shoulder Elbow Surg 22:1469–1473PubMed

29.

Kim JW, Yi Y, Kim TK, Kang HJ, Kim JY, Lee JM et al (2016) Arthroscopic lateral collateral ligament repair. J Bone Jt Surg Am 98:1268–1276

30.

King GJ, Dunning CE, Zarzour ZD, Patterson SD, Johnson JA (2002) Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow. J Shoulder Elbow Surg 11:60–64PubMed

31.

Lin KY, Shen PH, Lee CH, Pan RY, Lin LC, Shen HC (2012) Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury 43:1657–1661PubMed

32.

Lubowitz JH, MacKay G, Gilmer B (2014) Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech 3:e505–508PubMedPubMedCentral

33.

McAdams TR, Masters GW, Srivastava S (2005) The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability. J Shoulder Elbow Surg 14:298–301PubMed

34.

Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K (2007) The in vivo isometric point of the lateral ligament of the elbow. J Bone Jt Surg Am 89:2011–2017

35.

Morrey BF, O’Driscoll SW (1993) Lateral collateral ligament injury. The elbow and its disorders, 2nd edn. W. B. Saunders Company, Philadelphia, pp 573–580

36.

Nestor BJ, O’Driscoll SW, Morrey BF (1992) Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Jt Surg Am 74:1235–1241

37.

O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Jt Surg Am 73:440–446

38.

O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197

39.

Rhyou IH, Park MJ (2011) Dual reconstruction of the radial collateral ligament and lateral ulnar collateral ligament in posterolateral rotator instability of the elbow. Knee Surg Sports Traumatol Arthrosc 19:1009–1012PubMed

40.

Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Jt Surg Br 87:54–61

41.

Savoie FH 3rd, O’Brien MJ, Field LD, Gurley DJ (2010) Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Clin Sports Med 29:611–618PubMed

42.

Shukla DR, Golan E, Nasser P, Culbertson M, Hausman M (2016) Importance of the posterior bundle of the medial ulnar collateral ligament. J Shoulder Elbow Surg 25:1868–1873PubMed

43.

Takigawa N, Ryu J, Kish VL, Kinoshita M, Abe M (2005) Functional anatomy of the lateral collateral ligament complex of the elbow: morphology and strain. J Hand Surg Br 30:143–147PubMed

44.

Vernet E, Bacle G, Marteau E, Favard L, Laulan J (2015) Lateral elbow ligamentoplasty by autologous tendon graft in posterolateral rotatory instability: results in 18 cases at a mean 5 years’ follow-up. Orthop Traumatol Surg Res 101:S199–202PubMed

45.

Wilson WT, Hopper GP, Byrne PA, MacKay GM (2016) Anterior cruciate ligament repair with internal brace ligament augmentation. Surg Technol Int XXIX:273–278

Titel: LUCL internal bracing restores posterolateral rotatory stability of the elbow
verfasst von: Bastian Scheiderer
Florian B. Imhoff
Cameron Kia
James Aglio
Daichi Morikawa
Elifho Obopilwe
Mark P. Cote
Lucca Lacheta
Andreas B. Imhoff
Augustus D. Mazzocca
Sebastian Siebenlist
Publikationsdatum: 27.07.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2020
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05632-x

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2020

Anatomic ACL reconstruction reduces risk of post-traumatic osteoarthritis: a systematic review with minimum 10-year follow-up

Full recovery of hip muscle strength is not achieved at return to sports in patients with femoroacetabular impingement surgery

Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes

Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty

Total volume of cam deformity alone predicts outcome in arthroscopy for femoroacetabular impingement