Schnetzke, Marc and Bergmann, Moritz and Wegmann, Kilian and Mueller, Lars-Peter and Grechenig, Stephan and Gruetzner, Paul-Alfred and Guehring, Thorsten (2018) Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model A Cadaveric Study. JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 100 (7). pp. 564-571. ISSN 0021-9355, 1535-1386
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Background: The objective of our study was to analyze, under fluoroscopy, joint angulation of uninjured elbows and elbows with distinct induced collateral ligament injury. Methods: Twelve elbow specimens were tested for varus and valgus joint angulation using 4 different examination methods (application of both varus and valgus stress by each of 2 examiners [Examiner 1 and Examiner 2] and application of 1 and 2 Nm of torque using a calibrated electric force scale) in 4 elbow positions (in full extension with 90 degrees of supination and 90 degrees of pronation, and in 30 degrees of flexion with 90 degrees of supination and 90 degrees of pronation). Six elbow specimens were examined under varus stress at each of 5 sequential stages: (1) intact, (2) transection of the lateral ulnar collateral ligament (LUCL), (3) complete transection of the lateral collateral ligament complex (LCLC), (4) transection of the anterior aspect of the capsule (AC), and (5) transection of the medial collateral ligament (MCL). An additional 6 elbow specimens were examined under valgus stress at 5 sequential stages: (1) intact, (2) transection of the anteromedial collateral ligament (AML), (3) complete transection of the MCL, (4) transection of the AC, and (5) transection of the LCLC. Examinations under fluoroscopy were made to measure the joint angulation. Intraclass correlation coefficients (ICCs) were calculated. Results: Testing of the intact elbow specimen by both examiners showed a joint angulation of <5 degrees. Transection of the LUCL led to a varus joint angulation of 4.3 degrees to 7.0 degrees, and transection of the AML resulted in a valgus joint angulation of 4.9 degrees to 8.8 degrees. Complete dissection of the respective collateral ligament complex resulted in a joint angulation of 7.9 degrees to 13.4 degrees (LCLC) and 9.1 degrees to 12.3 degrees (MCL), and additional transection of the AC led to a joint angulation of >20 degrees in some positions in both the medial and the lateral series. Under varus stress, elbow dislocations occurred only after dissection of the LCLC+AC (26% of the examinations) and additional dissection of the MCL (59%). Under valgus stress, elbow dislocations occurred only after dissection of the MCL+AC (30%) and additional dissection of the LCLC (47%). Very good to excellent ICCs were found among Examiners 1 and 2 and the tests done with the standardized torques at stages 1 through 4. Conclusions: Dynamic fluoroscopy makes it possible to distinguish among different stages of collateral ligament injury of the elbow and therefore might be helpful for guiding treatment of simple elbow dislocations.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSTEROLATERAL ROTATORY INSTABILITY; DISLOCATION; RECONSTRUCTION; STABILITY; LIGAMENT; JOINT; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Unfallchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Mar 2020 07:45 |
| Last Modified: | 20 Mar 2020 07:45 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14749 |
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