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Background: The purpose of this study is to investigate how different diameters of radial head replacement affect posterolateral translation with a valgus and supination force. We hypothesized that there would be less posterolateral rotatory translation with larger implant diameter., Methods: Eleven cadaveric arms were stressed at 30 and 60° of flexion with a consistent supination and valgus stress force under five conditions: native radial head, radial head excision, and with 3 sizes of radial head prosthesis. Displacement of the radial head posteriorly in relation to the capitellum on radiographs was measured. Displacement was expressed as a percentage relative to the average of the maximum and minimum native radial head diameters., Findings: The native radial heads had average minimum and maximum diameters of 23.3 mm and 25.2 mm, respectively. The angle of testing did not significantly change translation of the radial head. There was increased posterior translation relative to native head as the radial head sizes decreased from 24 mm to 20 mm and with excision of the radial head. Compared to the native head, the differences in displacement were statistically significant for the 20 mm radial head, but not for the 22 mm or 24 mm replacements. Radial head translation significantly increased after radial head excision., Interpretations: This cadaveric study illustrates that patients treated with radial head excision and radial head prosthesis with undersized diameters have increased posterior translation with a valgus and supination stress. The larger the radial head prosthesis (closer to native radial head), the more closely it approximated the amount of translation of the native radial head., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Current commercial elbow braces have a straight hinge that does not account for the native carrying angle of the elbow. The objective of this study was to determine the effectiveness of a custom-designed hinged elbow orthosis (HEO) with variable valgus angulations in stabilizing a lateral collateral ligament (LCL) deficient elbow. Methods: Eight cadaveric upper extremities were mounted in an elbow motion simulator in the abducted varus gravity-loaded position. The specimens were examined before and after simulated LCL injury and then with the addition of the custom-designed HEO with 0°, 10°, and 20° of valgus angulation. Kinematic data were recorded using an electromagnetic tracking system. Results: The LCL injured state with or without the brace resulted in significant increases in varus angulation of the elbow compared to the intact state in both pronation and supination (P < 0.05). There were no significant differences in varus-valgus angulation or ulnohumeral rotation between any of the brace angles and the LCL injured state with the forearm pronated and supinated. Discussion: The custom-designed HEO did not provide any additional stability to the LCL injured elbow. The varus arm position should be avoided during the rehabilitation of an LCL injured elbow even when an HEO is used. [ABSTRACT FROM AUTHOR]

Repair or reconstruction of the lateral collateral ligament (LCL) using autograft or allograft is a well-accepted treatment of posterolateral rotatory instability. The prevalence and causes for failure of LCL reconstruction are not well documented in the literature. Any approach to the assessment and management of failed LCL reconstruction must begin with understanding the risk factors for failure in the first place. Such understanding would likely make many failures preventable as well. In our experience, there are a number of identifiable preoperative risk factors concerning bony and/or soft tissue constraints for failure of LCL reconstruction. There are also operative factors such as tunnel and graft placement as well as excessive lateral condyle stripping that play a role in risk of failure. This report is an attempt to provide a systematic approach to identifying and managing the preoperative and operative risk factors. Further studies are warranted to determine the indications for, and success rates of surgical intervention in managing these risk factors.

Purpose: To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy. Methods: Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow. Results: The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P =.008; Stage 0 vs. Stage 3: P =.010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P =.010; Stage 0 vs. Stage 3: P =.011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P =.157). Conclusion: Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more. [ABSTRACT FROM AUTHOR]

Purpose: The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods: Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results: The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions: Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Post‐traumatic joint contracture (PTJC) in the elbow is a biological problem with functional consequences. Restoring elbow motion after injury is a complex challenge because contracture is a multi‐tissue pathology. We previously developed an animal model of elbow PTJC using Long‐Evans rats and showed that the capsule and ligaments/cartilage were the primary soft tissues that caused persistent joint motion loss. The objective of this study was to evaluate tissue‐specific changes within the anterior capsule and lateral collateral ligament (LCL) that led to their contribution to elbow contracture. In our rat model of elbow PTJC, a unilateral surgery replicated damage that commonly occurs due to elbow dislocation. Following surgery, the injured limb was immobilized for 42 days. The capsule and LCL were evaluated after 42 days of immobilization or 42 days of immobilization followed by 42 days of free mobilization. We evaluated extracellular matrix protein biochemistry, non‐enzymatic collagen crosslink content, tissue volume with contrast‐enhanced micro‐computed tomography, and tissue mechanical properties. Increased collagen content, but not collagen density, was observed in both injured limb capsules and LCLs, which was consistent with the increased tissue volume. Injured limb LCLs exhibited decreased normalized maximum force, and both tissues had increased immature collagen cross‐links compared to control. Overall, increased tissue volume and immature collagen crosslinks in the capsule and LCL drive their contribution to elbow contracture in our rat model. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to report the radiographic findings and surgical outcomes of anteromedial facet (AMF) fracture of the ulnar coronoid process and to suggest an optimal approach. Methods In this retrospective study, 20 consecutive patients with unilateral AMF fracture of coronoid process were surgically treated and divided into two groups without (group A) and with (group B) additional proximal ulnar fractures in equal case number. Time from injury to surgery averaged 4.38 ± 2.56 weeks. Mayo Elbow Performance Score (MEPS) and Shortened Disability of the Arm and Shoulder and Hand (quickDASH) score were used for functional evaluation. Cohen kappa coefficient (kappa) analysis was used to determine interobserver reliability on a radiographic reading. Results All cases had a mean follow-up of 2.3 years. MEPS at 2 years averaged 87.75 ± 12.51; quickDASH, 7.05 ± 6.19. A significantly higher MEPS was found in subtype 3 than in subtype 2 (p = 0.036) and in group B than in group A (p = 0.020). Significantly lower quickDASH cores were found in group B than in group A (p = 0.011). Kappa analysis showed moderate agreement in the O’Driscoll classification (kappa = 0.56) and substantial agreement in categorization of the additional proximal ulnar fractures (kappa = 0.76). Conclusions Additional proximal ulnar lesions were considered an integral part of varus posteromedial rotatory instability and required further categorization in the management of AMF fractures. Significantly better functional outcomes were achieved when those lesions were fully addressed.

Purpose: The aims of this retrospective study were to describe the characteristics of anteromedial facet fracture of the coronoid (AMFF) and to determine the outcome following surgery using anatomically pre-formed coronoid buttress plates.Methods: Twenty-four patients underwent surgery for AMFF, using a pre-formed buttress plate, between 2011 and 2017 (20 men, four women), with a mean age of 47.7 years (range, 19-78 years) and a mean post-operative follow-up of 3.7 years (range, 12-86 months). Fracture classification, injury pattern, accompanying injuries, post-operative range of motion, and revision rate were noted. Post-operative radiographs assessed union, arthritic change, and joint articulation. Joint function was quantified using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores.Results: Eleven cases with subtype 2 and 13 cases with a subtype 3 AMFF could be included, of which 15 had an associated rupture of the lateral collateral ligament (LCL) and nine of the medial collateral ligament (MCL). Post-operatively, all cases went to bone union without secondary elbow instability. The mean post-operative range of motion was 125° (range, 90-140°), mean MEPS was 98, mean OES was 43, and mean DASH score was 7. Five patients required repeat surgery within two years due to a limited range of motion; 90% of patients regained their pre-trauma levels of physical activity.Conclusions: AMFF are challenging injuries, frequently associated with lesions to the collateral ligament complex. Using anatomically pre-formed coronoid plates, excellent functional outcomes can be achieved. [ABSTRACT FROM AUTHOR]

Clinical tests for posterolateral rotatory instability of the elbow apply external torsional moments to the forearm; however, biomechanical studies of lateral collateral ligament injuries and their surgical repair, reconstruction and rehabilitation have primarily relied on varus gravity loading to quantify instability. The aim of this investigation was to determine the effect of torsional moments on the posterolateral rotatory instability of the lateral ligament deficient elbow. Six cadaveric arms were tested in an elbow motion simulator with the arm in the varus position. A threaded outrigger was inserted on the dorsal aspect of the proximal ulna to suspend 400 g, 600 g, and 800 g of weight to allow torsional moments of 0.12, 0.18, and 0.23 Nm respectively on the ulna. An injured model was created by sectioning of the common extensor origin, and the lateral collateral ligament. During simulated active flexion with the arm in varus, the injured model resulted in a significant increase in external rotation of the ulnohumeral articulation with the forearm both pronated and supinated (pronation: P =.021; supination: P =.015). The application of torsional moments to the lateral ligament deficient elbow resulted in a significant increase in the posterolateral rotatory instability of the elbow. This investigation demonstrates that the application of even small amounts of external torsional moments on the forearm with the arm in the varus position increases the rotational instability of the lateral ligament deficient elbow. During clinical examination for posterolateral rotatory instability and biomechanical studies of lateral ligament injury, the application of external torsion to the forearm should be considered to detect subtle instability. Basic Science Study. • External torsion exacerbates instability of lateral ligament deficient elbow. • Examination of subtle posterolateral instability should apply external torsion. • Application of torsional moments allows for a more provocative biomechanical model. [ABSTRACT FROM AUTHOR]

The role of the anconeus in elbow stability has been a long-standing debate. Anatomic and electromyographic studies have suggested a potential role as a stabilizer. However, to our knowledge, no clinical or biomechanical studies have investigated its role in improving the stability of a combined lateral collateral ligament and common extensor origin (LCL + CEO)–deficient elbow. Seven cadaveric upper extremities were mounted in an elbow motion simulator in the varus position. An injured model was created by sectioning of the CEO and the LCL. The anconeus tendon and its aponeurosis were sutured in a Krackow fashion and tensioned to 10 N and 20 N using a transosseous tunnel. Varus-valgus angles and ulnohumeral rotations were recorded using an electromagnetic tracking system during simulated active elbow flexion with the forearm pronated and supinated. During active motion, the injured model resulted in a significant increase in varus angulation (P =.0001 for pronation; P =.001 for supination) and external rotation (P =.001 for pronation; P =.003 for supination) of the ulnohumeral articulation compared with the intact state. Tensioning of the anconeus significantly decreased the varus angulation (P =.006 for 10 N pronation; P =.0001 for 20 N pronation; P =.0001 for 10 N supination; P =.0001 for 20 N supination) and external rotation angle (P =.008 for 10 N pronation; P =.0001 for 20 N pronation; P =.0001 for 10 N supination; P =.0001 for 20 N supination) of the injured elbow. In the highly unstable varus elbow orientation, anconeus tensioning restores the in vitro stability of a combined LCL + CEO–deficient elbow during simulated active motion with the forearm in both pronation and supination. These results may have several clinical implications in managing symptomatic lateral elbow instability. [ABSTRACT FROM AUTHOR]

Introduction: Chronic elbow instability is a disable complication. This prospective study reports our experience with the box-loop reconstruction technique, compared with traditional Lateral Collateral Ligament (LCL) and eventual Medial Collateral Ligament (MCL) reconstruction, showing its functional outcome at 12-month follow-up. Methods: From January 2013 to February 2017, 27 patients with complex elbow instability were recruited. Group-A patients were managed using box-loop technique; in Group-B patients LCL reconstruction was performed and MCL lesions were always intraoperatively tested, under fluoroscopy, and eventually treated. Clinical evaluations were performed at baseline (T0) and at 1- month (T1), 6-month (T2) and 12-month (T3) follow- up. X-rays were performed at T0 and T3. Intergroup and intragroup variability was assessed. Results: In all the patients, an improvement of both the range of movement and the joint stability was observed after surgery. The mean increase in flexion-extension arch was 52° in Group-A patients at 12-month follow-up. A significant improvement (p<0.05) of Mayo Elbow Performance Score, Oxford Elbow Scores and Visual Analogue Scale was observed at 12-month follow-up in both groups. Conclusion: Box-loop technique revealed safe and effective in the management of multidirectional elbow instability. Level of evidence: IV, Cases Series. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the optimal repair tension of the lateral collateral ligament of the elbow by performing simulated active flexion with the arm in the varus gravity loaded position using an in vitro elbow simulator. Eight cadaveric specimens were mounted in the varus gravity loaded orientation onto an elbow motion simulator. Four states were studied (intact, lateral collateral ligament injured, and 15 N and 20 N lateral collateral ligament repairs) with the forearm in supination and pronation. An electromagnetic tracking system was used to measure joint kinematics during active elbow flexion. There was no difference in ulnohumeral rotation between the intact state and the 15 N repair (P =.150 for pronation; P = 1.0 for supination) or the 20 N repair (P = 1.0 for pronation; P =.568 for supination). For varus-valgus angulation, the 20 N repair was not statistically different from the intact state (P =.059 in pronation; P = 1.0 in supination). Repair of the lateral collateral ligament following injury can restore joint kinematics with the arm in the varus position. A repair tension of 20 N was successful in restoring joint stability for simulated active motion with the forearm in pronation and supination. This study shows that when the lateral collateral ligament is repaired with adequate tension, avoidance of the varus position may not be as crucial during early motion. • Complete rupture of the lateral collateral ligament results in elbow instability. • Lateral collateral ligament repair with adequate tension restores joint stability. • Avoidance of the varus position may not be crucial with adequate repair tension. [ABSTRACT FROM AUTHOR]

Purpose Elbow lateral collateral ligament injuries (LCLI) are often managed with protected mobilization using a hinged elbow orthosis (HEO). The objective of this investigation was to determine the effectiveness of an HEO in stabilizing the elbow following LCLI. Methods Seven fresh-frozen cadaveric upper extremity specimens were studied using a custom simulator that enabled elbow motion via computer-controlled actuators and servomotors attached to relevant tendons. Specimens were examined in 4 arm positions (dependent, overhead, horizontal, and varus) and 2 forearm positions (pronation and supination) during both passive and simulated active elbow extension. Specimens were examined before and after simulated LCLI, and then with the addition of an HEO. The lateral collateral ligament, common extensor origin, and lateral elbow capsule were sectioned in the injury model. An electromagnetic tracking system measured ulnohumeral kinematics. Results The orthosis did not change elbow stability in any arm position during active motion. Muscle activation and forearm pronation enhanced stability in the dependent, horizontal, and varus positions while the HEO was applied. Conclusions This HEO does not improve the in vitro stability of the elbow following simulated LCLI. Clinical relevance An HEO may be safe to use during active motion, but when a patient is not activating the muscles normally (ie, owing to fatigue or cognitive impairment) and the arm is in positions in which the weight of the orthosis might increase joint distraction, an HEO may be harmful. If an HEO is used, the forearm should be braced in pronation following LCLI. [ABSTRACT FROM AUTHOR]

Hypothesis The purposes of this study were to test the hypothesis that coronoid deficiency in the setting of posteromedial rotatory instability (PMRI) must be reconstructed to restore articular contact pressures to normal and to compare 3 different osteochondral grafts for this purpose. Methods After creation of a anteromedial fracture, six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow. Mean articular surface contact pressure data were collected and processed using TekScan sensors and software. After testing of the intact specimen (intact condition), a PMRI injury was created (PMRI condition). Testing was repeated after reconstruction of the lateral collateral ligament (LCL) (LCL-only condition), followed by reconstruction of the coronoid with 3 different osteochondral graft techniques (reconstructed conditions). Results Contact pressure was consistently significantly higher in the PMRI elbow compared with the intact, LCL-only, and reconstructed conditions ( P  < .006). The LCL-only elbow contact pressure was significantly higher than that of the intact and reconstructed conditions from 5° to 55° of flexion ( P  = .018). The contact pressure of the intact elbow was never significantly different from that of the reconstructed elbow, except at 5° of flexion ( P  ≤ .008). No significant difference was detected between each of the reconstructed techniques ( P  ≥ .15). However, the annular surface of the radial head was the only graft that yielded contact pressures not significantly different from normal at any flexion angle. Conclusion Isolated reconstruction of the LCL did not restore native articular surface contact pressure, and reconstruction of the coronoid using osteochondral graft was necessary. There was no difference in contact pressures among the 3 coronoid reconstruction techniques. [ABSTRACT FROM AUTHOR]

Background Elbow lateral collateral ligament (LCL) injury may arise after trauma or lateral surgical approaches. The optimal method of rehabilitating the LCL-insufficient elbow is unclear. Therapists often prescribe active motion exercises with the forearm pronated. Recently, overhead exercises have become popular as they may enable gravity to compress the elbow joint, improving stability, although this has not been proved biomechanically. This investigation aimed to quantify the effects of several variables used in LCL injury rehabilitation on elbow stability. Methods Seven cadaveric specimens were tested in a custom elbow motion simulator in 3 arm positions (overhead, dependent, and varus) and 2 forearm positions (pronation and supination) during passive and simulated active elbow extension. Three injury patterns were studied (intact, LCL injury, and LCL with common extensor origin injury). An electromagnetic tracking device measured ulnohumeral kinematics. Results Following combined LCL and common extensor origin injury, overhead positioning enhanced elbow stability relative to the other arm positions ( P  < .01 in pronation; P  = .04 in supination). Active motion stabilized the LCL-deficient elbow in the dependent ( P  = .02) and varus ( P  < .01) positions. Pronation improved stability in the overhead ( P  = .05), dependent ( P  = .06), and varus ( P  < .01) positions. Conclusions Rehabilitation with the arm overhead improves elbow stability after LCL injury. Initiating earlier range of motion in this “safe position” might decrease elbow stiffness and allow optimal ligament healing. If exercises are done in the dependent position, active motion with forearm pronation should be encouraged. Varus arm positioning should be avoided. [ABSTRACT FROM AUTHOR]

ABSTRACT A computational model capable of predicting the effects of lateral collateral ligament deficiency of the elbow joint would be a valuable tool for surgical planning and prediction of the long-term consequences of ligament deficiency. The purpose of this study was to simulate lateral collateral ligament deficiency during passive flexion using a computational multibody elbow joint model and investigate the effects of ligament insufficiency on the kinematics, ligament loads, and articular contact characteristics (area, pressure). The elbow was placed initially at approximately 20° of flexion and a 345 mm vertical downward motion profile was applied over 40 s to the humerus head. The vertical displacement induced flexion from the initial position to a maximum flexion angle of 135°. The study included simulations for intact, radial collateral ligament deficient, lateral ulnar collateral ligament deficient, and combined radial and lateral ulnar collateral ligament deficient elbow. For each condition, relative bone kinematics, contact pressure, contact area, and intact ligament forces were predicted. Intact and isolated radial collateral ligament deficient elbow simulations were almost identical for all observed outcomes. Minor differences in kinematics, contact area and pressure were observed for the isolated lateral ulnar collateral ligament deficient elbow compared to the intact elbow, but no elbow dislocation was detected. However, sectioning both ligaments together induced substantial differences in kinematics, contact area, and contact pressure, and caused complete dislocation of the elbow joint. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1645-1655, 2016. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to analyze the functional anatomy of the lateral collateral ligament complex (LCLC) and the surrounding forearm extensors.Materials and Methods: Using 81 human cadaveric upper extremities, the anatomy of the forearm extensors-especially the anconeus, supinator and extensor carpi ulnaris (ECU)-was analyzed. After removal of aforementioned extensors the functional anatomy of the LCLC was analyzed. The origin of the LCLC was evaluated for isometry. The insertion types of the lateral ulnar collateral ligament (LUCL) were analyzed and classified.Results: The ECU runs parallel to the RCL to dynamically preserve varus stability. The supinator and anconeus muscle fibers coalesce with the LCLC and lengthen during pronation. The anconeus fibers run parallel to the LUCL in full flexion. The LCLC consists of the annular ligament (AL) and the isometric radial collateral ligament (RCL). During elbow flexion, its posterior branches (LUCL) tighten while the anterior branches loosen. When performing a pivot shift test, the loosened LUCL fibers do not fully tighten in full extension. The LUCL inserts along with the AL at the supinator crest. Three different insertion types could be observed.Conclusions: The LUCL represents the posterior branch of the RCL rather than a distinct ligament. It is non-isometric and lengthens during elbow flexion. The RCL was found to be of vital importance for neutralization of posterolateral rotatory forces. Pronation of the forearm actively stabilizes the elbow joint as the supinator, anconeus and biceps muscle work in unison to increase posterolateral rotatory stability. [ABSTRACT FROM AUTHOR]

Background: Ligamentous injury associated with isolated coronoid fracture had been sparingly reported. Concealed or unclear fractures and ligamentous or articular cartilage lesions are promptly acknowledged by magnetic resonance imaging (MRI) but cannot be entirely pictured in regular radiological assessments. In isolated coronoid fracture, the fragment size is very small and due to the complex anatomy surrounding the coronoid radiographic imaging may not be sufficient. The purpose of this study was to evaluate the incidence of combined osteochondral and ligamentous injuries by magnetic resonance imaging (MRI) in 24 patients with an isolated coronoid fracture. Materials and Methods: In a retrospective study conducted at tertiary hospital between 2009 and 2011, elbow radiographs (anteroposterior and lateral views), computed tomography scan images, and MRI in the sagittal, coronal, axial, oblique, and coronal oblique planes were collected and reviewed. Musculoskeletal radiologist with subspecialty training in musculoskeletal MR interpretation and a fellowship-trained shoulder and elbow surgeon evaluated the MRI. Results: The incidence of associated injuries revealed torn lateral collateral ligament (LCL) in all 24 patients (100%) while 15 patients (62.5%) had common extensor muscle tears. Seven of 24 elbows (29.2%) showed medial collateral ligament (MCL) tear, and 13 of 16 patients (81.3%) with anteromedial facet fracture had MCL attached to the fragment. Five of 24 (20.8%) cases had contusions on the radial head. On the distal humeral side, 15 patients had bone contusions on the posterior inferior of the trochlear on sagittal view. The ligament affections of the LCL were confirmed intraoperatively and repaired. Conclusion: LCL injury was consistent in all isolated coronoid fracture. The forces resulting in the injury appear similar to varus distraction forces acting in the knee leading to distraction injuries of the lateral structures of the knee joint. As concurrent osteochondral injuries and ligamentous injuries are not rare, magnetic resonance analysis serves as an excellent tool for analysis of the ligamentous injuries preoperatively and aids in surgical planning. [ABSTRACT FROM AUTHOR]

The lateral collateral ligament (LCL) of the elbow is a complex capsuloligamentous structure critical in stabilizing the ulnohumeral and radiocapitellar articulations. LCL injury can result in elbow instability, allowing the proximal radius and ulna to externally rotate away from the humerus as a supination stress is applied to the forearm. Elbow dislocation is the most common cause of LCL injury, followed by iatrogenic injury. LCL pathology resulting in late recurrent instability is rare but disabling. The diagnosis requires a high index of suspicion, detailed history, and focused physical examination maneuvers. Stress radiographs are often the most useful imaging modality. Despite controversy over the anatomy of the LCL complex and the relative importance of its component structures, treatment of late instability is focused on lateral ligament reconstruction from the humerus to the ulna using tendon grafts with reasonably good outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To test the null hypothesis that there is no difference in flexion arc or Broberg and Morrey rating between patients treated within 2 weeks of the injury (acute treatment) and those treated 3 weeks or more after injury with persistent or recurrent dislocation or subluxation (subacute treatment). Methods: The acute cohort consisted of 18 patients treated an average 6 days after injury. The radial head was replaced in 17 patients and repaired with screw in 1, the coronoid was secured with suture in all patients and with an additional screw in 2, and the lateral collateral ligament was reattached in all patients. No external fixators were applied. Four of 14 patients in the subacute cohort had 5 operative procedures before presenting to us. All patients presented with instability and were treated an average 7 weeks after injury. Except for 1 patient who presented with an active infection, all patients were treated with radial head replacement and lateral collateral ligament repair, and fixation or reconstruction of the coronoid occurred in 9 patients. Stability was protected with a hinged external fixator for an average of 6 weeks. Results: Five patients in the acute cohort and 1 in the subacute cohort had 8 subsequent surgeries (addressing stiffness in 3 patients). Prior to subsequent surgeries, the flexion arc averaged 116° in the acute cohort and 93° in the subacute cohort and improved to an average 119° in the acute cohort and 100° in the subacute cohort after all subsequent surgeries. Broberg and Morrey scores were comparable between cohorts (90 vs 87 points). Conclusions: Stability and strength were restored with both acute and subacute treatment, but earlier treatment is more straightforward and is associated with a better flexion arc. Type of study/level of evidence: Therapeutic III. [Copyright &y& Elsevier]