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O Sneppen - One of the best experts on this subject based on the ideXlab platform.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8°) and external rotatory laxity (mean, 7.1°), as did isolated LCL division (mean, 14.1° for varus; mean, 14.7° for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0° and 20.1°, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6° and mean external rotatory laxity to 14.8°. Isolated LCL repair normalized varus laxity but resulted in a 2.9° increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8 degrees) and external rotatory laxity (mean, 7.1 degrees), as did isolated LCL division (mean, 14.1 degrees for varus; mean, 14.7 degrees for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0 degrees and 20.1 degrees, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6 degrees and mean external rotatory laxity to 14.8 degrees. Isolated LCL repair normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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elbow joint stability following experimental osteoLigamentous injury and reconstruction
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: Soren R Deutch, Bo S Olsen, Steen Lund Jensen, Stein Tyrdal, O SneppenAbstract:Elbow joint dislocation was simulated in cadaveric specimens to quantify laxity induced by radial head and coronoid process lesions, either alone or in combination with colLateral Ligament insufficiency. The effects of Lateral Ligament reconstruction and radial head prosthesis replacement were also considered. Absence of the radial head and the coronoid process induced rotatory laxity of 145% and 128% (both P <.01), respectively, compared with the intact joint. When both were absent, the joints subluxated regardless of colLateral Ligament status. Isolated radial head prosthesis implantation prevented this subluxation, and laxity almost normalized. Lateral colLateral Ligament reconstruction prevented major laxity even in the absence of the radial head. Lateral colLateral Ligament reconstruction and radial head prosthetic replacement yielded restraint against gross instability in the maximal unstable situation (terrible triad). The Lateral colLateral Ligament is the prime stabilizer to external rotation, and reconstruction of this alone, even with an absent radial head, is beneficial.
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posteroLateral elbow joint instability the basic kinematics
Journal of Shoulder and Elbow Surgery, 1998Co-Authors: Bo Sanderhoff Olsen, Jens Ole Søjbjerg, M T Vaesel, Michel Dalstra, K K Nielsen, O SneppenAbstract:Thirty-five osteoLigamentous elbows were included in a study on the kinematics of posteroLateral elbow joint instability during the pivot shift test (PST) before and after separate Ligament cuttings in the Lateral colLateral Ligament complex (LCLC). Division of the annular Ligament or the Lateral ulnar colLateral Ligament caused no laxity during the PST. Division of the Lateral colLateral Ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the Lateral colLateral Ligament to be the primary soft tissue constraint to PST stress and the annular Ligament and the Lateral ulnar colLateral Ligament to be only secondary constraints. This study indicates that the integrity of the medial colLateral elbow Ligaments should be evaluated during forced valgus in pronation or neutral forearm rotation. Furthermore an isometric Lateral colLateral Ligament reconstruction was shown to correct the joint laxity introduced by total LCLC transection.
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Lateral colLateral Ligament of the elbow joint: anatomy and kinematics.
Journal of shoulder and elbow surgery, 1996Co-Authors: Bo Sanderhoff Olsen, Jens Ole Søjbjerg, M T Vaesel, P Helmig, O SneppenAbstract:The structure and kinematics of the Lateral colLateral Ligament of the elbow joint were investigated in 10 cadaveric specimens. The Lateral colLateral Ligament was observed to be a distinct part of the Lateral colLateral Ligament complex. It contains posterior fibers that pass through the annular Ligament and insert on the ulna. Three-dimensional kinematic measurements in different forearm rotations showed that joint puncture induced a 1 degree joint laxity significant in forced varus from 30 degrees to 80 degrees of flexion and in forced external rotation from 30 degrees to 120 degrees of flexion. Division of the posteroLateral capsule caused no further laxity. Cutting the Lateral colLateral Ligament induced a maximum laxity of 11.8 degrees at 110 degrees of flexion in forced varus and a maximum laxity of 20.6 degrees at 110 degrees of flexion in forced external rotation. The corresponding maximal posterior radial head translation was observed at 80 degrees to 100 degrees of flexion and was 5.7 mm in forced varus and 8.1 mm in forced external rotation. This study suggests the Lateral colLateral Ligament to be an important stabilizer of the humeroulnar joint and the radial head in forced varus and external rotation. The humeroulnar stability is independent of forearm rotation.
Graham J W King - One of the best experts on this subject based on the ideXlab platform.
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in vitro kinematic assessment of a hinged elbow orthosis following Lateral colLateral Ligament injury
Journal of Hand Surgery (European Volume), 2017Co-Authors: Ranita Manocha, Graham J W King, James A JohnsonAbstract: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.
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optimizing the rehabilitation of elbow Lateral colLateral Ligament injuries a biomechanical study
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Ranita Manocha, James A Johnson, Jonathan Kusins, Graham J W KingAbstract: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 P = .04 in supination). Active motion stabilized the LCL-deficient elbow in the dependent ( P = .02) and varus ( P P = .05), dependent ( P = .06), and varus ( P 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.
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rehabilitation of the medial and Lateral colLateral Ligament deficient elbow an in vitro biomechanical study
Journal of Hand Therapy, 2012Co-Authors: Bashar Alolabi, Louis M Ferreira, James A Johnson, Alia Gray, George S Athwal, Graham J W KingAbstract:Abstract Design In vitro biomechanical research using an elbow motion simulator. Introduction The optimal rehabilitation of elbow dislocations with medial colLateral Ligament (MCL) and Lateral colLateral Ligament (LCL) injuries has not been defined. Purpose To determine a safe rehabilitation protocol for elbow dislocations with MCL and LCL injuries. Methods Eight cadaveric elbows underwent simulated active and passive motions with the arm in multiple orientations. Varus–valgus angulation and internal–external rotation of the ulna relative to the humerus were quantified for the intact joint and with injured MCL and LCL. Results Active motion with injured MCL and LCL in the horizontal and vertical orientations resulted in kinematics similar to the intact elbow, whereas passive motion resulted in significant kinematic alterations. Marked elbow instability was noted in the varus and valgus orientations using both active and passive motion. Conclusions Elbows with MCL and LCL injuries should be rehabilitated using active motion in the horizontal or vertical orientations. Level of Evidence Basic science research.
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the effect of anteromedial facet fractures of the coronoid and Lateral colLateral Ligament injury on elbow stability and kinematics
Journal of Bone and Joint Surgery American Volume, 2009Co-Authors: Whitcomb J Pollock, Jamie Brownhill, Louis M Ferreira, Colin P Mcdonald, James A Johnson, Graham J W KingAbstract:Background: It is postulated that fractures of the anteromedial facet of the coronoid process and avulsion of the Lateral colLateral Ligament lead to posteromedial subluxation and arthritis of the elbow. It is not clear which injuries require internal fixation and whether repair of the Lateral colLateral Ligament is sufficient. We hypothesized that increasing sizes and subtypes of anteromedial facet fractures cause increasing instability and that isolated Lateral colLateral Ligament repair without fracture fixation would restore elbow stability in the presence of small subtype-I fractures. Methods: Ten fresh-frozen cadaveric arms from donors with a mean age of 66.3 years at the time of death were used in this biomechanical study. Passive elbow flexion was performed with the plane of flexion oriented horizontally to achieve varus and valgus gravitational loading. An in vitro unconstrained elbow-motion simulator was used to simulate active elbow flexion in the vertical position. Varus-valgus angle and internal-external rotational kinematics were recorded with use of an electromagnetic tracking system. Testing was repeated with the coronoid intact and with subtype-I, subtype-II, and subtype-III fractures. Instability was defined as an alteration in varus-valgus angle and/or in internal-external rotation of the elbow. All six coronoid states were tested with the Lateral colLateral Ligament detached and after repair. Results: In the vertical position, the kinematics of subtype-I and subtype-II anteromedial coronoid fractures with the Lateral colLateral Ligament repaired were similar to those of the intact elbow. In the varus position, the kinematics of 2.5-mm subtype-I fractures with the Lateral colLateral Ligament repaired were similar to those of the intact elbow. However, 5-mm fractures demonstrated a mean (and standard deviation) of 6.2° ± 4.5° of internal rotation compared with a mean of 3.3° ± 3.1° of external rotation in the intact elbow (p < 0.05). In the varus position, subtype-II 2.5-mm fractures with the Lateral colLateral Ligament repaired demonstrated increased internal rotation (mean, 7.0° ± 4.5°; p < 0.005). Subtype-II 5-mm fractures demonstrated instability in both the varus and valgus positions (p < 0.05). Subtype-III fractures with the Lateral colLateral Ligament repaired were unstable in all three testing positions (p < 0.05). Conclusions: This study suggests that the size of the anteromedial coronoid fracture fragment affects elbow kinematics, particularly in varus stress. The size of an anteromedial coronoid fracture and the presence of concomitant Ligament injuries may be important determinants of the need for open reduction and internal fixation. Clinical Relevance: This biomechanical study suggests that small subtype-I anteromedial coronoid fractures may be managed with isolated repair of the Lateral colLateral Ligament while larger fragments probably should be treated with internal fixation in addition to Lateral colLateral Ligament repair. Additional clinical studies are needed to determine the outcomes of operative and nonoperative treatment of anteromedial coronoid fractures.
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Ligamentous stabilizers against posteroLateral rotatory instability of the elbow
Journal of Bone and Joint Surgery American Volume, 2001Co-Authors: Cynthia E Dunning, James A Johnson, Zane D S Zarzour, Stuart D Patterson, Graham J W KingAbstract:Background: The Lateral ulnar colLateral Ligament, the entire Lateral colLateral Ligament complex, and the overlying extensor muscles have all been suggested as key stabilizers against posteroLateral rotatory instability of the elbow. The purpose of this investigation was to determine whether either an intact radial colLateral Ligament alone or an intact Lateral ulnar colLateral Ligament alone is sufficient to prevent posteroLateral rotatory instability when the annular Ligament is intact. Methods: Sequential sectioning of the radial colLateral and Lateral ulnar colLateral Ligaments was performed in twelve fresh-frozen cadaveric upper extremities. At each stage of the sectioning protocol, a pivot shift test was performed with the arm in a vertical position. Passive elbow flexion was performed with the forearm maintained in either pronation or supination and the arm in the varus and valgus gravity-loaded orientations. An electromagnetic tracking device was used to quantify the internal-external rotation and varus-valgus angulation of the ulna with respect to the humerus. Results: Compared with the intact elbow, no differences in the magnitude of internal-external rotation or maximum varus-valgus laxity of the ulna were detected with only the radial colLateral or Lateral ulnar colLateral Ligament intact (p > 0.05). However, once the entire Lateral colLateral Ligament was transected, significant increases in internal-external rotation (p = 0.0007) and maximum varus-valgus laxity (p < 0.0001) were measured. None of the pivot shift tests had a clinically positive result until the entire Lateral colLateral Ligament was sectioned. Conclusions: This study suggests that, when the annular Ligament is intact, either the radial colLateral Ligament or the Lateral ulnar colLateral Ligament can be transected without inducing posteroLateral rotatory instability of the elbow. Clinical Relevance: Surgical approaches to the Lateral side of the elbow that violate only the anterior or posterior half of the Lateral colLateral Ligament should not result in posteroLateral rotatory instability of the elbow. This is important information for surgeons planning various procedures on the Lateral aspect of the elbow, such as reconstruction of a fractured radial head, radial head replacement, or total elbow arthroplasty.
Hill Hastings - One of the best experts on this subject based on the ideXlab platform.
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operative release for elbow contracture the Lateral colLateral Ligament sparing technique
Orthopedic Clinics of North America, 1999Co-Authors: Mark S Cohen, Hill HastingsAbstract:This article describes the technique of elbow release and debridement using a Lateral approach designed to spare the Lateral colLateral Ligament complex and extensor tendon origins of the elbow. This exposure allows for complete exposure of the anterior and posterior ulnohumeral and radiocapitellar joints through a single incision. Advantages include simplified surgical dissection, minimal operative morbidity, and less potential for postoperative instability after release.
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operative release for elbow contracture the Lateral colLateral Ligament sparing technique
Orthopedic Clinics of North America, 1999Co-Authors: Mark S Cohen, Hill HastingsAbstract:Posttraumatic stiffness is relatively common after trauma to the elbow joint. This stiffness occurs, in part, secondary to fibrosis and thickening of the capsule and periarticular soft tissues.5,11,17 Prolonged immobilization after trauma is a separate risk factor for the development of stiffness. Once it occurs, minor degrees of motion loss can often be managed with an aggressive therapy program, including dynamic splinting.4,6,10 When therapy fails and a significant contracture persists, the elbow can be released surgically using a variety of approaches.5,7,8,11,12,17,18 This article describes the technique of elbow release and debridement using a Lateral approach designed to spare the Lateral colLateral Ligament complex and extensor tendon origins of the elbow. This exposure allows for complete exposure of the anterior and posterior ulnohumeral and radiocapitellar joints through a single incision. Advantages include simplified surgical dissection, minimal operative morbidity, and less potential for postoperative instability after release.
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post traumatic contracture of the elbow operative release using a Lateral colLateral Ligament sparing approach
Journal of Bone and Joint Surgery-british Volume, 1998Co-Authors: Mark S Cohen, Hill HastingsAbstract:We performed a Lateral approach for the release of post-traumatic stiffness of the elbow in 22 patients using a modified technique designed to spare the Lateral Ligaments. They were reviewed after a mean interval of 26 months. The total humeroulnar joint movement had increased from a mean of 74° to 129° and forearm rotation from a mean of 135° to 159°. Both pain and function in the elbow had improved significantly. This modified Lateral approach allows release of post-traumatic contracture without disruption of the Lateral colLateral Ligament or the origins of the extensor tendon at the Lateral epicondyle of the humerus. The advantages include a simplified surgical procedure, less operative morbidity, and unrestricted rehabilitation.
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post traumatic contracture of the elbow operative release using a Lateral colLateral Ligament sparing approach
Journal of Bone and Joint Surgery-british Volume, 1998Co-Authors: Mark S Cohen, Hill HastingsAbstract:We performed a Lateral approach for the release of post-traumatic stiffness of the elbow in 22 patients using a modified technique designed to spare the Lateral Ligaments. They were reviewed after a mean interval of 26 months. The total humeroulnar joint movement had increased from a mean of 74 degrees to 129 degrees and forearm rotation from a mean of 135 degrees to 159 degrees. Both pain and function in the elbow had improved significantly. This modified Lateral approach allows release of post-traumatic contracture without disruption of the Lateral colLateral Ligament or the origins of the extensor tendon at the Lateral epicondyle of the humerus. The advantages include a simplified surgical procedure, less operative morbidity, and unrestricted rehabilitation.
Jens Ole Søjbjerg - One of the best experts on this subject based on the ideXlab platform.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8°) and external rotatory laxity (mean, 7.1°), as did isolated LCL division (mean, 14.1° for varus; mean, 14.7° for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0° and 20.1°, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6° and mean external rotatory laxity to 14.8°. Isolated LCL repair normalized varus laxity but resulted in a 2.9° increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8 degrees) and external rotatory laxity (mean, 7.1 degrees), as did isolated LCL division (mean, 14.1 degrees for varus; mean, 14.7 degrees for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0 degrees and 20.1 degrees, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6 degrees and mean external rotatory laxity to 14.8 degrees. Isolated LCL repair normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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functional anatomy of the Lateral colLateral Ligament complex of the elbow configuration of y and its role
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Atsuhito Seki, Bo Sanderhoff Olsen, Steen Lund Jensen, Denise Eygendaal, Jens Ole SøjbjergAbstract:A previous anatomic study has revealed that the Lateral colLateral Ligament (LCL) complex of the elbow has a Y-shaped configuration, which consists of a superior, an anterior, and a posterior band. The LCL complex, including the annular Ligament, functions as a 3-dimensional (3D) Y-shaped structure. On the basis of this concept, joint laxity after transection of the anterior band was studied in 5 normal, fresh-frozen cadaver elbows with a 3D kinematic testing apparatus. Cutting the anterior band produced significant laxity to varus torque with a mean 5.9° at 10° of elbow flexion and caused significant laxity to torque in external rotation with a mean 8.5° at 40° of flexion. No significant laxity was observed during application of valgus or internal rotational torque. Further transection of the posterior band resulted in gross instability with dislocation of the ulnohumeral joint. The laxity occurring after severance of the anterior band suggests that these fibers play a role in preservation of elbow stability against varus and external rotational torque. These results indicate that the LCL functions as a complex with a Y structure and not as an isolated linear Ligament. A concept of conjoint point is hypothesized for the function of the LCL complex to restrain posteroLateral rotatory instability. (J Shoulder Elbow Surg 2002;11:53-9.)
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posteroLateral elbow joint instability the basic kinematics
Journal of Shoulder and Elbow Surgery, 1998Co-Authors: Bo Sanderhoff Olsen, Jens Ole Søjbjerg, M T Vaesel, Michel Dalstra, K K Nielsen, O SneppenAbstract:Thirty-five osteoLigamentous elbows were included in a study on the kinematics of posteroLateral elbow joint instability during the pivot shift test (PST) before and after separate Ligament cuttings in the Lateral colLateral Ligament complex (LCLC). Division of the annular Ligament or the Lateral ulnar colLateral Ligament caused no laxity during the PST. Division of the Lateral colLateral Ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the Lateral colLateral Ligament to be the primary soft tissue constraint to PST stress and the annular Ligament and the Lateral ulnar colLateral Ligament to be only secondary constraints. This study indicates that the integrity of the medial colLateral elbow Ligaments should be evaluated during forced valgus in pronation or neutral forearm rotation. Furthermore an isometric Lateral colLateral Ligament reconstruction was shown to correct the joint laxity introduced by total LCLC transection.
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Lateral colLateral Ligament of the elbow joint: anatomy and kinematics.
Journal of shoulder and elbow surgery, 1996Co-Authors: Bo Sanderhoff Olsen, Jens Ole Søjbjerg, M T Vaesel, P Helmig, O SneppenAbstract:The structure and kinematics of the Lateral colLateral Ligament of the elbow joint were investigated in 10 cadaveric specimens. The Lateral colLateral Ligament was observed to be a distinct part of the Lateral colLateral Ligament complex. It contains posterior fibers that pass through the annular Ligament and insert on the ulna. Three-dimensional kinematic measurements in different forearm rotations showed that joint puncture induced a 1 degree joint laxity significant in forced varus from 30 degrees to 80 degrees of flexion and in forced external rotation from 30 degrees to 120 degrees of flexion. Division of the posteroLateral capsule caused no further laxity. Cutting the Lateral colLateral Ligament induced a maximum laxity of 11.8 degrees at 110 degrees of flexion in forced varus and a maximum laxity of 20.6 degrees at 110 degrees of flexion in forced external rotation. The corresponding maximal posterior radial head translation was observed at 80 degrees to 100 degrees of flexion and was 5.7 mm in forced varus and 8.1 mm in forced external rotation. This study suggests the Lateral colLateral Ligament to be an important stabilizer of the humeroulnar joint and the radial head in forced varus and external rotation. The humeroulnar stability is independent of forearm rotation.
Steen Lund Jensen - One of the best experts on this subject based on the ideXlab platform.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8°) and external rotatory laxity (mean, 7.1°), as did isolated LCL division (mean, 14.1° for varus; mean, 14.7° for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0° and 20.1°, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6° and mean external rotatory laxity to 14.8°. Isolated LCL repair normalized varus laxity but resulted in a 2.9° increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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elbow joint laxity after experimental radial head excision and Lateral colLateral Ligament rupture efficacy of prosthetic replacement and Ligament repair
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Steen Lund Jensen, Jens Ole Søjbjerg, Bo S Olsen, Stein Tyrdal, O SneppenAbstract:The objectives of this experimental study were to investigate the effect of radial head excision and Lateral colLateral Ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8 degrees) and external rotatory laxity (mean, 7.1 degrees), as did isolated LCL division (mean, 14.1 degrees for varus; mean, 14.7 degrees for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0 degrees and 20.1 degrees, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6 degrees and mean external rotatory laxity to 14.8 degrees. Isolated LCL repair normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the Ligamentous tension lost from radial head excision.
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elbow joint stability following experimental osteoLigamentous injury and reconstruction
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: Soren R Deutch, Bo S Olsen, Steen Lund Jensen, Stein Tyrdal, O SneppenAbstract:Elbow joint dislocation was simulated in cadaveric specimens to quantify laxity induced by radial head and coronoid process lesions, either alone or in combination with colLateral Ligament insufficiency. The effects of Lateral Ligament reconstruction and radial head prosthesis replacement were also considered. Absence of the radial head and the coronoid process induced rotatory laxity of 145% and 128% (both P <.01), respectively, compared with the intact joint. When both were absent, the joints subluxated regardless of colLateral Ligament status. Isolated radial head prosthesis implantation prevented this subluxation, and laxity almost normalized. Lateral colLateral Ligament reconstruction prevented major laxity even in the absence of the radial head. Lateral colLateral Ligament reconstruction and radial head prosthetic replacement yielded restraint against gross instability in the maximal unstable situation (terrible triad). The Lateral colLateral Ligament is the prime stabilizer to external rotation, and reconstruction of this alone, even with an absent radial head, is beneficial.
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functional anatomy of the Lateral colLateral Ligament complex of the elbow configuration of y and its role
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Atsuhito Seki, Bo Sanderhoff Olsen, Steen Lund Jensen, Denise Eygendaal, Jens Ole SøjbjergAbstract:A previous anatomic study has revealed that the Lateral colLateral Ligament (LCL) complex of the elbow has a Y-shaped configuration, which consists of a superior, an anterior, and a posterior band. The LCL complex, including the annular Ligament, functions as a 3-dimensional (3D) Y-shaped structure. On the basis of this concept, joint laxity after transection of the anterior band was studied in 5 normal, fresh-frozen cadaver elbows with a 3D kinematic testing apparatus. Cutting the anterior band produced significant laxity to varus torque with a mean 5.9° at 10° of elbow flexion and caused significant laxity to torque in external rotation with a mean 8.5° at 40° of flexion. No significant laxity was observed during application of valgus or internal rotational torque. Further transection of the posterior band resulted in gross instability with dislocation of the ulnohumeral joint. The laxity occurring after severance of the anterior band suggests that these fibers play a role in preservation of elbow stability against varus and external rotational torque. These results indicate that the LCL functions as a complex with a Y structure and not as an isolated linear Ligament. A concept of conjoint point is hypothesized for the function of the LCL complex to restrain posteroLateral rotatory instability. (J Shoulder Elbow Surg 2002;11:53-9.)
