Kinematics of partial and total ruptures of the medial collateral ligament of the elbow (original) (raw)
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Elbow valgus stability of the transverse bundle of the ulnar collateral ligament
BMC Musculoskeletal Disorders
Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified...
The Journal of Bone and Joint Surgery, 2003
We studied the stabilising effect of prosthetic replacement of the radial head and repair of the medial collateral ligament (MCL) after excision of the radial head and section of the MCL in five cadaver elbows. Division of the MCL increased valgus angulation (mean 3.9 ± 1.5°) and internal rotatory laxity (mean 5.3 ± 2.0°). Subsequent excision of the radial head allowed additional valgus (mean 11.1 ± 7.3°) and internal rotatory laxity (mean 5.7 ± 3.9°). Isolated replacement of the radial head reduced valgus laxity to the level before excision of the head, while internal rotatory laxity was still greater (2.8 ± 2.1°). Isolated repair of the MCL corrected internal rotatory laxity, but a slight increase in valgus laxity remained (mean 0.7 ± 0.6°). Combined replacement of the head and repair of the MCL restored stability completely. We conclude that the radial head is a constraint secondary to the MCL for both valgus displacement and internal rotation. Isolated repair of the ligament is ...
Surgical and Radiologic Anatomy, 1987
The authors describe in detail the position of greatest stability of the shoulder joint. They review the mechanical importance of this position in the overall physiology of the shoulder-girdle and stress the essential role of two articular ligaments of the shoulder joint (the Coracohumeral and inferior glenohumeral ligaments) in arrival at this reference position. There thus exists a Passive control, of ligamentous origin, of movements of the shoulder-girdle. The position is essential if the shoulder is to benefit from the full range of movement and full stability which it needs in every day functioning.
Functional Anatomy of the Ligaments of the Elbow
Clinical Orthopaedics and Related Research, 1985
Dissections of 10 fresh cadaver specimens revealed an important insertion of the posterior portion of the lateral collateral ligament to the ulna at the crista supinatoris. The humeral origin of the medial ligament attachments was found to lie posterior to the axis of elbow flexion; in this position a cam effect is created so that ligament tension varies with elbow flexion. The three-dimensional distance between the origin and the insertion of the anterior portion of the medial collateral ligament was found to increase slightly from extension to approximately 60" of flexion; thereafter, it remained nearly constant. The distance of the posterior portion increased by about 9 mm from 60" to 120" of flexion. The flexion axis was shown to pass through the origin of the lateral collateral ligament, so the length of this structure was not changed during elbow flexion. Most descriptions of the medial ligaments of the elbow are consistent, but there is less uniformity with regard to the lateral collateral ligament complex. Importantly, almost no information is available about the specific dimensions or functions of the collateral ligaments of the elbow. Yet the success of resurfacing total elbow arthroplasty is directly dependent on the stability of the implant, a design predicated on the integrity of the softtissue stabilizer^.^' Controversy concerning residual stability after excision of a radial head
Journal of Shoulder and Elbow Surgery, 2003
Instability of the glenohumeral joint can be associated with anteroinferior capsulolabral rupture. To understand its static stabilizing effect better, the collagen fiber orientation of the inferior glenohumeral ligament (IGHL), a component of the anteroinferior capsulolabrum, was studied with a small angle light scattering technique. Three rectangular samples (approximately 11 ϫ 6 mm) were excised from the axillary pouch, one from the anterior band (AB) of the IGHL and one control sample from the long head of the biceps tendon of 7 cadaveric shoulders. The small angle light scattering technique scans the tissue with a heliumneon laser beam and quantifies the fiber alignment based on the resultant scattering pattern. The fiber orientation was quantified by an orientation index, defined as the angle within which 50% of the fibers lie. The axillary pouch had a random orientation, whereas the AB-IGHL was random with some regions of localized alignment. The percentage of tissue with an orientation index range of 25°to 45°was 23.2% Ϯ 8.5% and 29.0% Ϯ 13.1% for the axillary pouch and the AB-IGHL, respectively, whereas that for the long head of the biceps tendon was 61.6% Ϯ 15.2%. This suggests that the collagen fibers in the IGHL are not highly aligned and the anteroinferior capsulolabrum can be modeled as a continuous sheet. Moreover, a biomechanical evaluation of the anteroinferior capsulolabrum that investigates the possibility that the mechanical properties may be directionally independent should be conducted. (J Shoulder Elbow Surg 2003; 12:247-52.) The glenohumeral joint is the most commonly dislocated diarthroidal joint in the body, and after the initial episode, 85% to 90% of young persons have subsequent dislocation. 12 Whereas surgical repair lowers recurrence, redislocation rates are as high as 12% and 23% after open and arthroscopic surgical procedures, respectively. 29 Acute dislocation in human beings was often found to result in a Bankart lesion, 3,4,21 which includes rupture of the anteroinferior capsulolabrum. This is now known to include a lesion of the glenoid insertion site of the inferior glenohumeral ligament (IGHL), 14,18,25 the primary static restraint to anterior translation of the humeral head on the glenoid. Given that surgical repairs have focused on restoration of the anteroinferior capsulolabrum, 1,24 its anatomy has been meticulously studied. The collagen cross-links, collagen fibril diameter and density, amino acid composition, and elastic fibers have also been examined. 23 When compared with the capsule from unstable shoulders, the normal capsule consists of a greater number of cross-links and smaller fibril diameters. Further research has demonstrated that the anterior capsule is composed of areolar (loose connective) tissue. The anterior band (AB), axillary pouch, and posterior band (PB) of the IGHL have been identified, 20 and the ability of each component to resist forces along its long axes in the medial-tolateral direction was studied. 5,6,30 The AB-IGHL exhibits an increased thickness and superior mechanical properties compared with the other components of the capsule. 5 Recent research also demonstrated the importance of the capsular tissue between the AB-IGHL and PB-IGHL, the axillary pouch. 8,17 Significant forces were transmitted in the direction perpendicular to the long axis of the AB-IGHL. In an effort to understand the role of the anteroinferior capsulolabrum in resisting dislocation better, the orientation of the collagen fibers within each of the three regions of the IGHL has been qualitatively examined with polarized light microscopy. 10,20 O'Brien et al 20 found the axillary pouch to be less organized than either the AB-IGHL or the PB-IGHL and demonstrated a great deal of intermingling of the fibers. This finding indicated that the axillary pouch could resist forces other than those in the medial-to-
The anatomy of the medial collateral ligament of the knee and its significance in joint stability
Italian journal of anatomy and embryology, 2016
The medial collateral ligament (MCL) is the most important stabilizer of the medial side of the knee together with the capsuloligamentous complex. As such, it has a distinctive role in joint stability, as far as its biomechanics are concerned, and major joint stability issues onset when it is injured or deficient. One of the main functions of the medial collateral ligament is mechanical as it passively stabilizes the knee and help in guiding it through its normal range of motion when a tensile load is applied. It exhibits nonlinear anisotropic mechanical behaviour, like all ligaments, and under low loading conditions it is relatively compliant, perhaps due to recruitment of “crimped” collagen fibres as well as to viscoelastic behaviours and interactions of collagen and other matrix materials. Continued ligament-loading results in increasing stiffness until a stage is reached where it exhibits nearly linear stiffness and beyond this it continues to absorb energy until it is disrupted...
Orthopaedic Journal of Sports Medicine
Background:The anterior bundle (AB) of the ulnar collateral ligament is the most important structure for valgus stabilization of the elbow. However, anatomic relationships among the AB, posterior bundle (PB) of the ulnar collateral ligament, and common tendon (CT) of the flexor-pronator muscles have not been fully clarified.Purpose:To classify the AB, PB, and CT and to clarify their morphological features.Study Design:Descriptive laboratory study.Methods:This investigation examined 56 arms from 31 embalmed Japanese cadavers. The CT investigation examined 34 arms from 23 embalmed Japanese cadavers with CTs remaining. Type classification was performed by focusing on positional relationships with surrounding structures. Morphological features measured were length, width, thickness, and footprint for the AB and PB and attachment length, thickness, and footprint for the CT.Results:The AB was classified as type I (44 elbows; 78.6%), can be separated as a single bundle, or type II (12 elbo...