Arthroscopic Techniques to Recognize and Quantify Subtle Medial and Lateral Elbow Instability
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PROVIDER: S-EPMC10533842 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability.MethodsThis is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study.ResultsThe AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%).ConclusionCombined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients.Level of evidenceLevel IV, retrospective case series.
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Project description:Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability. Thirty arthroscopies were performed on 30 patients, and all recordings were collected, blinded, and labeled. Three orthopedic surgeons reviewed and scored all 30 recordings three times with a period of at least seven days in between to analyze the intraobserver and interobserver reliability. The classification consisted of five different grades. Indications for elbow arthroscopy included impingement (n = 7), osteochondritis dissecans (n = 5), pain (n = 7), osteoarthritis (n = 6), and other (n = 5). The kappa value for intrarater reliability was 0.71, indicating good reliability, while the kappa value for inter-rater reliability was 0.38 indicating fair reliability. This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. We demonstrated good intrarater reliability (k = 0.71) with fair inter-rater reliability (k = 0.38). However, further research is necessary to study the clinical significance.
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Project description:The lateral collateral ligament complex of the elbow is pivotal for maintaining the stability of the elbow joint. The open technique for reconstructing the lateral ulnar collateral ligament (LUCL) is a standard procedure to treat elbow instability caused by LUCL deficiency. Nevertheless, as arthroscopy procedures in the elbow have advanced, we describe an arthroscopic technique to reconstruct the LUCL with suture anchors and bone tunnel techniques.
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Project description:Posterolateral rotatory instability (PLRI) is the most common form of symptomatic acute and chronic elbow instability. Diagnosis is usually made using a combination of clinical tests and imaging modalities; however, in more subtle forms of instability, these measures may be equivocal. Arthroscopy is a valuable adjunct for diagnosis and treatment of PLRI. It allows direct appreciation of the instability process, quantification of the degree of instability, and identification of concurrent associated pathology. The aim of this technique article is to report a series of reproducible arthroscopic tests used for diagnosis of PLRI with examples of normal and pathologic arthroscopic findings.
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Project description:Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow.
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Project description:The critical role of the meniscus in the biomechanics of the knee and articular cartilage preservation has led to an increased awareness of the importance of the meniscus. Meniscal allograft transplantation is a challenging surgical intervention that is saved as a last resort for patients who meet stringent criteria for salvage from meniscal deficiency. Proper arthroscopic implantation of a meniscal allograft takes precision and implementation of multiple fixation techniques to obtain a successful outcome.
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Project description:When the lateral collateral ligament (LCL) complex fails to support the radiocapitellar and ulnohumeral joints in advanced stages of insufficiency, the patient experiences posterolateral rotatory instability (PLRI). Open lateral ulnar collateral ligament repair with a ligamentous graft has been the standard treatment for PLRI. Despite producing good clinical stability rates, this method is associated with significant lateral soft-tissue dissection and a lengthy recovery period. By fastening the LCL to its humeral insertion, arthroscopic imbrication of the LCL can increase stability. The senior author modified this technique. With the aid of a passer, the LCL complex, lateral capsule, and anconeus may be weaved with a single (doubled) suture, secured with a Nice knot. LCL complex imbrication may be used to restore stability and improve pain and function in patients with grade I and II PLRI.
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Project description:Patellar dislocations are common injuries that can lead to recurrent dislocations and instability. Patellar instability is a complex problem and requires a multifactorial approach. Over the years, many different repair and reconstruction techniques has been developed. The variety of techniques proves that there is no best procedure, and different options must be taken into consideration in every case. Many of these techniques are complicated and require graft harvesting or drilling through the patella. We present a technique of arthroscopic patellar stabilization with a single suture anchor and lateral release that is easy to perform, cost-effective, and does not require drilling tunnels through patella or graft harvesting.
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