Abstract
PurposeThe effect of open release of a post-traumatic elbow contracture on the stability of the joint has not been so far studied in vivo. Resection of elbow joint capsule, the key element of surgery, was reported to have no effect on the stability of cadaveric elbows. The joint capsule is yet known to participate in maintaining elbow stability as one of secondary stabilizers.MethodsWe assessed elbow joint laxity in 39 patients who underwent an open contracture release via the ‘column procedure’ described by B. Morrey and P. Mansat within the preceeding three to nine months. The measurements were taken with an apparatus designed particularly for this experiment according to the predetermined protocol. A preliminary part of the experiment showed that there was no significant difference between laxity of two elbow joints in healthy volunteers. Laxity of the operated elbows could be then compared with the contralateral joints.ResultsMean absolute difference of laxity between healthy and operated elbows was 1.55° (0.1°–4.1°, SD = 1.1) being significantly lower than 2°, p = 0.0056. The difference of the joint laxity between the operated and healthy elbows did not differ statistically significantly by more than 0.6° from the difference of the laxity of two healthy elbows and, therefore, is not clinically noticeable.ConclusionsOur experiment confirmed that the ‘column procedure’ is a safe procedure which does not compromise the stability of the elbow joint.
Highlights
Elbow stability results primarily from the integrity of relevant anatomical structures which maintain physiological laxity of the joint
Elbow stability derives from the congruence of the articular surfaces in roughly 50%, while the remaining half depends on the integrity of ligaments, capsule, interosseous membrane and, to a lesser degree, muscles of the arm and forearm which act as dynamic stabilizers [2, 5, 6]
Primary stabilizers include the anterior bundle of the medial collateral ligament, lateral collateral ligament complex and the congruence of the ulnohumeral joint [1, 7,8,9]
Summary
Elbow stability results primarily from the integrity of relevant anatomical structures which maintain physiological laxity of the joint. Elbow stability derives from the congruence of the articular surfaces in roughly 50%, while the remaining half depends on the integrity of ligaments, capsule, interosseous membrane and, to a lesser degree, muscles of the arm and forearm which act as dynamic stabilizers [2, 5, 6]. Those structures are classified as either primary or secondary stabilizers; the former are those whose injury leads directly to increased laxity of the International Orthopaedics (SICOT) (2020) 44:911–918 joint, and the latter are the structures whose damage would increase laxity only after the relevant primary stabilizers had been injured. An important part of the lateral collateral ligament complex, the lateral ulnar collateral ligament, serves as a primary stabilizer acting against posterolateral rotatory instability of the elbow [10]
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