Collateral Instability Research Articles

Diagnosis and Treatment of Posteromedial Elbow Impingement in the Throwing Athlete.

Posteromedial elbow impingement is a common pathological entity in the throwing athlete. The posteromedial articulation of the elbow is a significant stabilizer to medial elbow forces and valgus stress noted during repetitive throwing. This current review investigates recent literature regarding the relevant anatomy, diagnosis, and treatment of posteromedial impingement in the thrower. Improvements in advanced imaging have provided accurate and detailed diagnostic capability for the assessment of the throwers' elbow. After failure of conservative measures, arthroscopic treatment of posteromedial elbow impingement with posteromedial osteophyte removal has demonstrated excellent outcomes with a reliable return to play in the competitive thrower. In addition to a thorough history and physical examination, MRI, MR arthrogram, CT, and dynamic ultrasound imaging modalities are useful in the assessment of a presumed diagnosis of posteromedial impingement. Arthroscopic decompression with posteromedial osteophyte removal provides effective clinical results and return to play. The surgeon should be careful to avoid creating medial ulnar collateral instability by means of over-resection of the posteromedial olecranon.

Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint.

Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10-124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t -test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

Osteochondritis of the second metacarpal head: a case report

Osteochondritis dissecans is rare in the metacarpal head. To our knowledge, only one previous case report has been published. The initial diagnosis was ulnar collateral instability. Intraoperatively, the osteochondritis lesion was noticed and the loose cartilage flap was removed. The patient was symptom free after surgery.

Risk Factors for Pes Anserinus Tendinitis/Bursitis Syndrome

Pes anserinus tendinitis/bursitis (PATB) is a frequent cause of knee pain. Its predisposing factors are still controversial. Assess the effect of a set of demographic, clinical, somatometric, and biomechanical factors on the risk for PATB. A case control design was used to evaluate the association between clinically diagnosed PATB and the presence of diabetes; knee osteoarthritis (and its radiographic severity); obesity; knee collateral, and anteroposterior instability; and knee or hindfoot malalignment. Twenty-two consecutive, incident PATB patients were included; all were females 62.1 +/- 11.5-year-old (limits 45-82). Thirty-eight sex- and age-matched (59.8 +/- 9.4-year-old; P = 0.41) subjects were used as controls; these had asymptomatic osteoporosis (20) and a series of rheumatic syndromes (18). There was no difference in prevalence of diabetes, knee osteoarthritis, obesity, knee instability, varus knee deformity, and hindfoot malalignment between cases and controls. Furthermore, no difference in overall, lateral, medial, and patellofemoral knee osteoarthritis radiographic severity mean score was found between study groups. The presence of valgus knee deformity alone (OR: 5.2; 95% CI: 1.1-25.5), or in combination with collateral instability (OR: 6.0; 95% CI: 1.4-26.0), was identified as associated with PATB. Valgus knee deformity, alone or in association with collateral instability, seems to be a risk factor for PATB. No association was found between PATB and some conditions previously reported as predisposing factors such as diabetes, knee osteoarthritis, and obesity. PATB should be kept in mind as a highly probable diagnosis in mature women with medial knee pain and valgus knee deformity.

Tibial realignment with external fixator

External fixation is a proved method for high tibial osteotomies. It is easy to access, allows postoperative corrections of the alignment, and can be removed without additional narcosis. Disadvantages are the frequent infection of the pin tracks and discomfort in bearing compared to internal fixation. In our own study no difference between unilateral and bilateral fixation could be found regarding loss of correction and complications. The advantage of unilateral fixation is the possibility of doing an open-wedge procedure by unilateral continuous callus distraction (hemicallotasis). This is indicated if medial collateral instability can be compensated by the open-wedge technique. The occurrence of neural injuries was significantly less frequent after hemicallotasis. Regular radiological and clinical control of the axis is necessary to prevent loss of correction, which was significantly more frequent in open-wedge osteotomies.

Results after meniscectomy in 147 athletes.

The object of this study was to ascertain the consequences of meniscectomy performed because of meniscus injury sustained during sports. Out of 147 athletes meniscectomized from 1964 to 1973 a total of 142 were seen at follow-up. The median follow-up period was 4.25 (range 2.25-11.0) years. During the follow-up period 8 per cent (11/142) had further surgical treatment because of new knee injuries. At the time of follow-up, 15 per cent (20/131) of the patients who had undergone operation solely for the primary meniscus injury had given up sports because of knee complaints and 12 per cent (16/131) had restricted their sporting activities. There were no complaints in 46 per cent (60/131). In 79 per cent (56/71) of the patients who had complaints, these had started immediately after operation. The main trouble was a feeling of instability and pain on weight-bearing. The complaints correlated with the physical findings at follow-up. In 14 per cent (18/13) there was increased collateral instability of the knee. Considering also previous experimental studies, it is concluded that meniscectomy causes immediate functional changes in the knee which explain the complaints. There was no correlation between complaints and radiological osteoarthrosis.

Stress radiographical measurement of the anteroposterior, medial and lateral stability of the knee joint.

A hydraulically operated machine for applying well-defined forces to the knee joint is described. The measurement of anteroposterior as well as lateral and medial stability in the knee joint is based upon roentgenograms exposed while the forces are being exerted on the patient. The advantage of the radiological measuring method over methods using external measurements is the elimination of inaccuracies due to displacements of the soft tissues of the limb. The accuracy was evaluated by test/retest examination of 50 healthy subjects. The radiographs were measured at random after cessation of examinations in the gonylaxometer. The accuracy is +/- 1.2 nm for medial/lateral, +/- 2.4 nm for drawer sign. Diagnostically the difference between the two knees must exceed 2.0 nm (collateral instability) or 3.1 nm (drawer) to exceed standard values. The standard values for the different ligament laxities are given. The applied force to be used for evaluation of medial/lateral stability is recommended to be 9 kg, and for anteroposterior stability between 20 and 30 kg.