Medial Ligament Complex Research Articles

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability.

Patellofemoral instability (PFI) encompasses symptomatic patellar instability, patella subluxations, and frank dislocations. Previous studies have estimated the incidence of acute patellar dislocation at 43 per 100,000 children younger than age 16 years. The medial patellofemoral ligament (MPFL) complex is a static soft tissue constraint that stabilizes the patellofemoral joint serving as a checkrein to prevent lateral displacement. The causes of PFI are multifactorial and not attributed solely to anatomic features within the knee joint proper. Specific anatomic features to consider include patella alta, increased tibial tubercle–trochlear groove distance, genu valgum, external tibial torsion, femoral anteversion, and ligamentous laxity. The purpose of this paper is to provide a review of the evaluation of PFI in the pediatric and adolescent patient with a specific focus on the contributions of coronal and transverse plane deformities. Moreover, a framework will be provided for the incorporation of bony procedures to address these issues.

High incidence of superficial and deep medial collateral ligament injuries in \u2018isolated\u2019 anterior cruciate ligament ruptures: a long overlooked injury

PurposeIn anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically ‘isolated’ ACL ruptures.MethodsPatients who underwent ACL reconstruction for complete ‘presumed isolated’ ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient’s characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.ResultsHundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus ‘ramp’ lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.ConclusionThe incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.Level of evidenceIII.

Deltoid Ligament Injuries Associated With Ankle Fractures: Arguments For and Against Direct Repair.

Ankle fractures are an extremely common orthopaedic injury treated by surgeons on a routine basis. The deltoid ligament is torn in a large number of these fractures and is commonly seen with associated radiographic changes of medial clear space widening. The clinical relevance of addressing the injured deltoid ligament with acute surgical repair has been debated for decades. The early literature documenting repair or reconstruction of the deltoid ligament dates back to the 1950s. Most commonly, orthopaedic surgeons restore the lateral column directly with fibula fracture fixation. The injury may then be further evaluated intraoperatively by stress testing to ensure syndesmosis integrity and mortise stability with indirect medial column reduction, which allows for secondary healing of the medial deltoid ligamentous complex. This popular treatment paradigm is based primarily on literature from the 1980s and has not been thoroughly evaluated with modern surgical implants, techniques, and research methods. A review and background of the supportive literature for and against deltoid ligament repair in the setting of acute ankle fractures is presented. Undeniably, the deltoid ligament complex has been proven to confer some element of stability to maintaining a congruent ankle mortise. The commonly cited data in favor of not repairing the deltoid ligament warrants careful consideration to allow accuracy in obtaining the best patient outcomes with the most predictable surgical methods available.

Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

PurposeUltrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions.MethodsA total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed.ResultsThirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p < 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found.ConclusionMean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee.Level of evidenceIII.

Längenänderung der passiven medialen Kniestabilisatoren über den Bewegungsradius

PurposeThe purpose of this study was to define the length-change patterns of the superficial medial collateral ligament (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL) across knee flexion and with applied anterior and rotational loads.Material and methodsTen cadaveric knees were mounted in a kinematics rig with loaded quadriceps and hamstrings muscles. Length change patterns of the anterior and posterior fibres of the sMCL, dMCL and POL were recorded from 0 to 100° flexion. Length changes were recorded while a 90 N anterior load and a 5 Nm internal and external rotational torque were applied. Length changes were normalized to lengths at 0° flexion.ResultsThe anterior sMCL tightened as the knee was flexed (p < 0.01), and further tensioned under tibial external rotation (p < 0.001). Conversely, the posterior sMCL slackened with flexion (p < 0.001), while internal rotation tightened these fibers between 10 and 100° (p < 0.05). Tibial external rotation significantly lengthened the anterior dMCL fibres by 10% compared to the unloaded condition throughout flexion (p < 0.001). Release of the sMCL caused the dMCL fibres to become taut and increased valgus rotation (p < 0.01). The lengths of the anterior and posterior POL fibres decreased continuously with knee flexion (p < 0.001). Tibial internal rotation significantly increased the length of the POL (p < 0.001).ConclusionThe structures of the medial ligament complex reacted differently to knee flexion and applied loads. Structures attaching proximal and posterior to the medial epicondyle were taut in extension, whereas the anterior sMCL tensioned during flexion. The anterior dMCL was extensively strained by tibial external rotation and after sMCL release.

Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity.

Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model. Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA). Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees (P = .031) and 5.8 ± 2.7 degrees (P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees (P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity (P = .04 and P = .02, respectively). The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model. The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV.

Length-change patterns of the medial collateral ligament and posterior oblique ligament in relation to their function and surgery

PurposeTo define the length-change patterns of the superficial medial collateral ligament (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL) across knee flexion and with applied anterior and rotational loads, and to relate these findings to their functions in knee stability and to surgical repair or reconstruction.MethodsTen cadaveric knees were mounted in a kinematics rig with loaded quadriceps, ITB, and hamstrings. Length changes of the anterior and posterior fibres of the sMCL, dMCL, and POL were recorded from 0° to 100° flexion by use of a linear displacement transducer and normalised to lengths at 0° flexion. Measurements were repeated with no external load, 90 N anterior draw force, and 5 Nm internal and 5 Nm external rotation torque applied.ResultsThe anterior sMCL lengthened with flexion (p < 0.01) and further lengthened by external rotation (p < 0.001). The posterior sMCL slackened with flexion (p < 0.001), but was lengthened by internal rotation (p < 0.05). External rotation lengthened the anterior dMCL fibres by 10% throughout flexion (p < 0.001). sMCL release allowed the dMCL to become taut with valgus rotation (p < 0.001). The anterior and posterior POL fibres slackened with flexion (p < 0.001), but were elongated by internal rotation (p < 0.001).ConclusionThe structures of the medial ligament complex react differently to knee flexion and applied loads. Structures attaching posterior to the medial epicondyle are taut in extension, whereas the anterior sMCL, attaching anterior to the epicondyle, is tensioned during flexion. The anterior dMCL is elongated by external rotation. These data offer the basis for MCL repair and reconstruction techniques regarding graft positioning and tensioning.

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

The effects of soft tissue lateral release on the stability of the ligament complex of the knee

PurposeValgus deformity presents a particular challenge in total knee arthroplasty. This condition regularly leads to contractures of the lateral capsular ligament complex and to overstretching of the medial ligamentous complex. Reconstruction of the knee joint kinematics and anatomy often requires lateral release. However, data on how such release weakens the stability of the knee are missing in the literature. This study investigated the effects of sequential lateral release on the collateral stability of the ligament complex of the knee in vitro.MethodsTen knee prostheses were implanted in 10 healthy cadaveric knee joints using a navigation device. Soft tissue lateral release consisted of five release steps, and stiffness and stability were determined at 0, 30, 60 and 90° flexion after each step.ResultsSoft tissue lateral release increasingly weakened the ligament complex of the lateral compartment. Because of the large muscular parts, the release of the iliotibial band and the M. popliteus had little effect on the stability of the lateral and medial compartment, but release of the lateral ligament significantly decreased the stability in the lateral compartment over the entire range of motion. Stability in the medial compartment was hardly affected. Conversely, further release of the posterolateral capsule and the posterior cruciate ligament led to the loss of stability in the lateral compartment only in deep flexion, whereas stability decreased significantly in the medial compartment.ConclusionOur study shows for the first time the association between sequential lateral release and stability of the ligamentous complex of the knee. To maintain the stability, knee surgeons should avoid releasing the entire lateral collateral ligament, which would significantly decrease stability in the lateral compartment.

Brostrom-Like Procedure Augmented with Swivelock Internal Brace for the Reconstruction of Chronic Medial Ankle Ligament Complex

Category:Midfoot/ForefootIntroduction/Purpose:The medial ligaments and joint capsules appear to stretch or rupture under the increasing stress following a tear of the PTT in patients with flat foot often leading to pain, swelling and dysfunctional foot. This study assesses the efficacy of a Brostrom like procedure augmented with Swivelock Internal Brace for the reconstruction of chronic medial ankle ligament complex.Methods:A retrospective study was performed reviewing 15 flat foot patients who presented with pronounced hindfoot pronation collapse of the medial longitudinal arch after injury. The procedures included exploration and direct repair of PTT, deltoid ligament and spring ligament. Our modification included Swivelock Internal Brace enhanced reconstruction of deltoid and spring ligaments, after calcaneal medializing osteotomy. Other additional procedures such as FDL transfer, subtalar arthroereisis and Cotton osteotomy were performed as needed (Fig.1). Weight bearing X-rays of the foot, AOFAS-AH and SF36 scoring were taken before and after surgery.Results:There were 8 males and 7 females among the 15 patients. The age was 29.8±10.1 years old. The follow-up time period was 32.6±11.4 months. Both the AOFAS-AH (52.8±15.2 to 90.4±7.5 and SF-36 (55.4±12.6 to 91.2±6.3 scores improved significantly (p<0.001). Comparing preoperative to postoperative standing radiographs, there was significant improvement in the AP talar first metatarsal angle (25.6±18.4 to 9.5±7.8 degrees（P<0.001), lateral talar first metatarsal angle (18.3±8.4 to +2.6±4.5 degrees（P<0.001）and moment arm on the Saltzman view (+15.2mm±10.8 to +2.5±3.6mm（P=0.003） (Fig.2). No recurrence of pronation deformity or foot arch collapse was observed after surgery.Conclusion:The medial ankle ligaments were attenuated and under the increasing stress following a tear of the PTT in patients of flat foot. Direct repair of the ligaments after rupture usually resulted in low strength and high recurrence. Simultaneous reconstruction of medial ankle ligaments with Swivelock internal brace maintained long term medial ankle stability and the longitudinal arch. This technique protects the repaired tendon and decreased the need for FDL transfer, potentially permitted earlier rehabilitation and improved function compared to traditional techniques.

Interposition Arthroplasty of the Elbow Utilizing a Lateral Epicondyle Osteotomy.

Management of severe elbow arthritis in young or active patients presents a challenging problem. Interposition arthroplasty is a useful salvage procedure for these patients but has a significant failure rate associated with postoperative instability. Previous studies have sought to preserve the integrity of the medial elbow ligament complex to decrease postoperative instability and the need for external fixation. Our lateral epicondylar osteotomy technique preserves the native lateral elbow ligament complex. Potential advantages include bone-to-bone healing of the osteotomy, decreased postoperative instability, and the decreased need for and associated costs and potential complications of supplemental external fixation.

Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee

BackgroundThe first biomechanical evaluation of new implants is usually carried out with cadavers. Fixation of Thiel-embalmed cadavers is supposed to preserve the histological structure, colour and consistency of the tissue and has a low risk of infection and toxicity. However, the biomechanical properties of Thiel-fixated tissue are still unknown. The aim of this study was to quantify the effect of the Thiel-embalming method on the elastic properties of the ligament complex of the knee compared to in vivo knees during total knee arthroplasty. MethodsThe results of biomechanical tensile tests with 10 Thiel-embalmed knees were compared with the findings of 10 patients who underwent total knee arthroplasty with a standardised knee balancer at our department. We reconstructed the force-elongation curves of the medial and lateral ligament complex and calculated the stiffness in direct correlation with overall soft tissue stability in full extension and in 90° of flexion. ResultsAll curves consisted of a non-linear part at the beginning and a linear part from about 80N onwards. In full extension, median stiffness in the cadavers was 26.6N/mm for the medial compartment and 31.6N/mm for the lateral compartment. The values for in vivo were 25.7N/mm for the medial compartment and 25.3N/mm for the lateral compartment (p=0.684 for the medial compartment and p=0.247 for the lateral compartment).In 90° of flexion, median stiffness in the cadaver group was 24.7N/mm for the medial compartment and 22.2N/mm for the lateral compartment. In vivo, median stiffness was 30.3N/mm for the medial compartment and 29.2N/mm for the lateral compartment (p=0.009 for the medial compartment and p=0.143 for the lateral compartment). ConclusionStiffness of the medial and lateral ligament complex in the knee was comparable between Thiel-embalmed cadavers and in vivo patients during total knee arthroplasty. Thiel fixation seems to preserve the soft tissue properties similar to those in vivo.

Anatomical and magnetic resonance imaging study of the medial collateral ligament of the ankle joint

IntroductionThe medial collateral ligament of the ankle joint also known as the deltoid ligament, is a multifascicular group of ligaments. It can be divided into a superficial and deep group of fibers originating from the medial malleolus to insert in the talus, calcaneus, and navicular bones. Wide variations have been noted in the anatomical description of the medial ligamentous complex of the ankle. The various components of the deltoid ligament are well visualized on both axial and coronal images on routine ankle MR imaging sequences including T1 weighted image and T2 weighted image. AimThis study was done to study the anatomy of the normal and variated attachment of the medial collateral ligament of the ankle joint, and also to study the MR imaging of the normal, variated and disrupted attachment of the medial collateral ligament. Materials and methodsTwenty preserved cadaveric adult ankle specimens were collected from the dissecting room, Anatomy Department, Faculty of Medicine, Alexandria University. MR imaging of ten ankles was performed before and after disruption of every band of the ligament of medial side of the ankle. ResultsThe medial collateral ligament of the ankle was found to consist of six bands or components, three of them are always present whereas the presence of the other three may vary. The exact attachments and measurements of these bands were described.Axial imaging provided optimum views of the deep layers of the medial collateral ligament and the tibionavicular ligament. Coronal imaging allowed complete visualization of the tibiocalcaneal, and deep posterior tibiotalar ligaments. High resolution MR imaging allows excellent visualization of the collateral ligaments of the ankle. ConclusionThe study of the anatomy of the ankle joint, its collateral ligaments and their functions aid for the proper diagnosis and treatment of the conditions affecting the ankle.

Reconstruction of the Medial Talonavicular Joint in Simulated Flatfoot Deformity

Reconstructing the ligamentous constraints of the medial arch associated with adult acquired flatfoot deformity remains a challenge. The purpose of this study was to test the efficacy of several reconstruction techniques of the medial arch. We hypothesized that an anatomic reconstruction of the spring ligament complex would correct the deformity better than other techniques tested. Three reconstructions of the medial support structures were performed on each specimen to recreate the different lines of action and insertions of the medial ligamentous complex in 12 specimens with a simulated flatfoot deformity. Talonavicular and tibiocalcaneal (hindfoot) orientations were measured in the axial, sagittal, and coronal planes in the intact, flatfoot, and reconstructed conditions. While each reconstruction technique corrected the deformity (P < .05), proximal fixation of the graft corrected the greatest amount of talonavicular deformity while also correcting hindfoot valgus (P < .05). The fixation points and lines of action of a medial arch reconstruction have important implications on deformity correction in a flatfoot model. Despite its fidelity to the native structure, the anatomic spring ligament reconstruction provided the least amount of correction. These findings suggest that other ligamentous structures of the medial arch are critical in supporting the midfoot. Reconstruction of the ligamentous supports of the medial arch might be able to correct substantial amounts of deformity without osseous procedures like calcaneal osteotomies or midfoot fusions.

Controversies in Trauma Care of the Foot and Ankle

This article discusses the pathomechanics and pathoanatomy of ankle fractures, challenges involving the medial ankle ligament complex, as well as midfoot (Lisfranc) lesion closures.

Medial Ankle Ligament Injuries in Athletes

Ankle sprains with injuries of the lateral or medial ligament complex have a high incidence in daily life and sports. Therefore, an appropriate concept for clinical examination, diagnosis, and surgical treatment is mandatory. Although clinical presentation and treatment modalities are well described for the lateral ligaments, little is known about the medial ankle and its ligament injuries. The purpose of this article is to provide an update of clinical examination, diagnosis, and treatment for these complex ligament injuries and report the primary results of our treatment concept.

MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs

Magnetic resonance imaging (MRI) has been found to be an excellent imaging tool for meniscal injuries. Various MRI signs have been described to detect displaced meniscal injuries, specifically the bucket-handle tears. Although these signs are quite helpful in diagnosing meniscal tears, various pitfalls have also been reported for these signs. Double anterior cruciate ligament (ACL) sign refers to presence of a linear hypointense soft tissue anterior to the ACL, which represented the flipped bucket-handle tear of the meniscus. Disproportional posterior horn and flipped meniscus signs represent asymmetrically thickened horns of the menisci due to overlying displaced meniscal fragments. We report a case wherein MRI of the knee showed tear and displacement of the medial patellofemoral ligament (MPFL) and vastus medialis complex, medial collateral ligament (MCL), and posterior cruciate ligament (PCL) mimicking these signs. To our knowledge, internally displaced MPFL and MCLs have not been described as mimics for displaced meniscal fragments.

Terrible triad of the elbow: influence of radial head treatment

Objectiveto test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head. Methodstwenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16–36 months). There were 17 men and nine women of mean age 41±13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process. Resultsthe mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment. Conclusionthere was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques.

Tríade terrível do cotovelo: a influência do tratamento da cabeça do rádio

Objectiveto test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head. Methodstwenty‐six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16 to 36 months). There were 17 men and nine women of mean age 41±13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process. Resultsthe mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment. Conclusionthere was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques.

The Anatomy and Function of the Deltoid Ligament

The deltoid ligament, also known as the medial collateral ligament complex, is a strong, broad ligament with multifascicular appearance that spans out from the medial malleolus toward the talus, calcaneus, and navicular bones. Despite various different anatomic descriptions of the medial ankle ligament complex over the past few years, a separation of the deltoid ligament into a superficial and a deep layer is nowadays widely accepted. The tibiospring, tibionavicular, superficial posterior tibiotalar, and tibiocalcaneal ligaments are components of the superficial portion of the medial collateral ligaments, whereas the deep posterior tibiotalar and deep anterior tibiotalar ligaments are components of the deep portion of the medial collateral ligaments. A further component of the medial collateral ligament is the spring ligament. All of these ligaments are involved in stabilizing the hindfoot as well as in guiding passive joint motion. The purpose of this article was to provide an update of the anatomy of the medial ankle ligament complex with regard to its specific function.