Search Results (8)

Background: The elbow joint is stabilized by complex interactions between bony structures and soft tissues, notably the lateral and medial collateral ligaments. Posterolateral rotatory instability (PLRI), a form of elbow instability, is challenging to diagnose due to overlapping symptoms with other conditions. The radiocapitellar line (RCL) is a radiographic tool for assessing humeroradial alignment and elbow stability, but its diagnostic accuracy remains debated. This study aims to provide normative data on RCL deviations in healthy individuals to improve diagnostic criteria for PLRI. Methods: A prospective study was conducted with 53 healthy individuals (27 males, 26 females) aged 18–45 years. MRI scans of the participants’ elbows were performed in maximum extension and supination to assess radiocapitellar deviations (RCDs). Two orthopedic surgeons independently analyzed the images to evaluate RCDs and assess interobserver reliability. Statistical analyses, including independent t-tests and Pearson correlations, were used to explore the relationship between RCDs, demographic factors, and elbow stability. Results: The average RCD in the cohort was 1.77 mm (SD 1.06 mm). Notably, 62.9% of participants had deviations greater than 1.2 mm, while 12.9% exceeded 3.4 mm, thresholds traditionally used to diagnose PLRI. Gender and age did not significantly influence RCD values. The interobserver reliability was almost good (ICC = 0.87), supporting the consistency of the RCL measurements. Conclusions: Significant RCDs occur even in asymptomatic individuals, challenging the current diagnostic thresholds for PLRI based solely on RCL measurements. A comprehensive assessment that includes clinical, anatomical, and functional evaluations is essential for accurate diagnosis. These findings highlight the need for refined diagnostic criteria and further research into elbow stability. Full article

Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon’s point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO’s condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making. Full article

Background: Medial meniscus ramp tears are present in 22.9–40.8% of anterior cruciate ligament tears. The diagnosis of ramp tears is difficult on MRI, with sensitivity reported around 48%, which has recently emphasized the importance of proper arthroscopic probing for ramp tears. Methods: A prospective evaluation was performed on patients undergoing a single bundle ACL reconstruction to assess patient demographics, posterior tibial slope, posterior cruciate ligament angle, Lachman’s exam, and rotational instability to determine secondary findings associated with medial meniscal ramp tears. Results: A total of 96 patients underwent ACL reconstruction, of these, 63 patients had an isolated ACL tear, and 33 patients had an ACL tear with a concomitant medial meniscus ramp tear. A high-grade Lachman’s exam and male sex were associated with medial meniscus ramp tears. There were no differences in posterior tibial slope, posterior cruciate ligament angle, or rotational instability between groups. Conclusions: This study found that a high-grade Lachman’s exam and male sex were significantly associated with patients with an ACL tear with a concomitant medial meniscus ramp tear. These findings suggest that an ACL tear with concomitant medial meniscus ramp tear may be better diagnosed based upon the clinical evaluation rather than other secondary radiological findings. Full article

Background: The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. Methods: This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. Conclusions: This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button. Full article

Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy’s tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL’s footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL–ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL–ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL–ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL–ALL-transected knees showed significant differences compared to the intact ALL–ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL. Full article

Clinical outcomes after anterior cruciate ligament reconstruction (ACLR) have improved remarkably. However, residual rotational instability of the knee joint remains a major concern. The anterolateral ligament (ALL) has recently gained interest as a secondary stabilizer of knee joint rotatory instability, and this has led to the attempt of ALL reconstruction (ALLR) in combination with ACLR to restore rotational stability in patients with anterior cruciate ligament (ACL) injury. Although several techniques for ALLR have recently been introduced, the ideal graft type and surgical technique for combined ACLR and ALLR are yet to be established. This technical note therefore aimed at introducing a novel surgical procedure involving the use of a single Achilles tendon allograft as a relatively simple and minimally invasive procedure for combined ALL and ACL reconstruction. Full article

Despite remarkable advances in the clinical outcomes after anterior cruciate ligament reconstructions (ACLRs), residual rotational instability of the knee joint remains a major concern. Since the anterolateral ligament (ALL) on the knee joint has been “rediscovered”, the role of anterolateral structures, including ALL and deep iliotibial band, as secondary stabilizers of anterolateral rotatory instability has gained interest. This interest has led to the resurgence of anterolateral procedures combined with ACLRs to restore rotational stability in patients with anterior cruciate ligament (ACL) deficiencies. However, the difference in concepts between anterolateral ligament reconstructions (ALLRs) as anatomical reconstruction and lateral extra-articular tenodesis (LETs) as non-anatomical reinforcement has been conflicting in present literature. This study aimed to review the anatomy and biomechanics of anterolateral structures, surgical techniques, and the clinical outcomes of anterolateral procedures, including LET and ALLR, in patients with ACL deficiencies. Full article

Background: Acute alcohol intake is known to cause gait instability, dizziness, and lack of psychomotor coordination. Previous studies demonstrated the positive effects of alcohol on the oculomotor system and the low-frequency vestibulo-ocular reflex (VOR). However, the low-frequency VORs is a rather un-physiologic stimulation, and the reported explanations regarding the relations between the alcohol-induced VOR changes and posture control are inconsistent. OBJECTIVE: The present study evaluates how acute alcohol intake affects more physiologic mid- to high-frequency VORs, postural control, and elucidates the connection between the VOR and posture control after alcohol intake. Methods: A total of 31 healthy volunteers participated. Each participant received calculated amounts of alcohol drinks according to their body weight and genders with the targeted blood alcohol content (BAC) level of 0.05% using the Widmark formula. A vestibular test battery composed of posturography, video head impulse test, rotatory chair test (slow harmonic acceleration (SHA) and step velocity), and subjective visual vertical/horizontal tests (SVV/SVH) were conducted twice in alcohol-free condition (no alcohol intake within 24 h) and acute alcohol condition. Results: Acute alcohol intake decreased stability scores in all NS/EO (normal stability-eyes open), NS/EC (normal stability- eyes closed), PS/EO (perturbed stability-eyes open), and PS/EC (perturbed stability-eyes closed) conditions. High-frequency VOR gains decreased, but mid-frequency VOR gains were not significantly affected by alcohol intake. In addition, time constants were reduced significantly after alcohol ingestion in both clockwise and counter-clockwise rotation. Phase lead in SHA test and SVV/SVH was not affected by alcohol intake. Conclusion: Acute alcohol intake affected postural stability, high-acceleration head impulses, and the velocity storage mechanism. Full article