Arrigoni Paolo, Cucchi Davide, D'Ambrosi Riccardo, Menon Alessandra, Aliprandi Alberto, Randelli Pietro
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2264-2270. doi: 10.1007/s00167-017-4531-9. Epub 2017 Mar 23.
Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow.
Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated.
SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up.
R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention.
Retrospective case series, Level IV.
轻微不稳定被认为是外侧肘部疼痛的一种可能病因。本研究展示了外侧副韧带（R-LCL）桡侧部分关节镜下折叠术减少外侧肘部轻微不稳定的结果。
纳入27例保守治疗失败、既往无创伤或明显不稳定的顽固性外侧上髁炎患者。在存在至少一项外侧韧带松弛迹象和一项关节内异常发现的情况下进行R-LCL折叠术。评估单评估数字评价（SANE）、牛津肘部评分（OES）、快速上肢功能障碍评分（quickDASH）、患者满意度和术后活动范围。
SANE评分从术前中位数30[2-40]分提高到末次随访时的90[80-100]分（p<0.0001），96.3%的患者获得了良好或优秀的主观结果。术后quickDASH中位数为9.1[0-25]分，OES为42[34-48]分。术后屈曲中位数为145°，伸展为0°。7例患者术后屈曲受限，8例患者伸展受限；59%的患者在末次随访时达到了全关节活动范围。
在中位随访2年时，R-LCL折叠术在有症状的外侧肘部轻微不稳定（SMILE）患者中产生了主观满意度和积极的临床结果。活动范围略有受限是该干预可能产生的不良后果。
回顾性病例系列，IV级。
