Arrigoni P, Luceri F, Cucchi D, Tamini J, Randelli P S
U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
Musculoskelet Surg. 2018 Oct;102(Suppl 1):85-91. doi: 10.1007/s12306-018-0554-8. Epub 2018 Oct 20.
The aim of this study is to describe a new surgical procedure to plicate the anterior bundle medial collateral ligament (aMCL) into its humeral footprint using a suture anchor, and to present the results of a preliminary clinical series.
Eight patients with posttraumatic medial elbow pain and signs of medial elbow instability underwent aMCL plication with suture anchors and decompression of ulnar nerve. Arthroscopic evaluation permitted to define signs of minor medial elbow instability; 70°-scope was used to document from an intra-articular point of view of the aMCL status. The patients were then retrospectively evaluated with the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPI) and single-assessment numeric evaluation (SANE) by an independent examiner.
In all cases, the 70°-scope allowed direct visualization of the aMCL. Lateral subluxation of the coronoid process into the trochlea was observed in all patients. Postoperative median SANE was 50 [35-74.5] points; postoperative median OES was 17 [15.5-31.5] points; postoperative median MEPI was 65 [57.5-72.5] points. None of the patients reported further episodes of medial elbow instability or pain and all patients returned to normal daily activities.
The 70°-scope arthroscopic evaluation of the joint allows a direct evaluation of the inner aMCL status. Lateral subluxation of the coronoid process into the trochlea was observed and can be considered a sign of minor medial elbow instability. Mini-open suture anchor aMCL plication is an original technique that enables an anatomic and minimally invasive ligament retension.
The authors introduce a valid and safe treatment of posttraumatic medial elbow laxity.
本研究旨在描述一种使用缝线锚钉将前束内侧副韧带（aMCL）折叠至其肱骨附着点的新手术方法，并展示初步临床系列的结果。
8例创伤后内侧肘部疼痛且有内侧肘部不稳定体征的患者接受了缝线锚钉aMCL折叠术及尺神经减压术。关节镜评估用于确定轻度内侧肘部不稳定的体征；使用70°关节镜从关节内视角记录aMCL的状态。然后由一名独立检查者采用牛津肘部评分（OES）、梅奥肘部功能评分（MEPI）和单评估数字评价（SANE）对患者进行回顾性评估。
在所有病例中，70°关节镜均可直接观察到aMCL。所有患者均观察到冠状突向滑车外侧半脱位。术后SANE中位数为50[35 - 74.5]分；术后OES中位数为17[15.5 - 31.5]分；术后MEPI中位数为65[57.5 - 72.5]分。所有患者均未报告内侧肘部不稳定或疼痛的进一步发作，且所有患者均恢复了正常日常活动。
70°关节镜对关节的评估可直接评估aMCL内部状态。观察到冠状突向滑车外侧半脱位，可将其视为轻度内侧肘部不稳定的体征。小切口缝线锚钉aMCL折叠术是一种能够实现解剖学和微创韧带复位的原创技术。
作者介绍了一种有效且安全的创伤后内侧肘部松弛的治疗方法。
