Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Western University, London, ON, Canada.
Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada.
J Shoulder Elbow Surg. 2019 May;28(5):974-981. doi: 10.1016/j.jse.2018.11.040. Epub 2019 Feb 2.
The role of the anconeus in elbow stability has been a long-standing debate. Anatomic and electromyographic studies have suggested a potential role as a stabilizer. However, to our knowledge, no clinical or biomechanical studies have investigated its role in improving the stability of a combined lateral collateral ligament and common extensor origin (LCL + CEO)-deficient elbow.
Seven cadaveric upper extremities were mounted in an elbow motion simulator in the varus position. An injured model was created by sectioning of the CEO and the LCL. The anconeus tendon and its aponeurosis were sutured in a Krackow fashion and tensioned to 10 N and 20 N using a transosseous tunnel. Varus-valgus angles and ulnohumeral rotations were recorded using an electromagnetic tracking system during simulated active elbow flexion with the forearm pronated and supinated.
During active motion, the injured model resulted in a significant increase in varus angulation (P = .0001 for pronation; P = .001 for supination) and external rotation (P = .001 for pronation; P = .003 for supination) of the ulnohumeral articulation compared with the intact state. Tensioning of the anconeus significantly decreased the varus angulation (P = .006 for 10 N pronation; P = .0001 for 20 N pronation; P = .0001 for 10 N supination; P = .0001 for 20 N supination) and external rotation angle (P = .008 for 10 N pronation; P = .0001 for 20 N pronation; P = .0001 for 10 N supination; P = .0001 for 20 N supination) of the injured elbow.
In the highly unstable varus elbow orientation, anconeus tensioning restores the in vitro stability of a combined LCL + CEO-deficient elbow during simulated active motion with the forearm in both pronation and supination. These results may have several clinical implications in managing symptomatic lateral elbow instability.
鹰嘴在肘部稳定性中的作用一直存在争议。解剖学和肌电图研究表明其可能具有稳定作用。然而，据我们所知，尚无临床或生物力学研究探讨其在改善伴有外侧副韧带和共同伸肌起点（LCL+CEO）损伤的肘部稳定性中的作用。
将 7 个尸体上肢安装在肘运动模拟器中，使其处于外翻位置。通过切断 CEO 和 LCL 来创建损伤模型。采用 Krackow 缝合方式缝合鹰嘴肌腱及其腱膜，并在前臂旋前和旋后位通过经皮隧道分别以 10 N 和 20 N 的张力拉紧。使用电磁跟踪系统记录模拟主动肘屈伸时，在前臂旋前和旋后位时的外翻-内翻角度和尺肱旋转。
在主动运动中，与完整状态相比，损伤模型使外翻角度（旋前，P=0.0001；旋后，P=0.001）和外旋（旋前，P=0.001；旋后，P=0.003）显著增加。拉紧鹰嘴显著减小了外翻角度（旋前，10 N 时 P=0.006；20 N 时 P=0.0001；旋后，10 N 时 P=0.0001；20 N 时 P=0.0001）和外旋角度（旋前，10 N 时 P=0.008；20 N 时 P=0.0001；旋后，10 N 时 P=0.0001；20 N 时 P=0.0001）。
在高度不稳定的外翻肘位置，拉紧鹰嘴在模拟主动运动时恢复了伴有 LCL+CEO 损伤的肘部的体外稳定性，此时前臂处于旋前和旋后位。这些结果在管理有症状的外侧肘部不稳定方面可能具有多种临床意义。
