Wrightington Upper Limb Unit, Wrightington Wigan and Leigh NHS Trust, Wigan, UK; Department of Orthopedics, Laniado Hospital, Netanya, Israel.
Wrightington Upper Limb Unit, Wrightington Wigan and Leigh NHS Trust, Wigan, UK.
J Shoulder Elbow Surg. 2024 Mar;33(3):573-582. doi: 10.1016/j.jse.2023.08.033. Epub 2023 Sep 30.
The posterolateral capsule was recognized in the past as an important structure for elbow stability but was later disregarded. Two recent biomechanical studies demonstrated its role in preventing posterolateral instability, and thus it should be identified as a distinct ligament: the posterolateral ligament (PLL). This study includes 2 parts: an anatomic study of the PLL's footprint and a collection of 5 cases of pathologic lesions of the PLL.
Six cadaveric upper limbs were assessed. The attachments of the PLL were dissected, the footprints were marked and photographed, and the 2-dimensional area and length were measured.
The mean proximal attachment dimensions were a length of 13 mm and an area of 101 mm, and the mean distal attachment dimensions were 19 mm and 111 mm, respectively. There were 2 cases of posterolateral elbow pain in professional cricket bowlers, diagnosed radiographically as enthesopathy of the PLL's proximal attachment on the posterior capitellum, probably due to repeated forced hyperextension of the elbow. Both patients were treated by débridement of the posterior capitellum and reattachment of the PLL, with complete resolution of symptoms. In addition, there were 3 cases of clinical posterolateral rotatory instability in young patients. Two athletes had an isolated acute tear of the PLL, and on physical examination, both had positive posterior draw test results but negative pivot-shift test results. Both underwent elbow arthroscopy and repair of the PLL with resolution of symptoms. The third patient had long-standing recurrent elbow instability, following a failed lateral ulnar collateral ligament reconstruction, in the presence of an Osborne-Cotterill lesion. He underwent revision lateral ulnar collateral ligament reconstruction, bone grafting of the bony lesion, and reattachment of the PLL, with complete resolution of symptomatic posterolateral rotatory instability.
The PLL of the elbow has a significant role in the elbow's posterolateral stability. Its footprints were described, and its clinical significance was demonstrated in cases of elbow instability caused by acute ligament tears and elbow pain due to ligament enthesopathy. Surgeons should be aware of this structure and potential pathology related to its injury.
既往，人们认为后外侧囊是维持肘关节稳定的重要结构，但后来被忽视。最近的两项生物力学研究表明其在防止后外侧不稳定方面起作用，因此应将其确定为一个独特的韧带：后外侧韧带（PLL）。本研究包括 2 部分：PLL 止点的解剖学研究和 PLL 病变 5 例的收集。
评估了 6 例尸体上肢。解剖 PLL 的附着点，标记并拍摄止点，测量二维面积和长度。
平均近端附着尺寸为 13mm 长和 101mm2 面积，平均远端附着尺寸为 19mm 长和 111mm2 面积。在职业板球投球手中有 2 例出现肘后外侧疼痛，放射学诊断为 PLL 近端附着于后肱骨小头的附着病，可能是由于反复强迫性肘过伸。这 2 例患者均行肱骨小头后缘清理和 PLL 再附着，症状完全缓解。此外，还有 3 例年轻患者出现临床后外侧旋转不稳定。2 例运动员 PLL 急性撕裂，体格检查时，后抽屉试验均为阳性，而轴移试验均为阴性。均行关节镜下 PLL 修复，症状缓解。第 3 例患者在外侧尺侧副韧带重建失败后，出现长期复发性肘不稳定，伴有 Osborne-Cotterill 病变。行外侧尺侧副韧带重建翻修、骨病变植骨和 PLL 再附着，症状性后外侧旋转不稳定完全缓解。
肘部 PLL 在肘部后外侧稳定性方面具有重要作用。描述了其止点，并通过急性韧带撕裂引起的肘不稳定和韧带附着病引起的肘痛病例展示了其临床意义。外科医生应该了解该结构及其相关损伤的潜在病理。
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