Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, South Korea.
Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
Int Orthop. 2024 Jan;48(1):143-150. doi: 10.1007/s00264-023-06046-8. Epub 2023 Dec 13.
To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy.
Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow.
The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157).
Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.
评估外侧副韧带复合体损伤导致的肘不稳定是否可以通过关节镜可靠地评估。
将 8 个新鲜的人体尸体肘部置于模拟侧卧位。使用来自后外侧观察通道的不同大小的探针测量桡肱关节（RCJ）间隙和尺肱关节（UHJ）间隙（mm）。RCJ 间隙测量时肘部屈曲 90 度，前臂中立位旋转；UHJ 间隙测量时肘部屈曲 30 度，完全旋前。对每个标本进行从阶段 0 到阶段 3 的连续测试（阶段 0：完整；阶段 1：前 1/3 外侧副韧带复合体释放；阶段 2：前 2/3 外侧副韧带复合体释放；阶段 3：整个外侧副韧带复合体释放）。用完整肘部的 RCJ 和外侧 UHJ 的平均间隙进行各阶段之间的比较。
与阶段 0 相比，阶段 2 和阶段 3 的 RCJ 平均间隙距离明显增加（阶段 0 与阶段 2：P=0.008；阶段 0 与阶段 3：P=0.010）。阶段 1、阶段 2 和阶段 3 的 UHJ 平均间隙距离明显大于阶段 0（阶段 0 与阶段 1：P=0.025；阶段 0 与阶段 2：P=0.010；阶段 0 与阶段 3：P=0.011）。相比之下，前 1/3 外侧副韧带复合体的释放（阶段 1）与 RCJ 的平均关节间隙距离相比没有明显增加（P=0.157）。
RCJ 和 UHJ 关节间隙增宽的关节镜测量是一种可靠的评估方法，可检测涉及前 2/3 或更多的外侧副韧带复合体缺陷。
