Kim Young-Bok, Fitzsimmons James S, Bellato Enrico, O'Driscoll Shawn W, Jang Hyo Seok, Kim Dae-Wook
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Clin Shoulder Elb. 2024 Dec;27(4):419-427. doi: 10.5397/cise.2024.00416. Epub 2024 Nov 29.
The purpose of this study is to describe anterolateral rotatory instability (ALRI) as a possible etiology of primary osteoarthritis (OA) of the elbow.
We examined 76 fresh frozen cadaveric elbows (male:female, 56:20; mean age, 81 years) for patterns of cartilage erosion that could be due to ALRI. These included erosions on the lateral trochlear ridge (LTR) lesion, crescent rim of the radial head (RC) lesion or the ventral capitellum (VC) lesion. The extent and location of the lesions were mapped by image processing of photographs of the humeral and radial articular surfaces, and the degeneration of the articular surface was graded.
Ten of 76 specimens (13%) had one or more lesions consistent with ALRI. LTR lesions were most common and were seen in 10 of 10 specimens (100%), typically involving the distal 30% of the LTR. RC lesions were seen in 9 of 10 and were located on anteromedial crescent of the radial head ranging from 6 to 10 o'clock. VC lesions were seen in 8 of 10 specimens directed anteroinferiorly about 60° to the long axis of the humerus.
ALRI is a possible mechanism initiating primary OA of the elbow. It has a characteristic pattern of triple lesions involving the LTR, the RC, and the VC. Level of evidence: IV.
本研究的目的是描述前外侧旋转不稳定（ALRI）作为肘关节原发性骨关节炎（OA）的一种可能病因。
我们检查了76个新鲜冷冻的尸体肘关节（男:女，56:20；平均年龄81岁），以寻找可能由ALRI导致的软骨侵蚀模式。这些包括外侧滑车嵴（LTR）病变、桡骨头新月形边缘（RC）病变或肱骨小头腹侧（VC）病变处的侵蚀。通过对肱骨和桡骨关节面照片进行图像处理来描绘病变的范围和位置，并对关节面的退变进行分级。
76个标本中有10个（13%）存在一处或多处与ALRI相符的病变。LTR病变最为常见，在10个标本中有10个（100%）出现，通常累及LTR的远端30%。RC病变在10个中有9个出现，位于桡骨头的前内侧新月形区域，范围在6点至10点。VC病变在10个标本中有8个出现，方向为前下，与肱骨长轴成约60°角。
ALRI是引发肘关节原发性OA的一种可能机制。它具有涉及LTR、RC和VC的三联病变特征模式。证据等级：IV级。
