Olsen B S, Søjbjerg J O, Nielsen K K, Vaesel M T, Dalstra M, Sneppen O
Biomechanics Laboratory, University Hospital of Aarhus, Denmark.
J Shoulder Elbow Surg. 1998 Jan-Feb;7(1):19-29. doi: 10.1016/s1058-2746(98)90179-3.
Thirty-five osteoligamentous elbows were included in a study on the kinematics of posterolateral elbow joint instability during the pivot shift test (PST) before and after separate ligament cuttings in the lateral collateral ligament complex (LCLC). Division of the annular ligament or the lateral ulnar collateral ligament caused no laxity during the PST. Division of the lateral collateral ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the lateral collateral ligament to be the primary soft tissue constraint to PST stress and the annular ligament and the lateral ulnar collateral ligament to be only secondary constraints. This study indicates that the integrity of the medial collateral elbow ligaments should be evaluated during forced valgus in pronation or neutral forearm rotation. Furthermore an isometric lateral collateral ligament reconstruction was shown to correct the joint laxity introduced by total LCLC transection.
35个骨韧带性肘关节被纳入一项关于外侧副韧带复合体（LCLC）各韧带切断前后在 pivot shift试验（PST）期间后外侧肘关节不稳定的运动学研究。在PST期间，环状韧带或尺侧副韧带的切断未引起松弛。外侧副韧带切断在旋前和外旋（旋后）位的强制PST期间分别导致最大4度和23度的松弛。对于任何因PST应力导致的肘关节松弛，必须在尺侧或肱骨附着点切断LCLC。LCLC完全切断在旋前和外旋（旋后）位的强制PST期间分别导致最大7.9度和37度的松弛。本研究表明外侧副韧带是PST应力的主要软组织约束，而环状韧带和尺侧副韧带仅是次要约束。本研究表明，在旋前或前臂中立位的强制旋前时应评估内侧副肘关节韧带的完整性。此外，等长外侧副韧带重建显示可纠正LCLC完全横断所导致的关节松弛。
