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Koukos C, Kotsapas M, Sidiropoulos K, Traverso A, Bilsel K, Montoya F, Arrigoni P. A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity. J Clin Med 2024; 13:2411. [PMID: 38673685 PMCID: PMC11051432 DOI: 10.3390/jcm13082411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.
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Affiliation(s)
- Christos Koukos
- Medical Center Wuppertal, 42329 Wuppertal, Germany;
- Sports Trauma and Pain Ιnstitute, 54655 Thessaloniki, Greece
| | - Michail Kotsapas
- Orthopaedic Department, General Hospital of Naousa, 59200 Naousa, Greece
| | - Konstantinos Sidiropoulos
- Medical School of Patras, University of Patras, 26504 Patras, Greece
- Emergency Department, Papageorgiou General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Aurélien Traverso
- Orthopaedic Department, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- ASST Pini-CTO, 20122 Milan, Italy
| | - Kerem Bilsel
- Faculty of Medicine, Acibadem Mehmet Ali Aydınlar University, 34752 Instanbul, Turkey;
- Orthopaedics and Traumatology Department, FulyaAcibadem Hospital, 34349 Instanbul, Turkey
| | - Fredy Montoya
- Sanatorio Aleman Clinic, Universidad de Concepcion, Concepcion 4070386, Chile;
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Ito T, Mifune Y, Inui A, Nishimoto H, Kuroda R. Lateral Collateral Ligament Reconstruction Using the Triceps Brachii Fascia for Posterolateral Rotatory Instability in Cubitus Varus: A Report of Two Cases. Cureus 2024; 16:e54530. [PMID: 38516447 PMCID: PMC10956481 DOI: 10.7759/cureus.54530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
A combination of osteotomy and ligament reconstruction is recommended for posterolateral rotatory instability (PLRI) with large cubitus varus deformities. There is a lack of reports regarding ligament donor selection for ligament reconstruction of PLRI with cubitus varus. Two cases of PLRI with cubitus varus have been described. In case one, a 40-year-old woman presented with left elbow pain. She had a cubitus varus deformity, resulting from a childhood elbow fracture. Radiographs showed an 18-degree cubitus varus deformity. A lateral closing wedge osteotomy and double plate osteosynthesis were performed. The lateral collateral ligament (LCL) was reconstructed with autologous triceps fascia. Postoperative radiographs confirmed correction with 10 degrees of the carrying angle (CA). Bone union at the osteotomy site occurred six months later with excellent results. In case two, a 45-year-old man presented an arm with persistent right elbow instability with cubitus varus deformity. This was due to a childhood supracondylar fracture of the right humerus. Radiographs showed a cubitus varus deformity of 25 degrees on the right. The surgical procedure included a lateral wedge osteotomy, double plate fixation, and LCL reconstruction with autologous triceps fascia. Postoperative radiographs confirmed a corrected CA of 5 degrees. Bone union was achieved at the six-month follow-up with satisfactory results. The use of triceps fascia for LCL reconstruction for PLRI due to cubitus varus would provide a minimally invasive and reasonable treatment option.
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Affiliation(s)
- Tatsuya Ito
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
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Wright MA, Deal JB, Schiffman BA, Gould HP, Forthman CL, Murthi AM. No difference in torque load to failure between split anconeus fascia transfer and autograft palmaris longus tendon for reconstruction of the lateral ulnar collateral ligament. JSES Int 2024; 8:232-235. [PMID: 38312284 PMCID: PMC10837686 DOI: 10.1016/j.jseint.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The split anconeus fascia transfer (SAFT) is an option for reconstruction of the lateral ulnar collateral ligament (LUCL) in chronic posterolateral rotatory instability (PLRI) of the elbow with potential advantages of using only local tissue within the surgical exposure and not requiring ulnar fixation. This study aimed to assess SAFT strength compared to a traditional free graft reconstruction in a PLRI biomechanical model. Methods To measure biomechanical strength, eight cadaveric upper extremity pairs were utilized. Within each pair, one specimen was randomly assigned to LUCL reconstruction with autograft palmaris longus and the other to SAFT reconstruction. Torque load to failure was assessed on a load frame with the elbow in 30 degrees of flexion, 5 degrees of valgus, and 25 N axial load as the elbow was brought into external rotation. Torque load to failure was compared between the two reconstruction techniques. Results No difference was found in the torque load to failure between SAFT specimens compared to palmaris longus autograft specimens (mean 14.6 ± 4.4 Nm vs. mean 11.3 ± 3.9 Nm; P = .16). Discussion In this biomechanical study, the SAFT LUCL reconstruction provided torque load to failure similar to that of the traditional technique. These findings suggest that the SAFT technique warrants continued study as a biomechanically sound option for LUCL reconstruction in the setting of elbow PLRI.
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Affiliation(s)
- Melissa A Wright
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - J Banks Deal
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brett A Schiffman
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Anand M Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Dimitrov N, Tsenkov T. Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability. J Orthop Sci 2023:S0949-2658(23)00327-5. [PMID: 38044214 DOI: 10.1016/j.jos.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE The adopted treatment for chronic elbow PLRI is lateral ulnar collateral ligament reconstruction. However, the most frequently reported complication after primary reconstruction is recurrent instability - up to 25 %. It was thus hypothesized that enhancing the secondary stabilizers will provide successful results with a lower rate of recurrent instability in comparison to techniques with primary reconstruction only. This study aimed to demonstrate a novel surgical technique involving secondary stabilizers. METHODS In this retrospective study of 29 cases with chronic PLRI the mean duration of symptoms was 39.6 ± 4.9 months. The mean age was 47.9 years with mainly male patients. The surgeries were performed by one senior surgeon at a single institution. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) were recorded. RESULTS The mean follow-up was 36.8 ± 7.7 months. The MEPS score improved significantly from 59.8 ± 13.1 to 84.7 ± 7.6 (p < 0.001). 23/29 patients (79.2 %) had converted to good and excellent results (MEPS >75 points). The DASH score improved from 40.8 ± 4.6 to 20.9 ± 7.2 (p < 0.001). The total complication rate was 10.3 % (N = 3). No recurrent instability was recorded in comparison to 12.2 % for primary reconstruction only, as reported in the literature (p < 0.05). CONCLUSION Enhancing the secondary stabilizers by utilizing an adjacently located autograft provided good and excellent results with no recurrent instability. This novel surgical procedure is easy to reproduce and provides a safe and reliable alternative in cases of chronic PLRI when compared to techniques with primary reconstruction only.
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Affiliation(s)
- Nikolay Dimitrov
- University Hospital of Orthopaedics "Prof. B. Boichev", Medical University of Sofia, Sofia, Bulgaria
| | - Tsvetan Tsenkov
- University Hospital of Orthopaedics "Prof. B. Boichev", Medical University of Sofia, Sofia, Bulgaria.
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Axford DT, Badre A, Johnson JA, King GJW. The effect of lateral collateral ligament repair tension on elbow stability: An in vitro biomechanical study. Clin Biomech (Bristol, Avon) 2023; 109:106101. [PMID: 37748380 DOI: 10.1016/j.clinbiomech.2023.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The aim of this study was to determine the optimal repair tension of the lateral collateral ligament of the elbow by performing simulated active flexion with the arm in the varus gravity loaded position using an in vitro elbow simulator. METHODS Eight cadaveric specimens were mounted in the varus gravity loaded orientation onto an elbow motion simulator. Four states were studied (intact, lateral collateral ligament injured, and 15 N and 20 N lateral collateral ligament repairs) with the forearm in supination and pronation. An electromagnetic tracking system was used to measure joint kinematics during active elbow flexion. FINDINGS There was no difference in ulnohumeral rotation between the intact state and the 15 N repair (P = .150 for pronation; P = 1.0 for supination) or the 20 N repair (P = 1.0 for pronation; P = .568 for supination). For varus-valgus angulation, the 20 N repair was not statistically different from the intact state (P = .059 in pronation; P = 1.0 in supination). INTERPRETATION Repair of the lateral collateral ligament following injury can restore joint kinematics with the arm in the varus position. A repair tension of 20 N was successful in restoring joint stability for simulated active motion with the forearm in pronation and supination. This study shows that when the lateral collateral ligament is repaired with adequate tension, avoidance of the varus position may not be as crucial during early motion.
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Affiliation(s)
- David T Axford
- Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.
| | - Armin Badre
- Western Hand & Upper Limb Facility, Sturgeon Hospital, St. Albert, Alberta, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - James A Johnson
- Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Graham J W King
- Western Hand & Upper Limb Facility, Sturgeon Hospital, St. Albert, Alberta, Canada; Division of Orthopaedic Surgery, Department of Surgery, Western University, London, Ontario, Canada
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Bachmaier S, Wijdicks CA, Verma NN, Higgins LD, Greiner S. Biomechanical Stability of Lateral Ulnar Collateral Ligament Reconstruction and Repair of the Elbow: The Role of Ligament Bracing on Gap Formation and Stabilization. Am J Sports Med 2023; 51:1303-1311. [PMID: 36876745 DOI: 10.1177/03635465231157735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Augmented (internal braced) lateral ulnar collateral ligament (LUCL) repair has been biomechanically compared with reconstruction techniques in the elbow. However, LUCL repair alone has not yet been compared with augmented repair and reconstruction techniques. HYPOTHESIS Internal bracing of LUCL repair would improve time-zero stabilization regarding gap formation, stiffness, and residual torque as compared with repair alone and reconstruction techniques to restore native elbow stability. STUDY DESIGN Controlled laboratory study. METHODS Overall, 24 cadaveric elbows were used for either internal braced LUCL repair (Repair-IB) or single- and double-strand ligament reconstruction with triceps (Recon-TR) and palmaris longus tendon graft (Recon-PL), respectively. Laxity testing in external rotation was consecutively performed at 90° of elbow flexion on the intact, dissected, and repaired conditions and with the previously assigned techniques. First, intact elbows were loaded to 7.0-N·m external torque to evaluate time-zero ligament rotations at 2.5, 4.0, 5.5, and 7.0 N·m. Rotation-controlled cycling was performed (total of 1000 cycles) for each surgical condition. Gapping, stiffness, and residual torque were analyzed. Finally, these and 8 additional intact elbows underwent torque-to-failure testing (30 deg/min). RESULTS The dissected state showed the highest gap formation and lowest peak torques (P < .001). While gap formation of Repair-IB (P < .021) was significantly lower than that of repair without internal bracing at all rotation levels, gaps of Recon-PL were similar to and Recon-TR were significantly higher than those of Repair-IB except for the highest torsion level. Residual peak torques at specific rotation angles between native state and Recon-TR (α2.5), Recon-PL (α4.0), and Repair-IB (α5.5) were similar; all other comparisons were significantly different (P < .027). Torsional stiffness of Repair-IB was significantly higher at all rotation angles measured. Analysis of covariance showed significantly less gap formation over residual peak torques for Repair-IB (P < .001) as compared with all other groups. The native state failure load was significantly higher than Recon-PL and Recon-TR failure loads, with similar stiffness to all other groups. CONCLUSION Repair-IB and Recon-PL of the LUCL showed increased rotational stiffness relative to the intact elbow for restoring posterolateral stability to the native state in a cadaveric model. Recon-TR demonstrated lower residual peak torques but provided near-native rotational stiffness. CLINICAL RELEVANCE Internal bracing of LUCL repair may reduce suture-tearing effects through tissue and provide sufficient stabilization for healing throughout accelerated and reliable recovery without the need for a tendon graft.
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Affiliation(s)
| | - Coen A Wijdicks
- Arthrex Department of Research and Development, Munich, Germany
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Tranier M, Bacle G, Marteau E, Sos C, Laulan J, Roulet S. Lateral elbow ligament reconstruction for posterolateral rotatory instability: 10 years follow-up in 32 patients. JSES Int 2023; 7:357-363. [PMID: 36911761 PMCID: PMC9998886 DOI: 10.1016/j.jseint.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Posterolateral rotatory instability (PLRI) is the most frequent form of both acute and chronic elbow instability. It is due to mechanical incompetence of the lateral collateral ligament. O'Driscoll et al described treatment of this instability by autologous reconstruction of the lateral ulnar collateral ligament. The aim of our study was to evaluate the medium and long-term clinical, functional and radiological results of patients who were surgically treated for PLRI by this technique. We hypothesized that such ligament reconstruction restores a functional joint complex and durably stabilizes the elbow and limits the long-term risk of osteoarthritis. Methods All patients treated for symptomatic PLRI by ligament reconstruction since January 1995 and who had a minimum follow-up of 36 months were retrospectively included. Results Thirty-two patients (32 elbows) underwent clinical and radiological evaluation with a mean follow-up of 112 months (range, 36-265 months). The success rate of the procedure was 97% with one patient requiring revision reconstruction. Twenty-four patients (75%) were free from pain. Pain was significantly greater in patients with associated lesions (P = .03) and those with morbid obesity (body mass index ≥40) (P = .03). Twenty-nine (91%) patients had resumed their previous activities. Twenty-eight patients (87%) were satisfied or very satisfied. The mean Mayo Clinic score was 96/100 and the QuickDash 14.7/100. Two patients (6%) with accompanying lesions developed severe osteoarthritis. Conclusion Elbow ligament reconstruction by the technique of O'Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term. The only failure in our series was due to several technical errors. Patients who had dislocation with associated lesions or morbid obesity are at risk of poorer functional results.
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Affiliation(s)
- Manon Tranier
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Guillaume Bacle
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Emilie Marteau
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Clara Sos
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Jacky Laulan
- Department of Orthopedic Surgery, Hand and Peripheral Nerve Surgery Unit, Trousseau University Hospital of Tours, Medical University François Rabelais of Tours, Tours, France
| | - Steven Roulet
- ELSAN, Clinique Belledonne, France.,Centre de l'Épaule et de la Main du Dauphiné - Groupe Chirurgical Verdun, Grenoble, France
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Lytle J, Meyers A, Ballard E, Fallahi AK, Nelson R. Global elbow instability: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:120-124. [PMID: 37588066 PMCID: PMC10426550 DOI: 10.1016/j.xrrt.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Jacob Lytle
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Amy Meyers
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Eric Ballard
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | | | - Ryan Nelson
- Greater Michigan Orthopedics, Grand Blanc, MI, USA
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Postoperative MR Imaging of the Elbow. Magn Reson Imaging Clin N Am 2022; 30:629-643. [DOI: 10.1016/j.mric.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Celli A, Paroni C, Bonucci P, Celli L. Elbow lateral ulnar collateral ligament reconstruction by transposition of the local extensor fascia septum: surgical technique and preliminary results. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:360-368. [PMID: 37588856 PMCID: PMC10426691 DOI: 10.1016/j.xrrt.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The lateral ulnar collateral ligament (LUCL) is a primary lateral stabilizer of the elbow that originates from the isometric center of the capitulum and inserts into the supinator crest of the ulna. LUCL injury may be due to trauma, chronic strain, or iatrogenic lesion. In patients with symptomatic LUCL insufficiency and recurrent posterolateral rotatory instability, surgical reconstruction can restore elbow stability. In primary acute treatment, the injured LUCL is reattached to the lateral epicondyle with transosseous sutures and anchors placed at the isometric origin of the ligament. If the ligament quality is poor, patients with chronic elbow instability may require reconstruction with a tendon autograft or allograft. Alternatively, the LUCL can be reconstructed by transposition of the local extensor fascia septum, a local flap that exploits the common extensor fascia connected to a thin strip of extensor digitorum quinti or the extensor digitorum communis intermuscular septum. We describe a new LUCL reconstruction technique based on the transposition of the local extensor fascia septum and report the preliminary result in a series of patients aged 50 years or less.
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Affiliation(s)
- Andrea Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
| | - Chiara Paroni
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
| | - Pierluigi Bonucci
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
| | - Luigi Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
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Zhang J. University Network and New Media Advertising Teaching Design Features and Influence: Environmental Perspective Analysis in Campus Humanistic Governance. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:6380719. [PMID: 35910756 PMCID: PMC9334032 DOI: 10.1155/2022/6380719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
Under the background of network development in the new era, the integration of multimedia technology and information technology promotes the development of teaching environment. Based on the influence of humanistic governance environment, the university network environment and the advertising teaching environment are constantly integrating new elements with the development of the times, becoming the key point to guarantee the teaching quality. In the research, the relevant data and information were collected and analyzed by the methods of inference and induction analysis. According to the sensory parameters of students' cognitive emotions (n = 64, a > 0.847), the standard deviation was 0.810/0.695 and the action was 0.927/0.655. How to construct the university network and advertising teaching environment were explored. And, in view of the design of the environment characteristics as well as the impact on students, the purpose was to ensure that students had a good learning environment, which could improve the learning efficiency.
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Affiliation(s)
- Jing Zhang
- Department of Literature, Modern College, Northwest University, Xi'an 710130, China
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Schneider MM, Müller K, Hollinger B, Nietschke R, Zimmerer A, Ries C, Burkhart KJ. Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability After Failed Common Extensor Origin Release: Outcomes at Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671211069340. [PMID: 35155705 PMCID: PMC8832605 DOI: 10.1177/23259671211069340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In patients with chronic lateral epicondylitis who have failed nonoperative treatment, open or percutaneous release of the common extensor origin (CEO) without subsequent reconstruction tends to result in good clinical outcomes. However, surgery can lead to iatrogenic injuries of the lateral collateral ligamentous complex, causing posterolateral rotatory instability (PLRI). Purpose: To determine the clinical outcomes of lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon graft after failed open CEO surgery. Study Design: Case series; Level of evidence, 4. Methods: A total of 103, patients underwent revision surgery at a single institution because of PLRI after failed open release of the CEO (Hohmann procedure) between January 2007 and October 2016. The primary surgery had been performed at other institutions in all cases. Of these patients, 72 were available for follow-up (49 by clinical examination, 23 by telephone interview). Standardized clinical examination; Mayo Elbow Performance Score (MEPS); 11-item version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH); subjective elbow value (SEV); and patient satisfaction were assessed at least 2 years after LUCL reconstruction. Results: The mean age of patients in the study was 46.9 years (range, 21-74 years), and the mean follow-up was 2.8 years after revision surgery. The mean MEPS was 78.9, and the mean QuickDASH score reached 20.4. The mean SEV was 78.6%, and 75% of the patients rated the surgery as good to excellent. Complications were detected in 14% of the patients, and 9 needed revision surgery, primarily owing to graft failure with recurrent instability (n = 5). Conclusion: LUCL reconstruction in patients with PLRI after release of the CEO can restore elbow stability and achieve high patient satisfaction. However, outcome scores and revision rates in this cohort were inferior to published outcomes of primary LUCL reconstruction for treatment of noniatrogenic or traumatic PLRI.
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Affiliation(s)
- Marco M. Schneider
- Arcus Sportklinik, Pforzheim, Germany
- University Witten/Herdecke, Witten, Germany
| | | | - Boris Hollinger
- Orthopädische Klinik Markgröningen, Abteilung Sportorthopädie, Markgröningen, Germany
| | | | | | - Christian Ries
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus J. Burkhart
- Arcus Sportklinik, Pforzheim, Germany
- University of Cologne, Cologne, Germany
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