Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

Research progress of posteromedial rotatory instability of the elbow / 中国修复重建外科杂志

Results: The most important factors related to PMRI of the elbow joint are lateral collateral ligament complex (LCLC) lesion, posterior bundle of the medial collateral ligament complex (MCLC) lesion, and anteromedial coronoid fracture. Clinical physical examination include varus and valgus stress test of the elbow joint. X-ray examination, computed tomography, particularly three-dimensional reconstruction, are particularly useful to diagnose the fracture. Also MRI, arthroscopy, and dynamic ultrasound can assistantly evaluate the affiliated injury of the parenchyma. It is important to repair and reconstruct LCLC and MCLC and fix coronoid process fracture for recovering stability of the elbow joint. There are such ways to repair ligament injury as in situ repairation and functional reconstruction, which include direct suturation, borehole repairation, wire anchor repairation, and transplantation repairation etc. The methods for fixation of coronal fracture include screw fixation, plate fixation, unabsorbable suture fixation, and arthroscopy technology.

Posterolateral Rotatory Instability of the Elbow without Epiphyseal Injury in Children

Posterolateral rotatory instability of the elbow in the absence of epiphyseal injury is extremely rare in children. We present a case of 12-year-old child in whom recurrent dislocation of the elbow was associated with a stretched lateral ulnar collateral ligament. We performed surgical repair and reefing of a stretched lateral ulnar collateral ligament by using a suture anchor and a continuous locking suture in order to avoid donor site morbidity and damage of the growth plate, which could occur when a transosseous tunnel for reconstruction was made. At 12 months after operation, satisfactory symptom relief was observed with no evidence of recurrence.

Treatment of Posterolateral Rotatory Instability of the Knee

Injury of posterolateral corner is unusual, but it can cause disability due to severe instability and cartilage damage. However, the anatomical structures, diagnosis and treatment have not defined clearly yet. Posterolateral corner injury is regarded as the one of main factor to the results of failure in cruciate ligament reconstcution if it was undiagnosed and untreated. Diagnosis of postetolateral corner injury is consists of physical exam, radiographic finding, MRI, and arthroscopic findings. The treatment method of of postetolateral corner injury depends on the time and severity of injury. Anatomical reconstruction of posterolateral corner shows the better clinical outcome than non anatomical reconstructions, but the clinical results of long term follow up is still needed. Therefore, the aim of this article is to review the recent literature and to organize diagnosis and treatment of posterolateral corner injury

The Influence of Tibial Positioning on the Diagnostic Accuracy of Combined Posterior Cruciate Ligament and Posterolateral Rotatory Instability of the Knee

BACKGROUND: To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries. METHODS: Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30degrees and 90degrees of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons. RESULTS: In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion. CONCLUSIONS: In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.

A Comparison of Fibular Head Tunnel and Tibial Tunnel in the Reconstruction of a Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study compared the surgical results of various posterolateral corner sling methods performed through either the fibula head tunnel or tibia tunnel in patients with chronic PLRI (PosteroLateral Rotatory Instability). MATERIALS AND METHODS: Between January 1999 and October 2003, 20 and 19 patients who had undergone surgery for PCL (posterior cruciate ligament) tensioning and an ALB (anterolateral bundle) reconstruction through the fibula head tunnel or tibia tunnel, respectively and were followed up more than 1 year were enrolled in this study. RESULTS: The fibular head tunnel was found to be superior compared with the tibia tunnel method in terms of the operation time (36.5+/-7.5 versus 68.4+/-12.8) (p<0.0001), rotational stability (p= 0.0018) and IKDC objective score (p<0.0001). In the fibula head tunnel group, 85% of patients had an equal to normal or tighter than normal rotational stability in the tibial tunnel group with 63% having an equal to normal or tighter than normal side at the last evaluation. In the IKDC objective score, 85% of patients in the fibula head tunnel group had a rating B or higher at the last evaluation compared with 79% in the tibial tunnel group (p<0.0001). However there were no significant differences in anteroposterior stability and OAK score. CONCLUSION: The modified posterolateral corner sling through the fibula head tunnel produces better results in terms of a posterolateral rotational stability of grade II chronic PLRL in a combined PCL injury than that using the tibia tunnel method.

Delayed Posterolateral Rotatory Instability of the Elbow after Cubitus Varus : A Case Report / 대한정형외과학회잡지

Cubitus varus deformity of the elbow may not only cause cosmetic problems, but delayed functional deficiencies also. This case report demonstrated delayed posterolateral rotatory instability due to lateral collateral ligament complex avulsion long after posttraumatic cubitus varus. Satisfactory results were obtained using cubitus varus correction and reattachment of the lateral collateral ligament complex to the lateral epicondyle of the humerus.

Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Rotatory Instability with Fresh-frozen Achilles Tendon Allograft

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.

Management of Concomitant Posterolateral Rotatory Instability and Anterior Cruciate Ligament Injuries of the Knee / 대한정형외과학회잡지

PURPOSE: Many failures of anterior cruciate ligament (ACL) reconstruction are due to a failure to treat concomitant posterolateral rotatory instability (PLRI). We report the results of reconstruction in cases of combined PLRI and ACL injury. MATERIALS AND METHODS: From January 1998 to December 2002, 24 patients were followed-up for a mean of 25 months (range, 12 to 58), postoperatively. PLRI was treated using a biceps tenodesis or posterolateral corner sling (PLCS), through a proximal tibial or fibular head obliquely anteroinferiorly to posterosuperiorly. ACLs were reconstructed using autogenous hamstring 4 bundles with RIGIDfix(TM) on the femoral side and Intrafix(TM) with additional staple fixation on the tibial side. Clinical results were evaluated using the Orthopadishe Arbeitsgruppe Knie (OAK) and International Knee Documentation Committee (IKDC) knee scoring system. Stability was measured on pull varus stress radiographs using a Telos stress device and by using the manual maximum displacement test using a KT-1000(TM) arthrometer with 30 degrees of knee flexion. RESULTS: The mean side-to-side difference in anterior displacement measured on the pull stress radiographs was reduced from a preoperative 7.9+/-3.4 to 2.1+/-0.8 mm at the last follow-up, from 2.1+/-0.8 to 0.4+/-0.7mm on varus stress radiographs, and from 6.5+/-1.3 mm to 2.3+/-1.3 mm as measured using the KT-1000 arthrometer. The average OAK score improved from 64.1+/-11.9 to 84.4+/-9.2 points over the same period. At the final evaluation, 22 of the 24 patients (92%) had a satisfactory result according to the IKDC system. CONCLUSION: Based on our experience, we recommend arthroscopically assisted ACL reconstruction and the correction of concomitant PLRI in cases of combined ACL and posterolateral rotatory instability.

Arthroscopic Evaluation of Posterolateral Rotatory Instability of the Knee / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to confirm the efficacy of arthroscopic findings for the diagnosis of posterolateral rotatory instability (PLRI) of the knee. MATERIALS AND METHODS: We retrospectively evaluated 27 patients (28 cases) who had been operated upon for PLRI between February 1998 and June 2001. All patients underwent preoperative or intraoperative arthroscopic examinations including anterior/posterior cruciate ligament, popliteus tendon, inferior and superior popliteomeniscal fascicle, popliteofibular ligament, lateral meniscus, instability and abnormal popliteomeniscal motion for internal and external rotation. RESULTS: Instability, which means popliteal hiatus widening during internal rotation of the tibia, was identified in all cases (100%). Tear of the inferior and superior popliteomenical fascicle was identified in 24 cases (86%) and abnormal popliteomeniscal motion during rotation was identified in 20 cases (71%). Popliteus tendons were abnormal in 18 cases (65%) with 5 cases (19%) of complete tear and 13 cases (46%) of partial tear or elongation. CONCLUSION: These results suggest that arthroscopic evaluation of the popliteal hiatus structures in the patients suspected for PLRI of the knee is helpful for diagnosis and the determination of treatment modality.