Relationship Between Objective and Subjective Markers of Muscle Recovery in Professional Handball Players.

PURPOSE: To evaluate the relationship between items of the Short Recovery and Stress Scale (SRSS) related to physical stress and recovery and the biomarker creatine kinase (CK) in professional handball. METHODS: CK and SRSS items (physical performance capability, overall recovery, muscular stress, and overall stress) were assessed in an observational study of 16 adult male professional handball players from a team in the highest German league during the 2019-20 preseason. Their preseason training schedule included several microcycles, each consisting of 3 consecutive days of intense training followed by a rest day. On 5 of these rest days, when players were classified as nonrested, and the 5 immediately following days, when players were classified as rested, players completed the SRSS between 8:00 and 9:00 AM, followed by blood sampling. Correlations between SRSS items were performed using Kendall τ. The relationship between each SRSS item and CK levels over time was examined using a mixed-effects model with a random intercept. RESULTS: CK levels and SRSS stress items were significantly higher and SRSS recovery items were significantly lower in nonrested players. SRSS items were significantly positively or negatively correlated (all items: P < .001) and showed a significant effect indicating lower CK levels in rested players (all items: P ≤ .001; ηp2=.1-.32). CONCLUSIONS: The investigated SRSS items may be a viable option for assessing muscle recovery in adult male professional handball players in a cost-effective and noninvasive manner. They can be used as a single monitoring tool or as part of a multimodal approach.

Mini-open vs. arthroscopic double tight-rope reconstruction after acute AC-joint dislocation: a comparison in functional outcome and sports activity.

INTRODUCTION: In athletes, acromioclavicular joint disruptions account for up to 50% of all shoulder injuries. In high-grade injuries, surgery is favored to ensure a correct restoration of the joint, especially in young athletes. The aim of this study was to compare the clinical, radiological and sport related outcomes of the arthroscopic stabilization with the fixation of the AC joint in a mini-open approach. MATERIALS AND METHODS: 19 patients treated arthroscopically (ASK) and 26 patients with an acute AC-joint dislocation Rockwood V who had undergone the mini-open (MO) surgery were included. Constant Murley Score (CMS), Taft Score (TS) and the Simple Shoulder Tests (SST) were evaluated. The sports activity level was determined according to Valderrabano and the athlete's recovery of their athletic activity level after surgery according to Rhee. Furthermore, all available X-ray images were analyzed. RESULTS: Patients in the ASK group achieved an average score of 11.7 ± 0.6 points in the SST, 10.3 ± 1.8 points in the TS and 91.2 ± 11.8 points in the CMS. On average, patients in the MO group achieved results of 10.5 ± 1.4 points in the SST, 11.7 ± 0.7 points in the TS and 91.6 ± 9.8 points in the CMS. The ASK group showed significant difference regarding the CC distance in side comparison (Δ = 3.6 mm), whereas no significant difference was found in the MO group (Δ = 0.8 mm). In comparison of both groups, the posterior as well as the combined translation were significantly greater in the ASK group than in the MO group (posterior: ASK: 24.8 mm, MO: 19.3 mm, combined: ASK: 29.1 mm, MO: 20.9 mm). Residual horizontal instability was greater in the ASK group (43%) than in the MO group (32%). Similar results were achieved in sports activity and the recovery of athletic activity (Valderrabano: ASK: 2.8, MO: 2.6; Rhee: ASK: 1.6, MO: 1.5). CONCLUSIONS: Both techniques prove to be effective for the stabilization of high-grade AC-joint disruptions in athletes and showed excellent clinical results. From a radiographic standpoint, the mini-open procedure appears superior to the arthroscopic technique. After mini-open surgery postoperative loss of correction is less common and greater horizontal stability is achieved. The results also suggest the mini-open technique is superior to the arthroscopic procedure when aiming to restore the athlete's original level of sports activity.

[Revision of anatomic shoulder arthroplasty]. / Revision der anatomischen Schulterprothese.

With the increasing number of primary arthroplasties, revisions of anatomical prostheses are becoming increasingly important. The most common reasons for revision are glenoid loosening, including protrusion, rotator cuff insufficiency, including instability, and early/late infection. The reconstruction of glenoid defects can be done with an autograft or allograft. Depending on the size and situation, it is carried out in one or two stages. The stemless humeral head replacement and the short-stem prostheses that have been used more frequently in recent years have significantly simplified humeral revision. Platform systems take a different approach with the option of conversion without major interventions on the glenoid or revision stem. Intraoperative complications mainly occur on the humeral side. Postoperative complications include dislocation, component loosening, and infection. Revision of anatomical to reverse arthroplasty shows better clinical outcomes and lower complication rates than anatomical revision.

Fourteen years of follow-up after first arthroscopic Bankart repair in athletes: functional outcomes and magnetic resonance imaging findings.

BACKGROUND: The arthroscopic Bankart procedure is the most performed surgery for shoulder stabilization. Short-term to midterm results are well studied; however, long-term results over 10 years are rare. PURPOSE: This study evaluates the long-term results and magnetic resonance imaging (MRI) findings in athletes at a mean follow-up of 14 years after an arthroscopic Bankart stabilization as well as risk factors for osteoarthritis. METHODS: A total of 63 athletes had an arthroscopic Bankart repair between 2001 and 2008, of whom 46 patients (73.0%) participated in the final follow-up. The Constant, Rowe, and Western Ontario Shoulder Instability Index (WOSI) score and the rate of return to sports were evaluated. Glenohumeral osteoarthritis was assessed using the Samilson-Prieto classification. Known risk factors for osteoarthritis were analyzed. MRI findings (bone marrow edema, cysts, and joint effusion) were analyzed. RESULTS: The average follow-up was 14 years. Assessment was performed on 46 athletes with an average age of 21.6 at the time of surgery. The overall redislocation rate was 21.7%. The Constant score was 96.7, the Rowe score was 83.4, and the Western Ontario Shoulder Instability Index score was 90.7 out of 100. A total of 84.8% of the athletes returned to their initial sports level. Glenohumeral osteoarthritis occurred in 28.1%. Known risk factors for osteoarthritis were confirmed. Further MRI findings were rare. CONCLUSIONS: Arthroscopic Bankart repair in athletes shows good long-term clinical results. However, this is only in patients without osteoarthritis, which was rare, but was confirmed as a risk factor. We assume that resorption of anchors differs in patients. If it does have an impact on developing arthrosis, this should be confirmed in further studies.

Biochemical Monitoring of Muscle Recovery in Elite Handball Using an Individualized Approach.

PURPOSE: To evaluate the classification performance of a new method to individualize reference ranges for biomarkers of muscle recovery in elite handball. METHODS: In a longitudinal observational study, creatine kinase (CK) and urea levels were assessed in 16 male elite handball players during the 2019-20 preseason. Blood samples were collected at prespecified time points when players were considered either recovered or nonrecovered. Initially, linear mixed-effects models were calculated, as outlined in the study design, to examine the effect of recovery status on CK and urea levels. Finally, a fixed-effect model was calculated for urea based on the law of parsimony. Individualized reference ranges were calculated using a recently published algorithm. To investigate whether the individualized approach resulted in a more accurate classification of recovery status (recovered or nonrecovered), it was compared with a group-based approach derived from the same data set, utilizing predefined error rates. RESULTS: Linear mixed-effects models showed a large effect of recovery status on CK (P < .001, d = 3.49) and a small effect on urea (P = .018, d = 0.382). In contrast to CK (P = .017), urea had no significant interindividual variation. Hence, individualization was examined only for CK. The numerical decrease in both CK error rates by the individualized approach was significant for the test-pass error rate (P = .0196, ϕ = .19). CONCLUSIONS: Our findings underscore the critical role of CK for monitoring in team sports such as handball. The observed improvement in CK error rates suggests a promising opportunity to individualize biochemical monitoring, although further studies encompassing larger sample sizes are warranted.

Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018.

BACKGROUND: The purpose of this study is to identify and analyze primary revision arthroplasties of the shoulder in the Germany Shoulder Arthroplasty Registry. The objective is to provide demographic and clinical data of the included cases and information about the revision surgery itself and to compare the findings to other registry studies and clinical studies. METHODS: All documented cases of primary revision arthroplasties of the Germany Shoulder Arthroplasty Registry in the time period 2014-2018 (n = 975) were included in the initial data analysis. Exclusion criteria were multiple revisions and data sets with a missing link of the revision arthroplasty to the data set of the primary implantation leaving n = 433 cases that were included. SPSS software (IBM SPSS Statistics for Windows, version 24.0; IBM Corp., Armonk, NY, USA) was used for statistical analyses. RESULTS: The age of patients with revised anatomic implants (66.3 years) was significantly lower than that of patients with reverse implants (77.1 years) (P = .001). Female patients with anatomic and fracture implants were significantly older than their male counterparts (70.1 vs. 60.5 years, P = .001; 74.3 vs. 62 years, P = .019) and showed a significantly higher rate of revision than their male counterparts (P = .001). The reason for revision was significantly different for anatomic and reverse implant systems (P = .001). Aseptic loosening of either the humeral or glenoid component was the most common reason for revision for anatomic implants, whereas unspecified reasons, dislocation, and loosening of the glenosphere were the most common reasons for reverse implants. The most common type of revision procedure for anatomic implants was conversion to a reverse system in about one third of the cases. Most of the revisions of reverse implants were not specified and almost equally distributed for revision at the humeral or the glenoid side. Anatomic implants showed significantly better Constant-Murley scores (26.1 points) than reverse implants (19.6 points) (P = .001) and significantly better function before revision for passive flexion (P = .002), passive abduction (P = .015), active external rotation (P = .002), and passive external rotation (P = .002). CONCLUSION: This study provides a well-documented basis to compare revision arthroplasties of the shoulder performed in Germany over the last decade as documented in the nationwide registry with other nationwide registries and with clinical studies. Especially, the detailed analysis of intraoperative and postoperative complications and the shoulder function at the time of revision offers new information in addition to the results of other registries.

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial.

BACKGROUND: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). PURPOSE: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. RESULTS: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 (P = .016). No significant differences were found between groups regarding clinical shoulder scores (P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. CONCLUSION: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

Clinical and radiologic results after anatomic stemless shoulder prosthesis: a minimum 4-year follow-up.

BACKGROUND: Since the introduction of stemless anatomic shoulder arthroplasty, few midterm functional and radiographic results have been published. This article presents results of the Arthrex Eclipse prosthesis with a mean follow-up of 70 months. METHODS: We prospectively evaluated the outcome of 53 arthroplasties in 51 patients with a mean age of 65 years at the time of implantation with a minimum follow-up of 48 months. All patients were physically and radiologically examined, and the results documented by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS: Significant improvements from preoperative to last follow-up were documented in the Constant-Murley score (53.8%-83.5%, P < .001) and active range of motion (abduction 84°-108°, flexion 98°-125°, and external rotation 19°-41°). There was no significant difference between total and hemiarthroplasty. The mean DASH score was 28.3 points (95% confidence interval 20.1-35.2). Lowering of bone mineral density was observed in anteroposterior radiographs at the humeral component in 24.5% and at the glenoid component in 33.3%. The rate of complications was 15.7%. CONCLUSION: This study finds improvements in functional, radiographic, and subjective midterm results comparable to other accessible data for stemless and stemmed arthroplasty.

[Monitoring and load management in team handball]. / Monitoring und Belastungssteuerung im Handball.

BACKGROUND: The monitoring of athletes has become a focus in elite-level team sports and research in recent years. The goal is to optimise load management for maximising performance. Due to the considerable amount of data gathered during monitoring in team sports, the trend is towards integrating different monitoring methods in a software-based tool. In addition, decision-support systems are used in order to enable coaches to make quick decisions to control further burdens. This article is intended to give an overview of the large number of monitoring methods used in contact team sports, to consider their test quality criteria and to check a useful application of monitoring methods for team handball, taking into account the sports-specific requirements. METHODS: PubMed-based review of the literature. Narrative review focusing on current data from the years 2010 to 2019. RESULTS: Demands on athletes in elite team handball vary depending on the playing position. Therefore, individualised load control is necessary. Monitoring methods with proven validity and reliability should ideally be used in a multivariate approach to represent the various aspects of external and internal load, recovery and fatigue, well-being and readiness. It is important to know the meaningful change for each athlete while using a monitoring method. This circumstance necessitates an individualised approach for each parameter. There are not many studies on the use of monitoring methods in team handball, neither in the amateur field nor in an elite sports environment. Nevertheless, based on evidence from other contact team sports, a recommendation for a combined use of monitoring methods can be given. Burden, time and cost/benefit should always be considered. CONCLUSION: There is a considerable need for research regarding the use of athlete monitoring in team handball. The combination of monitoring methods proposed in this article can be used as a framework for studies with handball players in an elite sports environment in order to implement an increasingly handball-specific monitoring concept in the future.

[The complex course of a concussion and an exceptional diagnosis]. / Der besondere Fall ­ Concussion und ihre Nebendiagnosen.

Concussion without loss of consciousness is common in every sport, but it occurs more often in high-impact sports such as handball or soccer. Concussion should be diagnosed early to protect the athlete. It is not easy to diagnose a concussion, but tests like the SCAT-5 can help. After the diagnosis, the athlete should undergo a return-to-sports procedure. Multiple concussions can cause long-term neurological deficits known as chronic traumatic encephalitis. If symptoms persist or clinical deterioration occurs, various differential diagnoses, some of them life threatening, have to be ruled out. In our case, a 29-year-old professional handball player was diagnosed with concussion and distortion of the cervical spine. Due to increasing symptoms and partly severe deterioration, the patient saw several doctors and underwent several diagnostic procedures. The correct diagnosis was made four weeks after the trauma. Today the player is playing handball on a professional basis again without any restriction.

Traumatic medial clavicle fracture induced by chin bar of a full-face helmet following a downhill mountainbike accident.

Downhill mountain biking is a rapidly growing sport. In our case we want to present an isolated medial clavicular fracture following a mountain bike accident with a critical review on the used protection device. A 35 year old healthy patient presented to our hospital after bike accident during downhill mountain biking in Austria with pain over his right medial clavicle. The imaging showed a multifragmentary medial clavicle fracture with an intact SC-joint. Surgical intervention was recommended. Postoperative x-rays showed an anatomic reposition and correct plate positioning. The implant was removed after 18 months without any complications. A full-face helmet with a chin bar is used to achieve better protection of the maxilla, mandible and the teeth. In a hyperflexion situation of the cervical spine, a direct contact of the chin bar with the sternum, sc-joint and the medial clavicle can occur. This impact sets the mentioned structures on a high risk of dislocation and fracture as seen in our case. This risk can be significantly reduced by the combined use of a full face helmet and a neck brace. If the injury is properly identified, positive results can be achieved by surgery.

Evaluation of a New Exercise Program in the Treatment of Scapular Dyskinesis.

An abnormal motion of the scapula, or scapular dyskinesis (SD), can be effectively treated through conservative therapy. The aim of this study is to evaluate a new specific exercise program to restore normal position. A standardized and specific exercise program was created. In a prospective multi-center approach, patients were randomized into two groups: one group received the specific exercise program over a period of six weeks and the controls received massage therapy. The visual-analog scale, QuickDASH score, SICK scapula rating scale, hand press-up position test, lateral scapular slide test and internal rotation of the shoulder were evaluated. Twenty-eight patients were included in the study: fifteen in the exercise group and thirteen in the control group. Pain levels on the visual analog scale (VAS) were significantly reduced in both groups (exercise p=0.007; control p=0.004). The scores for QuickDASH (p=0.001), SICK scapula rating scale (p=0.003) and hand press-up position test (p=0.026) were significantly improved in the exercise group only. Scapula-focused exercise programs, as well as massage therapy, can effectively relieve pain in patients with SD. However, scapula-focused exercises resulted, specifically, in greater improvement of shoulder function.

Rehabilitation following rotator cuff repair: A work of the Commission Rehabilitation of the German Society of Shoulder and Elbow Surgery e. V. (DVSE) in collaboration with the German Association for Physiotherapy (ZVK) e. V., the Association Physical Therapy, Association for Physical Professions (VPT) e. V. and the Section Rehabilitation-Physical Therapy of the German Society for Orthopaedics and Trauma e. V. (DGOU).

BACKGROUND: Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. OBJECTIVES: To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e. V. (DVSE) shoulder experts. MATERIALS AND METHODS: A literature search for the years 2004-2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane CentralRegister of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via online questionnaire. RESULTS: A total of 17 studies, four reviews and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.

Magnetic resonance imaging in evaluation of tunnel diameters prior to revision ACL reconstruction: a comparison to computed tomography.

OBJECTIVE: Revision ACL reconstruction is becoming more frequent because of a 10% rate of re-ruptures and insufficiencies. Currently, computed tomography (CT) represents the gold standard in detecting and measuring the tunnels of the initial ACL reconstruction. The purpose of this study was to compare measurement results of CT and thin-sliced MRI sequences, which were modified to a high soft tissue-bone contrast. MATERIALS AND METHODS: Prior to an ACL revision surgery, 16 consecutive patients had an MRI in addition to the standard CT scan. A dedicated 0.25-T Esaote G-Scan (Esaote Biomedica, Cologne, Germany) with a Turbo 3D T1 sequence was used for MRI. Tunnel diameters were measured at 11 defined points of interest. For the statistical evaluation, the Mann-Whitney U test for connected samples was used. Inter- and intraobserver reliability was additionally calculated. RESULTS: All measured diameters showed significant to highly significant correlations between both diagnostic tools (r = 0.7-0.98). In addition, there was no significant difference (p > 0.5) between the two techniques. Almost all diameters showed nearly perfect intraobserver reliability (ICC 0.8-0.97). Interobserver reliability showed an ICC of 0.91/0.92 for only one diameter in MRI and CT. CONCLUSION: Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved.

Partially loaded plain radiographic measurement to evaluate rotational alignment in total knee arthroplasty.

PURPOSE: Rotational alignment of prosthetic components after total knee arthroplasty (TKA) is predominantly monitored with computer tomography (CT), for example by relating the anatomical transepicondylar axis (a-TEA) of the native femur to the posterior bicondylar axis of the prosthetic component (PBCA). The purpose of the present study was to portray a reliable, novel plain radiographic method that likewise enables the evaluation of rotational positioning of prosthetic components in TKA. Furthermore, it was intended to evaluate the prosthetic femoro-tibial functional behavior under loaded conditions. METHODS: Modified plain axial radiographs under partial weight bearing (20 kg) were performed in 63 patients (63 knees) after TKA. On the obtained radiographs, all established, relevant anatomic, and prosthetic axis and angles reflecting the rotational position of the femoral (i.e., a-TEA/PBCA angle) and tibial component were detected twice by two independent examiners with an interval of one month. Additionally, in 14 cases with anterior knee pain after surgery, radiographic results were compared to obtained computer tomography images; intraclass coefficients (ICC's) for intra- and inter-rater reliability were calculated. RESULTS: All pre-assigned axis and angles could be identified doubtlessly by both examiners in all investigated knees. For all measurements, ICC's for intra-rater and inter-rater reliability ranged from 0.75 to 0.96. The comparison of the radiographic measurements with corresponding CT results (n = 14) revealed no significant differences (p > 0.05). Rotational alignment of the tibial tray in relation to the native tibial bone was not measurable due to display overlaying. Femoro-tibial behaviour of the prosthetic components under partial loading showed a high variability. CONCLUSION: We were able to establish a new reliable radiographic technique that is able to show the most established and relevant anatomic landmarks and prosthetic axis after TKA to assess the rotational alignment of the prosthetic components in TKA in relation to the distal femur. The evaluation of the femoro-tibal behaviour instead shows a high variability and so far does not allow valid explanatory conclusions.

Preventive lateral ligament tester (PLLT): a novel method to evaluate mechanical properties of lateral ankle joint ligaments in the intact ankle.

PURPOSE: To construct and evaluate an ankle arthrometer that registers inversion joint deflection at standardized inversion loads and that, moreover, allows conclusions about the mechanical strain of intact ankle joint ligaments at these loads. METHODS: Twelve healthy ankles and 12 lower limb cadaver specimens were tested in a self-developed measuring device monitoring passive ankle inversion movement (Inv-ROM) at standardized application of inversion loads of 5, 10 and 15 N. To adjust in vivo and in vitro conditions, the muscular inactivity of the evertor muscles was assured by EMG in vivo. Preliminary, test-retest and trial-to-trial reliabilities were tested in vivo. To detect lateral ligament strain, the cadaveric calcaneofibular ligament was instrumented with a buckle transducer. After post-test harvesting of the ligament with its bony attachments, previously obtained resistance strain gauge results were then transferred to tensile loads, mounting the specimens with their buckle transducers into a hydraulic material testing machine. RESULTS: ICC reliability considering the Inv-ROM and torsional stiffness varied between 0.80 and 0.90. Inv-ROM ranged from 15.3° (±7.3°) at 5 N to 28.3° (±7.6) at 15 N. The different tests revealed a CFL tensile load of 31.9 (±14.0) N at 5 N, 51.0 (±15.8) at 10 N and 75.4 (±21.3) N at 15 N inversion load. CONCLUSIONS: A highly reliable arthrometer was constructed allowing not only the accurate detection of passive joint deflections at standardized inversion loads but also reveals some objective conclusions of the intact CFL properties in correlation with the individual inversion deflections. The detection of individual joint deflections at predefined loads in correlation with the knowledge of tensile ligament loads in the future could enable more individual preventive measures, e.g., in high-level athletes.

Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability.

PURPOSE: In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy. METHODS: We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction. RESULTS: Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation. CONCLUSION: Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate. LEVEL OF EVIDENCE: Level III.