Traumatic Valgus Instability of the Elbow: Pathoanatomy and Results of Direct Repair

Richard, Marc J.; Aidridge, III, J. Mack; Wiesler, Ethan R.; Ruch, David S.
November 2008
Journal of Bone & Joint Surgery, American Volume;Nov2008, Vol. 90-A Issue 11, p2416
Academic Journal
Background: The medial collateral ligament provides valgus stability to the elbow. The purpose of the present study was to describe the pathoanatomy of acute traumatic medial collateral ligament ruptures and to report the rationale and results of direct repair. Methods: Between 1996 and 2006, eleven athletes presented with acute rupture of the medial collateral ligament of the elbow and no history of dislocation. Three patients had received steroid injections for the treatment of medial epicondylitis, but none had a history of medial elbow insufficiency. All patients demonstrated gross valgus instability on clinical examination and medial joint space widening on valgus stress radiographs. Complete avulsion of the medial collateral ligament from its humeral origin was documented with magnetic resonance imaging in all patients. Operative findings uniformly demonstrated avulsion of the flexor-pronator muscles with distal retraction. The underlying medial collateral ligament was avulsed in a sleeve-like fashion from the denuded medial epicondyle. The ligament was directly reattached to its footprint. The avulsed flexor-pronator tendon was repaired to the residual tendon with use of interrupted figure-of-eight nonabsorbable sutures. All patients were followed for a minimum of sixteen months with serial clinical examinations, radiographs, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Full active range of motion was achieved in ten patients; the remaining patient had a 20° flexion contracture. Three patients had acute ulnar nerve palsies at the time of the injury, and all three recovered complete motor and sensory function by six months after the injury. Nine of the eleven patients returned to competitive college athletics between four and six months. The mean DASH score at the time of the most recent follow-up was 6. Conclusions: Direct repair of an acute traumatic medial collateral ligament avulsion of the elbow reliably restores valgus stability, even in throwing athletes. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee.  // Journal of Bone & Joint Surgery, American Volume;May2010, Vol. 92-A Issue 5, p84 

    An abstract of the article "Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee," by S. -J. Kim and colleagues is presented.

  • Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Koga, Hideyuki; Muneta, Takeshi; Yagishita, Kazuyoshi; Ju, Young-Jin; Sekiya, Ichiro // Knee Surgery, Sports Traumatology, Arthroscopy;Jan2012, Vol. 20 Issue 1, p88 

    Purpose: Although various surgical procedures have attempted to restore valgus stability in medial knee injuries, so far none has achieved satisfactory results. The purpose of this study was to assess clinical outcome for patients with grade 3 valgus instability who were treated according to our...

  • In vivo length patterns of the medial collateral ligament during the stance phase of gait. Fang Liu; Gadikota, Hemanth R.; Kozánek, Michal; Hossein, Ali; Bing Yue; Gill, Thomas J.; Rubash, Harry E.; Guoan Li // Knee Surgery, Sports Traumatology, Arthroscopy;May2011, Vol. 19 Issue 5, p719 

    Purpose: The function of the medial collateral ligament (MCL) during gait has not been investigated. Our objective was to measure the kinematics of the medial collateral ligament during the stance phase of gait on a treadmill using a combined dual fluoroscopic imaging system (DFIS) and MRI...

  • Medial Collateral Ligament "Tibial" Injuries: Indication for Acute Repair. Wilson, Timothy C.; Satterfield, William H.; Johnson, Darren L. // Orthopedics;Apr2004, Vol. 27 Issue 4, p389 

    Emphasizes that complete avulsions of the superficial and deep medial collateral ligament from the tibia with disruption of the meniscal coronary ligament should be managed with acute surgical repair for maximum benefit. Mechanism of injury of the medial collateral ligament (MCL); Treatment for...

  • Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Forkel, Philipp; Herbort, Mirco; Schulze, Martin; Rosenbaum, Dieter; Kirstein, Lars; Raschke, Michael; Petersen, Wolf // Archives of Orthopaedic & Trauma Surgery;May2013, Vol. 133 Issue 5, p621 

    Purpose: The purpose of this study was to evaluate the effects of different types of lateral meniscus root tears in terms of tibiofemoral contact stress. Methods: Ten porcine knees each underwent five different testing conditions with the menisci intact, a simulated lateral posterior root tear...

  • Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results. Koskinen, Esa; Paavolainen, Pekka; Eskelinen, Antti; Harilainen, Arsi; Sandelin, Jerker; Ylinen, Pekka; Tallroth, Kaj; Remes, Ville // Archives of Orthopaedic & Trauma Surgery;May2009, Vol. 129 Issue 5, p617 

    The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA) unicondylar knee arthoplasty (UKA). The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7–13.1 years). Survival rate of the...

  • The Anatomy of the Medial Part of the Knee. Laprade, Robert F.; Hauge Engebretsen, Anders; Ly, Thuan V.; Johansen, Steinar; Wentorf, Fred A.; Engebretsen, Lars // Journal of Bone & Joint Surgery, American Volume;Sep2007, Vol. 89-A Issue 9, p2000 

    Background: While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee...

  • Tendon trouble. Crabbe, Barb // Horse & Rider;Jun94, Vol. 33 Issue 6, p66 

    Explains the mechanics behind the contracted-tendons condition of horses to facilitate its prevention. Flexural deformity of the legs; Structures involved; Risk assessment guidelines. INSET: Congenital deformities..

  • Tendon stiffness? Barakat, Christine; McCluskey, Mick // Equus;Sep2011, Issue 408, p13 

    The article reports that a study performed in the bioengineering lab at Newcastle University's School of Mechanical and Systems Engineering revealed the relationship between advancing age and changes in the elasticity of two flexor tendons in the equine leg.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics