Lateral Elbow Laxity Is Affected by the Integrity of the Radial Band of the Lateral Collateral Ligament Complex: A Cadaveric Model With Sequential Releases and Varus Stress Simulating Everyday Activities

Abstract

Background: An elongation of the radial lateral collateral complex (R-LCL) can provoke symptomatic minor instability of the lateral elbow leading to lateral elbow pain. Biomechanical models investigating the effects of elongation and partial or complete lesions of the R-LCL on lateral elbow stability are lacking. Purpose: To evaluate how partial and complete R-LCL release affects radiocapitellar joint stability in a setting of controlled varus load and progressive soft tissue release. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric specimens were obtained and mounted on a custom-made support to control elbow flexion and extension and to allow for controlled varus loading. Stress tests were performed on all intact specimens under gravity load alone, a 0.5-kg load applied to the hand, and a 1-kg load applied to the hand. After load application, anteroposterior radiographs were obtained. The following release sequence was applied to all specimens: release of the anterior half of the common extensor origin, pie crusting of the R-LCL, and R-LCL release. After each release, stress tests and radiographs were performed. The varus joint angulation of the elbow (α) was measured by 2 examiners as the main outcome parameter. Results: Significant changes in α from the initial condition occurred after each release, and a significant effect of varus load on α was documented for all release steps. A significant effect of the releases on α could be documented for all identical varus load conditions. A linear regression model was generated to describe the effect of varus load on α. Conclusion: Varus loads simulating everyday activities produce changes in the varus joint angulation of the elbow already in the intact specimen, which are linearly dependent on the applied moment and persist after release of the lateral stabilizing structures. With progressive load, a pie crusting of the R-LCL is the minimal procedure able to provoke a significant change in the varus joint angulation, and a complete R-LCL release produces additional increase in the varus joint angulation in all testing conditions. Clinical Relevance: These findings confirm the role of the R-LCL as static lateral stabilizer, supporting a pathological model based on its insufficiency and culminating with a symptomatic minor instability of the lateral elbow.

Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM* Approach

“…3). 33 As previously mentioned for the CET, the RCL should also be assessed by combining B-mode and color/power Doppler imaging in every patient with lateral epicondylitis. Indeed, a normal appearing ligament on grayscale can display pathological perfusion due to mechanical overload, healing process, or inflammatory changes (Video 14, Supplemental Digital Content 14, http://links.lww.com/PHM/B791).…”

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

“…Limited evidence exists regarding the speciic contribution of the R-LCL to a pattern of minor elbow instability related to varus-pronation overload [38]. Previous studies mainly focussed on detecting major posterolateral rotatory instability in terms of pivot shift test, radial head translation or subluxation, or degrees of rotation or varus, being unable to detect a signiicant contribution of isolated sectioning of the R-LCL [26,[39][40][41].…”

Don’t forget to SMILE—a novel radiological index to characterize symptomatic minor instability of the lateral elbow

“…In contrast to previous considerations, epicondylitis appears to be merely the result of secondary stabilizer overuse to compensate for the true underlying cause, i.e., functional incompetence of the lateral collateral ligament complex and in particular the annular ligament. This condition has been investigated arthroscopically before, leading to the authors establishing the term "symptomatic minor instability of the lateral elbow" (SMILE) [5].…”