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Joint Structures

Elbow joint anatomy & biomechanics: humeroulnar, humeroradial, and proximal radioulnar joints, UCL stability, and common fracture patterns.

65 citationsUpdated Sep 2026
Illustration: Joint Structures

Overview

Elbow stability and complex kinematics depend on a combination of bony articulation and soft-tissue stabilizers [11]. The proximal radioulnar joint anatomy features a significant negative relationship between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage [8]. Anatomic variations in the ulnar greater sigmoid notch "coverage angle" require further biomechanical and clinical studies to determine their true clinical relevance [9]. Understanding the unique structural and functional properties of articular cartilage is key to developing chondroprotective agents that can improve its metabolic function [23]. A more thorough understanding of the detailed mechanisms involved in mechanotransduction may lead to novel approaches for enhancing tissue growth or attenuating mechanically driven processes that lead to osteoarthritis [67].

Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma [2]. Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures in pediatric elbows [4]. The insertional anatomy of the anterior medial collateral ligament at the sublime tubercle has been described in detail [26]. Thorough knowledge of distal biceps insertional and footprint anatomy is essential for understanding the biomechanics of rupture and reconstruction and to avoid nerve injuries [27]. Awareness of the neuroanatomical distribution of sensory receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology [7].

Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint [5]. A combination of ligament-preserving approaches enables viewing the entirety of the capitellar joint surface and may represent an alternative to ligament-releasing approaches [1]. Clinical evaluation for joint pain, severe cartilage destruction, and chondrolysis should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and, in some cases, arthroscopic evaluation to minimize risk of inappropriate clinical management [20].

Osseous Anatomy

Elbow Joint

Significant areas of the articular surface of all three bones in the elbow joint may be overlooked during standard elbow arthroscopy [10]. A combination of ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [1]. Osteochondral lesions show location and size dependent consequences in valgus angulation and radiocapitellar contact characteristics [32]. The synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure [31].

Proximal Ulna

The ulnar greater sigmoid notch "coverage angle" involves bone and cartilage contribution, with anatomic variations requiring further biomechanical and clinical study to determine clinical relevance [9]. Using the narrowest edge lacking cartilage as a reference to locate the bare area of the proximal ulna, a designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage [15].

Proximal Radioulnar Joint

The proximal radioulnar joint anatomy features a significant negative relationship between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage [8].

Glenoid

The fulcrum axis can be used to obtain information on the version of the glenoid from anatomical landmarks [28].

Trochlea

Optimal cutoff values for all measurements except cartilaginous trochlear depth differed between female and male patients, suggesting sex-specific parameters may be needed for defining trochlear dysplasia [36].

Ligaments and Joint Capsule

Anatomy and Structure

The elbow joint capsule contains three distinct bands in both the anterior and posterior capsule, excluding the medial and lateral collateral ligaments [17]. The annular ligament is a wrap-around structure containing fibrocartilaginous tissue [50]. No synovial lining is present on the articulating surface between the annular ligament and the radial head [50]. The superior and inferior oblique bands of the annular ligament attach proximally and distally onto the ulna to secure the ligament in place [51]. The distal oblique bundle in the distal membranous portion of the interosseous membrane may stabilize the distal radioulnar joint in 40% of human subjects who possess this ligament [19]. Ligaments may function as a 'static-dynamic' stabilizer rather than a simple static one [21].

Biomechanics and Stability

Both collateral ligaments are essential stabilizers, and their integrity is a prerequisite for stable function [34]. The anterior oblique ligament is the primary stabilizer of the elbow [54]. The transverse ligament of the ulnar collateral ligament plays a role in joint laxity [54]. The direction of radial head instability varies depending on the degree of soft tissue sectioning and specific forearm rotation [55].

Surgical Considerations

Operative Planning: An appreciation of relevant neurovascular and ligamentous structures is critical to safely performing surgical procedures about the elbow [6]. Knowledge of precise ligamentous attachments and relationships to the physis and joint surface is important for reconstructive procedures in pediatric patients [4]. Recognizing complex soft tissue injuries is important to restore anatomic attachments and prevent chronic instability in global elbow instability [12].

Technique and Access: A combination of two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [1]. Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy [48].

Specific Pathologies: Interposition of the annular ligament in the radiocapitellar joint is the most frequent factor hindering reduction in irreducible dislocation of the radial head associated with pediatric Monteggia lesions [49]. Stability can usually be maintained without the need for hinged external fixation or ligament reconstruction in unilateral interposition arthroplasty of the elbow, which facilitates postoperative management [14].

Muscles and Tendons

Triceps

Arthroscopic double-row repair of triceps tendon avulsion provides anatomic coverage of the triceps footprint [13]. This technique allows more surface area for healing [13].

Brachialis

A distally based tendon graft reconstruction of the annular ligament using the tendon of the superficial head of the brachialis muscle is feasible in most patients [74].

Patellar Tendon

The patellar apex is offset medially relative to the tendon midline [79]. The patellar tendon narrows distally due to converging fascicles [79].

Neurovascular Anatomy

Nerves

The course of the radial nerve in the distal part of the upper arm exhibits significant variety [18]. Thorough anatomical knowledge is essential for the surgeon to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid nerve injuries [27]. Regarding the ulnar nerve, knowledge of possible compression sites is important to avoid complications and decrease postoperative recurrence [68]; consequently, surgeons must remain vigilant about ulnar nerve complications [72]. The unicortical nature of specific fixation techniques avoids the rare but devastating complication of posterior interosseous nerve palsy while providing robust fixation [70]. Furthermore, awareness of the neuroanatomical distribution of receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology [7].

Ligaments and Capsule

An appreciation of the relevant neurovascular and ligamentous structures is critical to safely performing surgical procedures about the elbow [6]. A cadaveric study demonstrated the presence of 3 distinct bands in both the anterior and posterior capsules, excluding the medial and lateral collateral ligaments [17]. Resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle [25]. The distal oblique bundle in the distal membranous portion may stabilize the distal radioulnar joint in 40% of human subjects who have this ligament [19]. Educational video findings regarding the real anatomy of the lateral collateral ligament of the elbow discuss how these findings affect decision making regarding the best surgical approach to the lateral elbow [71].

Surgical Implications

A combination of two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [1]. Stability can usually be maintained without the need for hinged external fixation or ligament reconstruction, which facilitates postoperative management [14].

Biomechanics and Function

Elbow Stability and Kinematics

Elbow position influences the kinematics of the distal radioulnar joint. These kinematics are primarily affected by forearm rotation and secondarily by elbow flexion [60].

Load Transmission and Contact Mechanics

The native human elbow distributes load with a 58% ratio for the radiocapitellar joint and a 42% ratio for the ulnotrochlear joint [52]. In the shoulder, the anterior glenoid cartilage experiences the highest strains immediately after pushups [65]. Regarding radial head morphology, a nonaxisymmetric radial head provides improved contact mechanics at certain forearm rotations and flexions; however, there are orientations where contact area is reduced and stress is increased [61]. Conversely, no significant differences were found between three implant morphologies for contact area, contact location, or joint kinematics, suggesting that the shape of the implant may not be that important with respect to articular mechanics [53].

Radial Head and Forearm Biomechanics

Insertion of a correctly sized metallic radial head replacement recreates near normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane [58]. However, the kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius [56].

Ligament Biomechanics and Reconstruction

The anterolateral ligament shows no isometric behavior during the range of motion of the knee [59]. For lateral collateral ligament injuries, no significant differences were noted between docking reconstruction and repair techniques for load to failure, gapping, or valgus opening angle during cyclic loading at time zero [63]. Suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction may offer enhanced early biomechanical stability, simplify revision cases, and support improved return to function in high-demand patients [62]. Limited biomechanical investigations conclude efficacy for stability profiles regarding the internal joint stabilizer of the elbow [41].

Anatomical Biomechanical Relationships

There is a significant negative relationship between the Alpha Angle and the Beta Angle in the proximal radioulnar joint, emphasizing the biomechanical impact of joint congruence on bony coverage [8].

Common Sites of Injury

Elbow

Complex soft tissue injuries in the elbow require recognition to restore anatomic attachments and prevent chronic instability [12]. A combination of two ligament-preserving surgical approaches enables viewing the entirety of the elbow joint surface [1]. Evidence supports elbow ligament repairs and reconstructions in both acute and chronic settings [46]. Dynamic ultrasonography shows different changes in clinical laxity with injury of particular bands of the ulnar collateral ligament [40]. Anterior bundle injuries of the medial ulnar collateral ligament exhibit heterogeneity in injury configurations and chronic attritional damage in patients undergoing reconstruction [37].

Fracture Management: Standardized communication of radial head fracture type with details of other injuries helps in understanding treatment outcomes based on the precise injury complex [39]. For small subtype 2 posteromedial rotatory incongruity fractures, ligamentous repair alone may not reliably restore kinematics [38]. Larger posteromedial rotatory incongruity fractures should ideally have fragments fixed or reconstructed [38]. Patients older than 65 years with coronal fractures of the capitellum have a large number of concomitant injuries [42], yet they have no substantial risk of complex fracture patterns [42]. Articular shear injuries of the capitellum in adolescents require a high index of suspicion for identification [43]. Early recognition of articular shear injuries of the capitellum in adolescents likely would have changed initial conservative management decisions [43].

Tendon and Soft Tissue Pathology: Arthroscopic double-row repair of the triceps tendon provides anatomic coverage of the triceps footprint, allowing more surface area for healing [13]. Surgical anatomical repair is typically performed for acute complete distal biceps and triceps ruptures [44]. Nonoperative treatment is reserved for partial distal biceps and triceps ruptures or patients unfit for surgery [44]. Posttraumatic contracture of the elbow is characterized by pathologic thickening, disorganization of collagen fiber arrangement, and involvement of cytokines [33]. Excellent functional outcomes can be achieved with a conservative approach after extensive soft tissue damage from minor injury in open antero-lateral elbow dislocation [45].

Shoulder

The glenoid labrum involves specific embryology, anatomy, microscopy, biomechanical properties, and clinical lesions that aid in understanding its function and pathology [3].

Hip

In pure transverse acetabular fractures, the intra-articular fracture line distribution is focused on the superior and middle thirds of the joint surface [24].

Surgical Anatomy

Bony Anatomy and Cartilage

When designing a chevron osteotomy, the surgeon should use the narrowest edge lacking cartilage as a reference to locate the bare area. In most specimens, this approach ensures the osteotomy enters the joint within the bare area, thereby decreasing associated damage to the joint cartilage [15].

Ligamentous Integrity and Stability

Recognizing complex soft tissue injuries is critical to restore anatomic attachments and prevent chronic instability [12].

Surgical Access and Visualization

To manage pathologies in all areas of the posterior compartment while preventing specific complications, the surgeon can use an accessory posterolateral portal instead of the direct posterior portal [57]. Additionally, the technique provides anatomic coverage of the triceps footprint, allowing more surface area for healing [13].

Key Evidence

  • [L5] A combination of these two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches. [1] (10.1016/j.jse.2022.01.013)
  • [L5] Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma. [2] (10.1016/j.jse.2014.05.003)
  • [L5] This review presents a concise summary of the embryology, anatomy, microscopy, biomechanical properties and clinical lesions involving the glenoid labrum to aid the clinician in understanding its function and pathology. [3] (10.1111/j.1758-5740.2010.00050.x)
  • [L5] Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. [4] (10.1177/2325967120s00264)
  • [L5] Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint. [5] (10.1016/j.arthro.2019.05.014)
  • [L5] An appreciation of the relevant neurovascular and ligamentous structures is critical to safely performing surgical procedures about the elbow. [6] (10.5435/00124635-200905000-00007)
  • [L5] Awareness of the neuroanatomical distribution of the receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology. [7] (10.1177/1758573218760245)
  • [L4] This study describes anatomical structures of the PRUJ and highlights a significant negative relationship between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage. [8] (10.1016/j.xrrt.2026.100695)
  • [L5] Biomechanical and clinical studies are needed to understand the true clinical relevance of these anatomic variations. [9] (10.1016/j.jse.2015.06.006)
  • [L5] There are significant areas of the articular surface of all three bones in the elbow joint which may be overlooked during standard elbow arthroscopy. [10] (10.1016/j.arthro.2015.04.048)
  • [L5] This article discusses the basic anatomy of the elbow and the biomechanics of this joint, noting that a combination of bony articulation and soft-tissue stabilizers accounts for the elbow's stability and complex kinematics. [11] (10.1016/j.csm.2004.06.008)
  • [Case_report] The authors highlight the importance of recognizing complex soft tissue injuries to restore anatomic attachments and prevent chronic instability. [12] (10.1016/j.xrrt.2022.08.005)
  • [L5] The technique provides anatomic coverage of the triceps footprint, allowing more surface area for healing. [13] (10.1016/j.eats.2024.103129)
  • [L5] Stability can usually be maintained without the need for hinged external fixation or ligament reconstruction, which facilitates postoperative management. [14] (10.1016/j.eats.2023.09.010)
  • [L5] Using the narrowest edge lacking cartilage as a reference to locate the bare area, the designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage. [15] (10.1016/j.jhsa.2017.02.012)
  • [L5] This cadaveric study demonstrated the presence of 3 distinct bands present in both the anterior capsule and posterior capsule, excluding the medial and lateral collateral ligaments. [17] (10.1016/j.jhsa.2012.09.031)
  • [L5] The course of the radial nerve in the distal part of the upper arm has great variety. [18] (10.1371/journal.pone.0186890)
  • [L5] The distal oblique bundle in the distal membranous portion may stabilize the distal radioulnar joint in 40% of human subjects who have this ligament. [19] (10.1016/j.jhsa.2009.01.015)
  • [L4] Clinical evaluation should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and, in some cases, arthroscopic evaluation to minimize risk of inappropriate clinical management. [20] (10.1016/j.arthro.2011.03.025)
  • [L5] Based on these perspectives, ligaments could function as a 'static-dynamic' stabilizer rather than a simple static one. [21] (10.1016/j.jseint.2024.01.006)
  • [L5] Understanding the unique structural and functional properties of articular cartilage is key to developing chondroprotective agents that can improve its metabolic function. [23] (10.5435/00124635-200311000-00006)
  • [L4] The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. [24] (10.1186/s13018-022-03148-8)
  • [L5] Resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle. [25] (10.2106/00004623-200411000-00010)
  • [L5] The study presents a detailed description of the insertional anatomy of the anterior medial collateral ligament at the sublime tubercle. [26] (10.1016/j.jse.2018.08.006)
  • [L4] Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. [27] (10.1007/s00167-014-3322-9)
  • [L4] The findings of this study were similar to previous studies that concluded that the fulcrum axis could be used to obtain information on the version of the glenoid from the anatomical landmarks. [28] (10.5397/cise.2018.21.3.111)
  • [L4] The synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure, and ultrasonography can be a useful, non-invasive diagnostic tool for patients presenting with a painful snapping elbow. [31] (10.1016/j.jse.2006.10.019)
  • [L5] Osteochondral lesions show location and size dependent consequences in valgus angulation and radiocapitellar contact characteristics. [32] (10.1177/2325967125s00017)
  • [L4] This study demonstrates pathologic thickening, disorganization of the collagen fiber arrangement, and involvement of cytokines in the pathology of posttraumatic contracture of the elbow. [33] (10.1016/j.jse.2006.06.018)
  • [L5] Both collateral ligaments are essential stabilizers, and their integrity is a prerequisite for stable function. [34] (10.2106/00004623-199509000-00023)
  • [L3] Optimal cutoff values for all measurements except cartilaginous trochlear depth differed between female and male patients, suggesting sex-specific parameters may be needed. [36] (10.1177/03635465231158099)
  • [L4] This study shows the heterogeneity of anterior bundle injuries in patients undergoing UCL reconstruction, with a variety of injury configurations and chronic attritional damage observed. [37] (10.1016/j.jse.2019.01.017)
  • [L5] For small subtype 2 fractures, ligamentous repair alone may not reliably restore kinematics, and larger fractures should ideally have fragments fixed or reconstructed. [38] (10.1016/j.jse.2018.02.018)
  • [L4] This provides an opportunity to standardize the communication of fracture type with further details of other injuries that ultimately can help with better understanding of treatment outcome based on the precise injury complex. [39] (10.1007/s11999-007-0064-8)
  • [L5] The results suggest that different changes in clinical laxity are seen on DUS with injury of particular bands of the UCL. [40] (10.1177/2325967113s00016)
  • [L4] The limited biomechanical investigations conclude efficacy for stability profiles. [41] (10.1016/j.jhsg.2023.09.004)
  • [L4] Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. [42] (10.1016/j.jse.2015.12.004)
  • [L4] A high index of suspicion is necessary to identify this injury pattern, and early recognition likely would have changed the initial conservative management decision in each. [43] (10.1016/j.jse.2016.03.013)
  • [Paper] Surgical anatomical repair is typically performed in acute complete ruptures, while nonoperative treatment is reserved for partial ruptures or patients unfit for surgery. [44] (10.1016/j.injury.2013.01.003)
  • [Case_report] This case highlights that excellent functional outcomes can be achieved with a conservative approach even after extensive soft tissue damage from minor injury. [45] (10.1186/1471-2474-3-1)
  • [L4] This study provides evidence for elbow ligament repairs and reconstructions in both acute and chronic settings. [46] (10.1016/j.jseint.2024.02.013)
  • [L4] Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy. [48] (10.1016/j.jse.2010.01.003)
  • [L4] The most frequent factor hindering reduction was interposition of the annular ligament in the radiocapitellar joint. [49] (10.5435/jaaosglobal-d-17-00035)
  • [L5] The annular ligament is a wrap-around ligament containing (fibro)cartilaginous tissue, with no synovial lining present on the articulating surface between the ligament and the radial head. [50] (10.1016/j.jseint.2025.07.002)
  • [L5] The superior and inferior oblique bands of the annular ligament attached proximally and distally onto the ulna, thus helping to secure the annular ligament in place. [51] (10.1177/0363546504266070)
  • [L5] The study establishes a load sharing ratio of 58%:42% for the radiocapitellar and ulnotrochlear joints, respectively, and is the first to comprehensively evaluate loading mechanics across both native joints simultaneously throughout the entire functional range of elbow flexion and forearm rotation. [52] (10.1177/1758573220961025)
  • [L5] No significant differences were found between the three implant morphologies for contact area or contact location, and joint kinematics suggesting that the shape of the implant may not be that important with respect to articular mechanics. [53] (10.1016/j.jse.2012.12.022)
  • [L5] The authors conclude that while the anterior oblique ligament is the primary stabilizer, the transverse ligament plays a role in joint laxity. [54] (10.1016/j.jseint.2021.01.009)
  • [L5] The direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. [55] (10.1186/s12891-017-1829-1)
  • [L5] The kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius. [56] (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
  • [L5] This can be prevented by using an accessory posterolateral portal instead of the direct posterior portal, while still being able to manage pathologies in all the area of the posterior compartment. [57] (10.1016/j.eats.2023.07.047)
  • [L5] Insertion of a correctly sized metallic radial head replacement recreates near normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane. [58] (10.1302/0301-620x.95b10.31844)
  • [L5] The ALL shows no isometric behavior during the range of motion of the knee. [59] (10.1177/2325967114562205)
  • [L5] Elbow position affects the kinematics of the distal radioulnar joint, which are primarily affected by forearm rotation and secondarily by elbow flexion. [60] (10.1016/j.jhsa.2009.04.025)
  • [L5] Whereas a nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions, there are also orientations where contact area is reduced and stress is increased. [61] (10.1016/j.jse.2014.12.011)
  • [L5] This technique may offer enhanced early biomechanical stability, simplify revision cases, and support improved return to function in high-demand patients. [62] (10.1016/j.eats.2025.103797)
  • [L5] No significant differences were noted between docking reconstruction and repair techniques for load to failure, gapping, or valgus opening angle during cyclic loading at time zero. [63] (10.1177/0363546518803771)
  • [L4] Specifically, the anterior glenoid cartilage was observed to experience the highest strains. [65] (10.1177/2325967117s00361)
  • [L5] A more thorough understanding of the detailed mechanisms involved in mechanotransduction may lead to novel approaches for enhancing tissue growth, or attenuating the mechanically driven processes that lead to osteoarthritis. [67] (10.5435/jaaos-d-16-00938)
  • [L5] Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. [68] (10.1016/j.jse.2009.03.004)
  • [L4] The unicortical nature of the technique avoids the rare but devastating complication of posterior interosseous nerve palsy while providing robust fixation. [70] (10.1016/j.xrrt.2021.12.002)
  • [L5] The purpose of this educational video is to report findings regarding the real anatomy of the lateral collateral ligament of the elbow and to discuss how these findings affect decision making regarding the best surgical approach to the lateral elbow. [71] (10.5435/jaaos-d-18-00385)
  • [L3] Surgeons must be vigilant about ulnar nerve complications. [72] (10.1186/s13018-022-03292-1)
  • [L5] A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. [74] (10.1016/j.jhsa.2013.04.008)
  • [L5] The patellar apex is offset medially relative to the tendon midline, and the tendon narrows distally due to converging fascicles. [79] (10.1007/s001670000133)

See Also

References

[1] Surgical Approaches To The Capitellum: A Comparative Anatomic Study. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.013

[2] Three-dimensional analysis of elbow soft tissue footprints and anatomy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.05.003

[3] The Glenoid Labrum. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00050.x

[4] PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00264

[5] Elbow Arthroscopy Made Simple: Indications and Techniques. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.014

[6] Surgical Approaches to the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200905000-00007

[7] Neuroanatomical distribution of sensory receptors in the human elbow joint capsule. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218760245

[8] Functional shape of the proximal radioulnar joint: anatomical characterization through Alpha and Beta Angles. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100695

[9] The ulnar greater sigmoid notch “coverage angle”: bone and cartilage contribution. Magnetic resonance imaging anatomic study on 78 elbows. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.006

[10] Quantification of The Articular View of The Elbow Afforded by Standard Arthroscopy Portals. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.048

[11] Elbow anatomy and structural biomechanics. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.06.008

[12] Global elbow instability: a case report. JSES Reviews, Reports, and Techniques. 2023. DOI: 10.1016/j.xrrt.2022.08.005

[13] Arthroscopic Repair of the Triceps Tendon Avulsion—Double‐Row Repair. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103129

[14] Unilateral Technique for Interposition Arthroplasty of the Elbow—A Technical Note. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.09.010

[15] The Bare Area of the Proximal Ulna: An Anatomic Study With Relevance to Chevron Osteotomy. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.02.012

[17] Gross Anatomy of the Elbow Capsule: A Cadaveric Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.09.031

[18] The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment. PLOS ONE. 2017. DOI: 10.1371/journal.pone.0186890

[19] Interosseous Membrane of the Forearm: Length Change of Ligaments During Forearm Rotation. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.01.015

[20] Joint Pain, Severe Cartilage Destruction, and Chondrolysis: Guidelines for Improving Diagnostic Differentiation and Clinical Management (SS‐22). Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.025

[21] Elbow anatomy in perspective of joint capsule and surrounding aponeuroses: a narrative review. JSES International. 2024. DOI: 10.1016/j.jseint.2024.01.006

[23] Articular Cartilage Biology. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200311000-00006

[24] Three-dimensional mapping study of pure transverse acetabular fractures. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03148-8

[25] Medial Collateral Ligament Strain with Partial Posteromedial Olecranon Resection: A Biomechanical Study. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00010

[26] Insertional anatomy of the anterior medial collateral ligament on the sublime tubercle of the elbow. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.006

[27] Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3322-9

[28] Are the Anatomical Landmarks Adequate for Central Guide Insertion in Shoulder Arthroplasty?. Clinics in Shoulder and Elbow. 2018. DOI: 10.5397/cise.2018.21.3.111

[31] Ultrasonographic examination of the synovial fold of the radiohumeral joint. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.019

[32] Osteochondral Defects Show Location and Size Dependent Adverse Consequences in Valgus Angulation and Radiocapitellar Contact Characteristics with an intact UCL. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00017

[33] Structural and biochemical evaluation of the elbow capsule after trauma. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.018

[34] Motion and laxity of the capitellocondylar total elbow prosthesis.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199509000-00023

[36] Redefining Trochlear Dysplasia: Normal Thresholds Vary by Measurement Technique, Landmarks, and Sex. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231158099

[37] The pathoanatomy of the anterior bundle of the medial ulnar collateral ligament. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.01.017

[38] Posteromedial Rotatory Incongruity of the Elbow: A Computational Kinematics Study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.018

[39] Documentation of Associated Injuries Occurring With Radial Head Fracture. Clinical Orthopaedics & Related Research. 2008. DOI: 10.1007/s11999-007-0064-8

[40] Sequential Sectioning of the Ulnar Collateral Ligament of the Elbow in Cadaveric Arms with Ulnohumeral Laxity Assessed by Dynamic Ultrasonography. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00016

[41] The Internal Joint Stabilizer of the Elbow: A Systematic Review of the Clinical and Biomechanical Evidence. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.09.004

[42] Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.004

[43] Articular shear injuries of the capitellum in adolescents. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.03.013

[44] Distal biceps and triceps ruptures. Injury. 2013. DOI: 10.1016/j.injury.2013.01.003

[45] Open antero-lateral dislocation of the elbow. A case report. BMC Musculoskeletal Disorders. 2002. DOI: 10.1186/1471-2474-3-1

[46] A clinical review of elbow ligament repairs and reconstructions in the acute and chronic settings. JSES International. 2024. DOI: 10.1016/j.jseint.2024.02.013

[48] Arthroscopic capsular release of the elbow. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.01.003

[49] Irreducible Dislocation of the Radial Head Associated With Pediatric Monteggia Lesions. JAAOS: Global Research and Reviews. 2018. DOI: 10.5435/jaaosglobal-d-17-00035

[50] The nature of the annular ligament: a scoping review and histological analysis using a dual approach. JSES International. 2025. DOI: 10.1016/j.jseint.2025.07.002

[51] The Annular Ligament. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504266070

[52] Biomechanics of axial load transmission across the native human elbow. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220961025

[53] The Effect of Radial Head Implant Design on Radiocapitellar Contact and Kinematics. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.12.022

[54] Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study. JSES International. 2021. DOI: 10.1016/j.jseint.2021.01.009

[55] Biomechanical study of isolated radial head dislocation. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1829-1

[56] Elbow kinematics with increased lengthening of a radial head arthroplasty evaluated with dynamic radiostereometric analysis. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b10.bjj-2024-0405.r1

[57] Avoidance of Direct Posterior Portal During Elbow Arthroscopic Surgery in Posterior Compartment. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.07.047

[58] The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b10.31844

[59] Evaluation of the Length and Isometric Pattern of the Anterolateral Ligament With Serial Computer Tomography. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114562205

[60] Elbow Position Affects Distal Radioulnar Joint Kinematics. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.04.025

[61] Contact analysis of the native radiocapitellar joint compared with axisymmetric and nonaxisymmetric radial head hemiarthroplasty. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.011

[62] Suture‐Augmented Lateral Ulnar Collateral Ligament and Radial Collateral Ligament Reconstruction for Subacute and Chronic Posterolateral Rotatory Instability. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103797

[63] Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With the Docking Technique Versus Repair With Internal Bracing. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518803771

[65] Quantitation of Cartilage Strains in the Glenohumeral Articulation Immediately After Pushups. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00361

[67] Mechanical Signals as Regulators of Cartilage Degeneration and Regeneration. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00938

[68] Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.004

[70] Intramedullary, unicortical repair of distal biceps tendon rupture. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2021.12.002

[71] Kocher Approach or Kaplan Approach to the Lateral Elbow: An Anatomic Insight to Drive Our Choice - Award Winner. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-18-00385

[72] Complications associated with open reduction and internal fixation for adult distal humerus fractures: a multicenter retrospective study. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03292-1

[74] Annular Ligament Reconstruction Using the Distal Tendon of the Superficial Head of the Brachialis Muscle: An Anatomical Feasibility Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.008

[79] The anatomy of the patellar tendon. Knee Surgery, Sports Traumatology, Arthroscopy. 2000. DOI: 10.1007/s001670000133

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