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Joint Structures

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

Overview

Clinical evaluation for joint pain, severe cartilage destruction, and chondrolysis requires a comprehensive approach to minimize inappropriate management. This encompasses a detailed history reviewing all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and, in some cases, arthroscopic evaluation [1]. Standard and specialized views of the elbow provide valuable clinical information during patient evaluation when used appropriately [4]. Elbow arthroscopy is a reliable procedure that requires a clear understanding of anatomy to safely access the joint [70].

Prognostic factors and biomechanical considerations significantly influence surgical planning and outcomes. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up in late multiple ligament and posterolateral corner-reconstructed knees [7]. In the proximal radioulnar joint, a significant negative relationship exists between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage [8]. For capitellar pathology, a combination of ligament-preserving surgical approaches enables viewing of the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [9].

Surgical integrity and patient selection are critical determinants of success. Both collateral ligaments are essential stabilizers, and their integrity is a prerequisite for stable function of the capitellocondylar total elbow prosthesis [24]. Observed differences in knee scores between study groups not matched for clinically relevant factors are at least as likely to represent differences in patient populations as they are to represent differences in operative technique or implant design [23]. Smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of combined procedures [19]. Caution should be used in indicating combined high tibial osteotomy and cartilage treatment until more evidence is available to prove efficacy and weigh risks and benefits [22]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including Cheilectomy, Arthroplasty, and Arthrodesis, with selection depending on disease stage and patient factors [26].

Anatomy & Pathophysiology

Osseous and Joint Mechanics

Elbow stability and complex kinematics result from a combination of bony articulation and soft-tissue stabilizers [20]. The load sharing ratio across the native human elbow is 58% for the radiocapitellar joint and 42% for the ulnotrochlear joint [42]. This distribution was established by comprehensively evaluating loading mechanics across both native joints simultaneously throughout the entire functional range of elbow flexion and forearm rotation [42]. Elbow valgus torque increases contact pressure in the radiocapitellar joint [45]. The axis of rotation during elbow flexion lies approximately at the center of the trochlea [44].

Ligamentous and Soft-Tissue Stabilizers

The functional contribution of certain bands to elbow stability has not been evaluated, and more study is needed to define their role [3]. Limited biomechanical investigations conclude efficacy for stability profiles regarding the internal joint stabilizer of the elbow [6]. Three-dimensional analysis of elbow soft tissue footprints and anatomy provides information that may aid in restoring elbow biomechanics and preserving range of motion [34]. Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy [49]. A non-invasive elbow valgus laxity measurement device demonstrates high interobserver and intraobserver reliability using manual maximum valgus force [51].

Kinematics and Forearm Mechanics

Elbow joint moments vary in different directions during simulated activities of daily living [31]. The carrying angle of the forearm remains constant as the elbow flexes [37]. Dynamic elbow testing characterizes a decrease of valgus carrying angle during elbow flexion, with most varus angle changes occurring between 30 and 90 degrees of flexion [38]. Kinematics of the distal radioulnar joint are primarily affected by forearm rotation and secondarily by elbow flexion [32]. Elbow position affects the kinematics of the distal radioulnar joint [32]. The kinematics of the elbow deviate increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius in radial head arthroplasty [33].

Radial Head and Interosseous Membrane

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 [43]. A nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions, but there are also orientations where contact area is reduced and stress is increased [47].

Instability and Clinical Considerations

Both directions of instability must be addressed surgically to restore elbow stability in cases of combined posterolateral and posteromedial rotatory instability [46]. The biomechanics of the throwing motion involve diagnosis and treatment of elbow injuries common to throwers other than injuries to the ulnar collateral ligament [35]. Demographic and anthropometric factors are associated with elbow range of motion in healthy adults [48].

Classification

Clinical Evaluation Framework: Comprehensive assessment for joint pain, severe cartilage destruction, and chondrolysis requires a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and arthroscopic evaluation to minimize the risk of inappropriate clinical management [1].

Mason Fracture Extension: A proposed system offers a logical and reproducible (98%) extension of the current Mason fracture classification to document the presence of additional articular and ligamentous injuries [36].

Other Considerations: Elbow stability and complex kinematics are accounted for by a combination of bony articulation and soft-tissue stabilizers [20], with ligaments potentially functioning as 'static-dynamic' stabilizers rather than simple static stabilizers [60]. The functional contribution of specific bands to elbow stability has not been evaluated and requires further study [3]. Knowledge of precise ligamentous attachments and relationships to the physis and joint surface is important for pediatric elbow reconstructive procedures [15]. Substantial deformities or deformities close to the joint can cause abutment of the stems of components in total elbow arthroplasty [59].

A combination of ligament-preserving surgical approaches enables viewing the entirety of the capitellar joint surface and may represent an alternative to ligament-releasing approaches [9]. The synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure that can be identified via ultrasonography, a useful non-invasive diagnostic tool for painful snapping elbow [10]. 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].

The medial side of the knee demonstrates a consistent three-layered anatomical pattern, suggesting the use of specific nomenclature for the superficial medial ligament and posteromedial capsule rather than the term 'posterior oblique ligament' [40]. Terminology for shoulder ligaments is oriented to address the lack of official anatomic terminology, with disputes regarding historical descriptions and anatomical comparisons [56]. Multiple involvement of various types of cartilage in various parts of the body results in an obscure clinical picture that does not conform to any known clinical entity [11]. Observed differences in knee scores between study groups not matched for clinically relevant factors are at least as likely to represent differences in patient populations as they are to represent differences in operative technique or implant design [23].

Clinical Presentation

Clinical evaluation for joint pain and severe cartilage destruction requires a comprehensive approach to minimize the risk of inappropriate management. This encompasses a detailed history, including a review of all previous surgeries, a thorough bilateral examination, orthogonal radiographs, advanced imaging, and, in some cases, arthroscopic evaluation [1]. Standard and specialized radiographic views of the elbow provide valuable clinical information during patient evaluation [4].

For synovial chondromatosis of the hip, early diagnosis is critical for proper treatment [5]. In cases of osteochondritis dissecans of the capitellum, an MRI should be performed if healing does not occur by a reasonable time despite successful bony healing, to assess for potential cartilage damage [21]. Ultrasonography serves as a useful, non-invasive diagnostic tool for patients presenting with a painful snapping elbow, as the synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure [10].

In knees undergoing multiple ligament and posterolateral corner reconstruction, the presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up [7]. Multiple involvement of various types of cartilage in various parts of the body can result in an obscure clinical picture that does not conform to any known clinical entity [11].

Acute traumatic radial head subluxation in young children presents with symptoms that disappear immediately upon reduction; normal painless function resumes the following day with no evidence of joint damage [12]. Patients with lateral collateral ligament instability of the elbow experience resolution of instability symptoms and regain a near full arc of elbow flexion and forearm rotation [13]. A consistent distribution pattern for articular sensory receptors exists in the human elbow joint capsule, allowing for further understanding of elbow pathology [52].

Investigations

Plain radiography: Clinical evaluation for joint pain, severe cartilage destruction, and chondrolysis requires orthogonal radiographs as part of a comprehensive assessment [1]. Standard and specialized views of the elbow provide valuable clinical information when used appropriately [4]. Gentle valgus stress roentgenograms are utilized to carefully evaluate the knee before deciding on treatment for proximal tibial epiphyseal fracture separation [76].

MRI: Magnetic resonance imaging (MRI) is indicated if healing does not occur by a reasonable time despite successful bony healing, to assess potential cartilage damage in osteochondritis dissecans of the capitellum [21]. MRI indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [79].

Dynamic imaging: Dynamic imaging study with double contrast arthrogram under fluoroscopic control has high diagnostic value for detecting interposed tissue as a cause of snapping elbow [74].

Ultrasonography: Ultrasonography is a useful, non-invasive diagnostic tool for patients presenting with a painful snapping elbow, as the synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure [10]. Stress ultrasonography is a reliable, efficient, and clinically feasible method to assess ulnar collateral ligament (UCL) thickness, loaded joint gapping, and stiffness following UCL reconstruction (UCLR) [75].

Other Considerations: Clinical evaluation should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, advanced imaging, and, in some cases, arthroscopic evaluation to minimize the risk of inappropriate clinical management [1]. Early diagnosis and proper treatment are important for synovial chondromatosis of the hip [5].

Treatment

Diagnostic Evaluation and Differentiation

Clinical evaluation for joint pain and severe cartilage destruction requires a detailed history, including a review of all previous surgeries, a thorough bilateral examination, orthogonal radiographs, advanced imaging, and arthroscopic evaluation to minimize the risk of inappropriate clinical management [1]. Standard and specialized radiographic views of the elbow provide valuable clinical information during patient evaluation [4].

Non-Operative

Conservative management strategies are supported by specific evidence across various pathologies. For lateral elbow tendinopathy, the BESS patient care pathway provides a guidance summary using the GRADE system, establishing recommendations based on evidence quality and the balance of consequences [66]. In osteochondritis dissecans of the humeral capitellum, progression of ossification during the first 3 months is a significant predictor of successful nonoperative treatment and complete union [30]. For medial knee overload or arthritis, patients with a preoperative symptom duration of two years or greater do not experience inferior patient-reported outcomes or clinical outcomes at mid-term follow-up compared to patients with symptom duration of less than 2 years [17].

Operative

Indications: Surgical management for coxa vara is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery [25]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures, with selection depending on disease stage and patient factors [26]. Surgical repair of ligaments following elbow dislocation does not yield better results than non-surgical treatment [57]. Excellent functional outcomes can be achieved with a conservative approach for open antero-lateral elbow dislocation even after extensive soft tissue damage from minor injury [65].

Surgical Approach / Technique: Complete resection and correction osteotomy for Trevor's disease in patients with functional impairment or remarkable deformity can restore normal anatomy and result in good function without local recurrence [2]. Ligament-preserving surgical approaches to the capitellum enable viewing of the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [9]. Lateral or combined lateral and medial capsuloligamentous repair is recommended as adequate treatment for recurrent elbow dislocation, while bone block and dynamic stabilization procedures are unnecessary [58]. Surgical reconstruction of the lateral ulnar collateral ligament (LUCL) and internal joint stabilization can prevent recurrent instability in atraumatic, bilateral elbow instability refractory to nonoperative management [64]. Ligament repairs and reconstructions are an effective way of stabilizing the elbow joint in chronic instability patients and result in improved overall range of motion [55].

Implant Selection: Surgical management of proximal humeral dysplasia epiphysealis hemimelica with custom hemiarthroplasty is a reasonable salvage method when nonsurgical management fails to provide relief [67]. The Discovery Elbow System results in improved function, reduced pain, and high patient satisfaction with a 4-year mean follow-up [18]. Both collateral ligaments are essential stabilizers for the capitellocondylar total elbow prosthesis, and their integrity is a prerequisite for stable function [24].

Adjuncts: Improved histology at the tendon-to-bone interface using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair is correlated with improved final construct strength at 12 weeks [16].

Other Considerations: AMIC is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [14]. The benefit of high tibial osteotomy (HTO) augmentation with cartilage treatment is not proven, and caution should be used in indicating combined HTO-cartilage treatment until more evidence is available to prove efficacy and weigh risks and benefits [22]. Understanding the unique structural and functional properties of articular cartilage is key to developing chondroprotective agents that can improve its metabolic function [61]. Treatment options for ulnar collateral ligament injury vary based on the injury mechanism, ranging from conservative management for acute dislocations to surgical reconstruction for chronic overload in athletes [62]. Surgical anatomical repair is typically performed for acute complete distal biceps and triceps ruptures, while nonoperative treatment is reserved for partial ruptures or patients unfit for surgery [63].

Complications

Infection (PJI): Severe cartilage destruction and chondrolysis are recognized complications associated with joint pain [1]. Inappropriate clinical management is a risk if detailed history, bilateral examination, orthogonal radiographs, advanced imaging, and arthroscopic evaluation are not utilized to differentiate diagnoses [1].

Instability: Lateral collateral ligament instability of the elbow causes symptoms of instability [13]. Untreated posterolateral rotatory instability of the elbow can result in long-term sequelae including elbow arthrosis, progressing deformity, flexion contracture, and tardy ulnar nerve palsy [28]. Synovial chondromatosis can lead to secondary subluxation of the hip [5]. Traumatic subluxation of the radial head in young children can occur without evidence of damage to the joint [12]. Posterior capsular avulsion of the elbow can occur without associated dislocation or ligamentous injury [27].

Stiffness / Arthrofibrosis: Untreated posterolateral rotatory instability of the elbow can result in long-term sequelae including elbow arthrosis, progressing deformity, flexion contracture, and tardy ulnar nerve palsy [28].

Nerve palsy: Untreated posterolateral rotatory instability of the elbow can result in long-term sequelae including elbow arthrosis, progressing deformity, flexion contracture, and tardy ulnar nerve palsy [28].

Polyethylene wear: Major primary complications and a high incidence of radiographic signs of degenerative changes are associated with bipolar radial head arthroplasty [71].

Other Considerations: Trevor's disease (dysplasia epiphysealis hemimelica) can cause functional impairment and remarkable deformity [2]. Coxa vara in childhood can present as a progressive, painful, unilateral deformity or leg-length discrepancy [25]. Chondrosis present at the time of surgery is an important prognosticator of poor functional outcome at intermediate follow-up in late multiple ligament and posterolateral corner-reconstructed knees [7]. Autologous Matrix-Induced Chondrogenesis (AMIC) is used to treat symptomatic full-thickness chondral defects of the knee [14].

Recovery

Light activity (weeks): Clinical evaluation for joint pain and severe cartilage destruction should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and arthroscopic evaluation to minimize inappropriate clinical management [1].

Full activity (months): Complete resection and correction osteotomy in patients with functional impairment or remarkable deformity from Trevor's disease can lead to restoration of normal anatomy and good function without local recurrence [2]. Early diagnosis and proper treatment are important for synovial chondromatosis of the hip [5]. Limited biomechanical investigations conclude that the internal joint stabilizer of the elbow provides efficacy for stability profiles [6]. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up in late multiple ligament and posterolateral corner-reconstructed knees [7]. Symptoms of traumatic radial head subluxation in young children disappear immediately upon reduction, with normal painless function resuming the following day and no evidence of joint damage [12]. Patients with lateral collateral ligament instability of the elbow experience resolution of instability symptoms and regain a near full arc of elbow flexion and forearm rotation [13]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [14]. Improved histology at the tendon-to-bone interface using an interposition bioresorbable scaffold is correlated with improved final construct strength at 12 weeks in primary rotator cuff repair [16]. Patients with a preoperative symptom duration of two years or greater for medial knee overload/arthritis do not experience inferior patient-reported outcomes or clinical outcomes compared to those with symptom duration less than 2 years at mid-term follow-up after high tibial osteotomy [17]. The Discovery Elbow System results in improved function, reduced pain, and high patient satisfaction at a 4-year mean follow-up [18].

Complete recovery / outcome plateau (months): Further research is needed to investigate the incidence, biomechanical effects, and long-term clinical outcomes of isolated ulnohumeral capsular injury without associated dislocation or ligamentous injury [27]. Untreated posterolateral rotatory instability of the elbow can result in long-term sequelae including elbow arthrosis, progressing deformity, flexion contracture, and tardy ulnar nerve palsy [28]. Absence of heterotopic ossification on 2-week radiographs may predict a decreased likelihood of its ultimate development after radial head implantation [29]. Progression of ossification during the first 3 months is a significant predictor of successful nonoperative treatment and complete union for osteochondritis dissecans of the humeral capitellum [30]. Open reduction of interposed tissues in irreducible isolated anteromedial radial head dislocation can result in a good functional outcome in the short term [69]. Degenerative changes and the number of prior surgeries are predictors for less favorable outcomes in chronic posterolateral rotatory instability of the elbow [80].

Key Evidence

  • [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. (10.1016/j.arthro.2011.03.025)
  • [L4] Complete resection and correction osteotomy in patients with functional impairment or remarkable deformity can lead to restoration of normal anatomy and result in good function without local recurrence. (10.1016/j.jse.2012.10.031)
  • [L5] Their functional contribution has not been evaluated, and more study is needed to define the contribution of these bands to elbow stability. (10.1016/j.jhsa.2012.09.031)
  • [L5] Standard and specialized views of the elbow can be very beneficial and, when used appropriately, will provide valuable clinical information during the evaluation of patients. (10.1016/j.jhsa.2014.04.035)
  • [Case_report] The findings stress the importance of early diagnosis and proper treatment of synovial chondromatosis of the hip. (10.2106/00004623-199173090-00019)
  • [L4] The limited biomechanical investigations conclude efficacy for stability profiles. (10.1016/j.jhsg.2023.09.004)
  • [L4] The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up. (10.1177/0363546507311091)
  • [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. (10.1016/j.xrrt.2026.100695)
  • [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. (10.1016/j.jse.2022.01.013)
  • [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. (10.1016/j.jse.2006.10.019)
  • [L4] Symptoms disappear immediately upon reduction and normal painless function is resumed the following day, with no evidence of damage to the joint. (10.2106/00004623-195436030-00018)
  • [L4] All patients in the series had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation. (10.1016/j.hcl.2007.11.001)
  • [L4] AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. (10.1007/s00167-010-1042-3)
  • [L5] Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. (10.1177/2325967120s00264)
  • [L5] Improved histology was correlated with improved final construct strength at the 12-week time point. (10.1016/j.jse.2019.05.024)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L4] The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. (10.1016/j.jse.2014.08.013)
  • [L5] The authors believe that smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of these combined procedures. (10.1016/j.arthro.2017.01.005)
  • [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. (10.1016/j.csm.2004.06.008)
  • [Case_report] The authors recommend performing an MRI if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage. (10.1007/s00402-005-0018-0)
  • [Letter] The benefit of an HTO augmentation with a cartilage treatment is far from being proven, and caution should be used in giving indications for a combined HTO-cartilage treatment until more evidence is available to prove their efficacy and to weigh their risks and benefits. (10.1016/j.arthro.2017.01.006)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L5] Both collateral ligaments are essential stabilizers, and their integrity is a prerequisite for stable function. (10.2106/00004623-199509000-00023)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L5] Further research is needed to investigate the incidence, biomechanical effects, and long-term clinical outcomes in patients with isolated ulnohumeral capsular injury. (10.1016/j.jse.2018.04.021)
  • [Case_report] This case presents the possibility of the natural course of untreated posterolateral rotatory instability of the elbow, characterized by long-term sequelae including elbow arthrosis, progressing deformity, flexion contracture, and tardy ulnar nerve palsy. (10.1186/1749-799x-5-5)
  • [L3] Absence of heterotopic ossification on 2-week radiographs may predict a decreased likelihood of its ultimate development. (10.1016/j.jse.2013.07.022)
  • [L4] The progression of ossification during the first 3 months was a significant predictor of successful nonoperative treatment and complete union. (10.1016/j.jseint.2021.01.004)
  • [L5] This study analyzed elbow joint moments in different directions during daily tasks. (10.1016/j.jse.2023.07.042)
  • [L5] Elbow position affects the kinematics of the distal radioulnar joint, which are primarily affected by forearm rotation and secondarily by elbow flexion. (10.1016/j.jhsa.2009.04.025)
  • [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. (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
  • [L5] This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients. (10.1016/j.jse.2014.05.003)
  • [L5] The purpose of the present review article is to describe the biomechanics of the throwing motion and the diagnosis and treatment of elbow injuries common to a thrower other than injuries to the ulnar collateral ligament. (10.2106/jbjs.rvw.n.00011)
  • [L4] The proposed system offers a logical and reproducible (98%) extension of the current Mason fracture classification to document the presence of additional articular and ligamentous injuries. (10.1007/s11999-007-0064-8)
  • [L5] The carrying angle of the forearm remains constant as the elbow flexes. (10.2106/00004623-198163040-00003)
  • [L5] The dynamic elbow testing apparatus characterized a decrease of valgus carrying angle during elbow flexion and found that most varus angle changes occurred between 30 and 90 degrees of flexion. (10.1016/j.jhsa.2023.07.010)
  • [L5] The study delineated a consistent three-layered anatomical pattern of the medial knee, suggesting the use of specific nomenclature for the superficial medial ligament and posteromedial capsule rather than the term 'posterior oblique ligament'. (10.2106/00004623-197961010-00011)
  • [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. (10.1177/1758573220961025)
  • [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. (10.1302/0301-620x.95b10.31844)
  • [L5] The axis of rotation during elbow flexion lies approximately at the center of the trochlea. (10.2106/00004623-197658040-00013)
  • [L5] Elbow valgus torque increases contact pressure in the radiocapitellar joint. (10.1177/0363546513490652)
  • [L4] Both directions of instability must be addressed surgically to restore elbow stability. (10.1016/j.injury.2007.01.039)
  • [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. (10.1016/j.jse.2014.12.011)
  • [L4] This study confirms the association between various demographic and anthropometric factors and elbow range of motion in healthy adults. (10.1016/j.jse.2012.05.028)
  • [L4] Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy. (10.1016/j.jse.2010.01.003)
  • [L4] The noninvasive valgus elbow tester demonstrates high interobserver and intraobserver reliability using manual maximum valgus force and can be used for further research and daily practice. (10.1186/s40634-020-00290-2)
  • [L5] A consistent distribution pattern for articular sensory receptors was observed, which allows further understanding of elbow pathology. (10.1177/1758573218760245)
  • [L4] It is an effective way of stabilizing the elbow joint in chronic instability patients, and results in an improvement in their overall range of motion. (10.1016/j.jseint.2024.02.013)
  • [Letter] The authors clarify that their terminology is more anatomically oriented to address the lack of official anatomic terminology for shoulder ligaments and dispute specific claims made by Pouliart regarding historical descriptions and anatomical comparisons. (10.1016/j.jse.2011.01.010)
  • [L1] The results of surgical repair of the ligaments were not better than those of non-surgical treatment. (10.2106/00004623-198769040-00018)
  • [L4] Lateral or combined lateral and medial capsuloligamentous repair is recommended as adequate treatment, while bone block and dynamic stabilization procedures are unnecessary. (10.2106/00004623-197557080-00008)
  • [L4] This is explained by abutment of the stems of the components and is particularly severe when there are substantial deformities or the deformities are close to the joint. (10.1302/0301-620x.97b11.36071)
  • [L5] Based on these perspectives, ligaments could function as a 'static-dynamic' stabilizer rather than a simple static one. (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. (10.5435/00124635-200311000-00006)
  • [L4] Treatment options vary based on the injury mechanism, ranging from conservative management for acute dislocations to surgical reconstruction for chronic overload in athletes. (10.1111/sae.12014)
  • [Paper] Surgical anatomical repair is typically performed in acute complete ruptures, while nonoperative treatment is reserved for partial ruptures or patients unfit for surgery. (10.1016/j.injury.2013.01.003)
  • [Case_report] In the setting of atraumatic, bilateral elbow instability that is refractory to nonoperative management, recurrent instability can be prevented by surgical reconstruction of the LUCL and internal joint stabilization. (10.1016/j.jse.2015.12.020)
  • [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. (10.1186/1471-2474-3-1)
  • [L1] The article provides a guidance summary for the management of lateral elbow tendinopathy using the GRADE system, establishing recommendations based on the quality of available evidence and the balance between desirable and undesirable consequences of alternative management options. (10.1177/17585732231170793)
  • [Case_report] This appears to be a reasonable method to salvage this difficult and challenging problem when nonsurgical management has failed to provide relief. (10.1016/j.jse.2011.08.043)
  • [Case_report] Open reduction of interposed tissues can result in a good functional outcome, at least in the short term. (10.1177/17585732211039459)
  • [L5] Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint. (10.1016/j.arthro.2019.05.014)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] Dynamic imaging study with double contrast arthrogram under fluoroscopic control has high diagnostic value for detecting interposed tissue as a cause of snapping elbow. (10.1007/s00167-010-1076-6)
  • [L3] Stress ultrasonography is a reliable, efficient, and clinically feasible method to assess UCL thickness, loaded joint gapping, and stiffness post-UCLR. (10.1177/2325967115s00082)
  • [L4] Physicians should utilize gentle valgus stress roentgenograms and carefully evaluate the knee before deciding on treatment. (10.2106/00004623-196345040-00011)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] Degenerative changes and the number of prior surgeries are predictors for less favourable outcome. (10.1302/2058-5241.160033)

See Also

References

[1] 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

[2] A rare case of Trevor's disease (dysplasia epiphysealis hemimelica) in the elbow. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.10.031

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

[4] Radiographic Evaluation of the Elbow. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.035

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