Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Can be released to gain flexion in patients with post-traumatic contracture
76%
5025/6617
Has the highest tensile strength of any elbow ligament
4%
272/6617
Is reconstructed in the Tommy John procedure
3%
214/6617
Is the primary ligamentous restraint to valgus force during throwing
11%
751/6617
Is responsible for the pivot shift of the elbow
264/6617
Select Answer to see Preferred Response
Addressing flexion in a post-traumatic contracture of the elbow requires releasing the posterior oblique ligament (or band) of the medial ulnar collateral complex. The medial ulnar collateral ligament is one of the primary static stabilizers of the elbow and is composed of three parts: anterior, posterior and transverse. The MCL provides resistance to valgus and distractive stresses. The anterior oblique fibers (of the anterior bundle) are the most important against valgus stresses. The posterior bundle is involved elbow contractures and releasing it can yield significant flexion gains, without creating valgus instability. Morrey et al. performed a pilot study on 4 specimens and found the valgus stability is equally divided among the medial collateral ligament complex, anterior capsule, and bony articulation in full extension; whereas, at 90 degrees of flexion the contribution of the anterior capsule is assumed by the medial collateral ligament which provides approximately 55% of the stabilizing contribution to valgus stress. Regan et al. was a subsequent study by the same group that found the posterior medial collateral ligament (PMCL) was taut only when the elbow was in a flexed position. Among the collateral ligaments, the anterior (AMCL) was the strongest and stiffest. (Of note, using present terminology these would be referred to as posterior oblique and anterior oblique portions of the medial ulnar collateral complex). Wada et al. reported a series of open medial releases for post-traumatic elbow contracture and found scarring on the posterior oblique bundle in all cases. Large increases in flexion were achieved by releasing this structure and the capsule without the need for a lateral incision in most cases. Illustrations A and B show the posterior oblique portion of the medial collateral ligament. Illustration C shows the most recent terminology and identifies the area to be resected for stiffness. Incorrect Answers: Answers 2,3,4: All refer to the anterior oblique bundle of the medial ulnar collateral ligament. Answer 5: Lateral ulnar collateral (LUCL) insufficiency is responsible for posterolateral rotatory instability and a positive pivot shift of the elbow.
4.5
(6)
Please Login to add comment