• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.236-241
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• 1998

Recurrent dislocation of elbow joint occurs relatively rarely by the injury of the collateral ligament which contributes elbow joint stability. Among them, posterolateral rotatory instability occurs by the injury to the lateral ulnar collateral ligament. We experienced a case of recurrent dislocation of elbow joint due to posterolateral rotatory instability. We treated operatively with lateral ulnar collateral ligament reconstruction using the palmaris longus tendon by technique of Nestor et al. We report it with literature analysis.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.191-195
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• 2001

Posterolateral rotatory instability is the most common pattern of elbow instability especially which is recurrent, and is usually post-traumatic because of inadequate soft tissue healing. The lateral ulnar collateral ligament was reconstructed by using ipsilateral palmaris longus tendon. Functionally good result was obtained. This is a case report illustrating the posterolateral rotatory instability of the elbow and its reconstruction with palmaris longus.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.287-295
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• 2023

Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• v.23 no.1
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• pp.27-30
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• 2020

Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. The patient subsequently presented episodes of instability, and additional work-up studies diagnosed the occurrence of Osborne-Cotterill lesion. An open reduction and internal fixation of the bony lesion was performed, with reinsertion of the lateral ligamentous complex. Three months after surgery, the patient was asymptomatic, having a flexion of 130° and extension of 0°, and resumed his daily activities without any limitation. Currently, the patient remains asymptomatic 2 years after the procedure. Elbow instability includes a large spectrum of pathological conditions that affect the biomechanics of the joint. The Osborne-Cotterill lesion is one among these conditions. It is a pathology that is often forgotten and easily overlooked. Undoubtedly, this lesion requires surgical intervention.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2002.10a
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• pp.227-231
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• 2002

. Open posterior capsulolabral reconstruction(PCLR) in posterior subluxation yields very excellent clinical results if it is positional. . The main pathologic lesion is an excessive redundancy of the posteroinferior capsule. . The muscular type of posterior instability is contraindicated in PCLR.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2001.03a
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• pp.106-108
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• 2001

1. Open rotator interval lesion, related with the capsular laxity, could be anther cause of the instability, the sizes and shapes were variable. 2. Rl imbrication and capsular shift could be thought adequate treatment for the inferior and AP instability with no other lesions

• Clinics in Shoulder and Elbow
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• v.19 no.2
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• pp.78-83
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• 2016

Background: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. Methods: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. Results: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. Conclusions: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.254-262
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• 2024

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2003.11a
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• pp.51-56
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• 2003

The trained examiner can gain considerable information from visual inspections of the elbow joint, Because much of the joint is subcutaneous, any appreciable alteration in the skeletal anatomy often is detectable. Gross soft tissue swelling or muscle atrophy is also early observed. Inspection and palpation of the medial and lateral epicondyles and the tip of the otecranon from an equilateral triangle with the elbow is flexed. Normally, the arc of flexion extension, although variable, ranges from about O to 140 degrees plus or minus 10 degrees. The posterolateral rotatory instability(PLRI) of the elbow is most common pattern of elbow instability. The lateral collateral ligament complex also includes a narrow but stout band of ligamentous tissue blending with the distal and proterior fibers of the capsule to insert distally on the crista supinatoris of the ulna. This is the lateral ulnar collateral ligament(LUCL). A clinical elbow pivot shift test confirms the PLRI. There are also two active apprehension signs.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2004.03a
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• pp.52-52
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• 2004