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Chronische mediale Ellenbogeninstabilität – aktuelle Datenlage

  • K. J. BurkhartEmail author
  • M. M. Schneider
  • M. Hackl
  • R. Nietschke
  • L. P. Müller
  • B. Hollinger
Übersicht

Zusammenfassung

Eine chronische Valgusinstabilität kann durch ein akutes Trauma, eine iatrogene Schädigung oder durch Überbelastungen verursacht werden. Insbesondere bei Über-Kopf- und Wurfsportarten ist der Ellenbogen hohen Valguskräften ausgesetzt, die durch repetitive Überlastungen das mediale Kollateralband sukzessive schwächen. Die zunehmende Valgusinstabilität des Ellenbogens führt zu zunehmenden Kompressionskräften im radialen Kompartiment, was zu erheblichen Knorpelschäden führen kann. Durch das verstärkte Anschlagen des Olecranons am medialen Rand der Fossa olecrani kommt es hier zur typischen Osteophytenbildung und freien Gelenkkörpern. Der vorliegende Artikel befasst sich mit den Grundlagen und der Diagnostik der chronischen Valgusinstabilität und diskutiert konservative und operative Therapieoptionen anhand der aktuellen Literatur.

Schlüsselwörter

Kollateralband, mediales  Valgusinstabilität Osteophyten Olecranon Bandplastik 

Chronic medial elbow instability—status quo

Abstract

Chronic valgus instability can result from acute trauma, iatrogenic injury or overuse. Especially the overhead athlete’s and thrower’s elbow experience high valgus loads. Repetitive microtraumata weaken the medial collateral ligament. Increasing valgus instability leads to increasing compressing forces in the radial column which may lead to severe cartilage damage. Contact stress of the olecranon and medial fossa cause typical osteophyte formations and loose bodies. This article reviews the fundamentals and diagnostics of chronic valgus instability. Nonoperative and operative therapy options are discussed in the light of the current literature.

Keywords

Collateral ligament, medial Valgus Osteophytes Olecranon Ligament reconstruction 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K.J. Burkhart, M.M. Schneider, M. Hackl, R. Nietschke, L.P. Müller und B. Hollinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    King GJ, Morrey BF, An KN (1993) Stabilizers of the elbow. J Shoulder Elbow Surg 2(3):165–174CrossRefGoogle Scholar
  2. 2.
    Safran M, Ahmad CS, Elattrache NS (2005) Ulnar collateral ligament of the elbow. Arthroscopy 21(11):1381–1395CrossRefGoogle Scholar
  3. 3.
    Callaway GH, Field LD, Deng XH, Torzilli PA, O’Brien SJ, Altchek DW et al (1997) Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am 79(8):1223–1231CrossRefGoogle Scholar
  4. 4.
    Labott JR, Aibinder WR, Dines JS, Camp CL (2018) Understanding the medial ulnar collateral ligament of the elbow: review of native ligament anatomy and function. World J Orthop 9(6):78–84CrossRefGoogle Scholar
  5. 5.
    Rongieres M, Akhavan H, Mansat P, Mansat M, Vaysse P, Becue J (2001) Functional anatomy of the medial ligamentous complex of the elbow. Its role in anterior posterior instability. Surg Radiol Anat 23(5):301–305CrossRefGoogle Scholar
  6. 6.
    Rossy WH, Oh LS (2016) Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete. Curr Rev Musculoskelet Med 9(2):207–214CrossRefGoogle Scholar
  7. 7.
    Kodde IF, Rahusen FT, Eygendaal D (2012) Long-term results after ulnar collateral ligament reconstruction of the elbow in European athletes with interference screw technique and triceps fascia autograft. J Shoulder Elb Surg 21(12):1656–1663CrossRefGoogle Scholar
  8. 8.
    O’Holleran JD, Altchek DW (2006) The thrower’s elbow: arthroscopic treatment of valgus extension overload syndrome. HSS J 2(1):83–93CrossRefGoogle Scholar
  9. 9.
    Hyman J, Breazeale NM, Altchek DW (2001) Valgus instability of the elbow in athletes. Clin Sports Med 20(1):25–45CrossRefGoogle Scholar
  10. 10.
    O’Driscoll SW, Lawton RL, Smith AM (2005) The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med 33(2):231–239CrossRefGoogle Scholar
  11. 11.
    Hsu SH, Moen TC, Levine WN, Ahmad CS (2012) Physical examination of the athlete’s elbow. Am J Sports Med 40(3):699–708CrossRefGoogle Scholar
  12. 12.
    Eygendaal D, Heijboer MP, Obermann WR, Rozing PM (2000) Medial instability of the elbow: findings on valgus load radiography and MRI in 16 athletes. Acta Orthop Scand 71(5):480–483CrossRefGoogle Scholar
  13. 13.
    Rijke AM, Goitz HT, McCue FC, Andrews JR, Berr SS (1994) Stress radiography of the medial elbow ligaments. Radiology 191(1):213–216CrossRefGoogle Scholar
  14. 14.
    Bruce JR, Hess R, Joyner P, Andrews JR (2014) How much valgus instability can be expected with ulnar collateral ligament (UCL) injuries? A review of 273 baseball players with UCL injuries. J Shoulder Elbow Surg 23(10):1521–1526CrossRefGoogle Scholar
  15. 15.
    Ellenbecker TS, Mattalino AJ, Elam EA, Caplinger RA (1998) Medial elbow joint laxity in professional baseball pitchers. A bilateral comparison using stress radiography. Am J Sports Med 26(3):420–424CrossRefGoogle Scholar
  16. 16.
    Nakanishi K, Masatomi T, Ochi T, Ishida T, Hori S, Ikezoe J et al (1996) MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow. Skeletal Radiol 25(7):629–634CrossRefGoogle Scholar
  17. 17.
    Schwartz ML, al-Zahrani S, Morwessel RM, Andrews JR (1995) Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography. Radiology 197(1):297–299CrossRefGoogle Scholar
  18. 18.
    Timmerman LA, Schwartz ML, Andrews JR (1994) Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med 22(1):26–31 (discussion 2)CrossRefGoogle Scholar
  19. 19.
    Gaary EA, Potter HG, Altchek DW (1997) Medial elbow pain in the throwing athlete: MR imaging evaluation. Ajr Am J Roentgenol 168(3):795–800CrossRefGoogle Scholar
  20. 20.
    Potter HG (2000) Imaging of posttraumatic and soft tissue dysfunction of the elbow. Clin Orthop Relat Res 370:9–18CrossRefGoogle Scholar
  21. 21.
    Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P (2001) Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med 29(1):15–17CrossRefGoogle Scholar
  22. 22.
    Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T (2016) Return-to-play outcomes in professional baseball players after medial ulnar collateral ligament injuries: comparison of operative versus nonoperative treatment based on magnetic resonance imaging findings. Am J Sports Med 44(3):723–728CrossRefGoogle Scholar
  23. 23.
    Dines JS, Frank JB, Akerman M, Yocum LA (2009) Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med 37(3):566–570CrossRefGoogle Scholar
  24. 24.
    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM (2006) Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med 34(3):385–391CrossRefGoogle Scholar
  25. 25.
    Chaudhari AM, McKenzie CS, Borchers JR, Best TM (2011) Lumbopelvic control and pitching performance of professional baseball pitchers. J Strength Cond Res 25(8):2127–2132CrossRefGoogle Scholar
  26. 26.
    Chaudhari AM, McKenzie CS, Pan X, Onate JA (2014) Lumbopelvic control and days missed because of injury in professional baseball pitchers. Am J Sports Med 42(11):2734–2740CrossRefGoogle Scholar
  27. 27.
    Scher S, Anderson K, Weber N, Bajorek J, Rand K, Bey MJ (2010) Associations among hip and shoulder range of motion and shoulder injury in professional baseball players. J Athl Train 45(2):191–197CrossRefGoogle Scholar
  28. 28.
    Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA (2013) Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med 41(7):1689–1694CrossRefGoogle Scholar
  29. 29.
    Dines JS, Williams PN, ElAttrache N, Conte S, Tomczyk T, Osbahr DC et al (2016) Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop 45(5):296–300PubMedGoogle Scholar
  30. 30.
    Conway JE, Jobe FW, Glousman RE, Pink M (1992) Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am 74(1):67–83CrossRefGoogle Scholar
  31. 31.
    Richard MJ, Aldridge JM 3rd, Wiesler ER, Ruch DS (2008) Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am 90(11):2416–2422CrossRefGoogle Scholar
  32. 32.
    Savoie FH 3rd, Trenhaile SW, Roberts J, Field LD, Ramsey JR (2008) Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med 36(6):1066–1072CrossRefGoogle Scholar
  33. 33.
    Jobe FW, Stark H, Lombardo SJ (1986) Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 68(8):1158–1163CrossRefGoogle Scholar
  34. 34.
    Vitale MA, Ahmad CS (2008) The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med 36(6):1193–1205CrossRefGoogle Scholar
  35. 35.
    Savoie FH 3rd, Morgan C, Yaste J, Hurt J, Field L (2013) Medial ulnar collateral ligament reconstruction using hamstring allograft in overhead throwing athletes. J Bone Joint Surg Am 95(12):1062–1066CrossRefGoogle Scholar
  36. 36.
    Cain EL Jr., Dugas JR, Wolf RS, Andrews JR (2003) Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med 31(4):621–635CrossRefGoogle Scholar
  37. 37.
    Ahmad CS, Conway JE (2011) Elbow arthroscopy: valgus extension overload. Instr Course Lect 60:191–197PubMedGoogle Scholar
  38. 38.
    Burkhart KJ, Schneider MM, Hollinger B (2018) Chronische ulnare Instabilität. In: Imhoff A, Lenich A (Hrsg) Arthroskopie und minimal-invasive Chirurgie des Ellenbogens. Springer, Heidelberg, S 91–99CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • K. J. Burkhart
    • 1
    • 2
    Email author
  • M. M. Schneider
    • 1
    • 3
  • M. Hackl
    • 4
  • R. Nietschke
    • 1
  • L. P. Müller
    • 4
  • B. Hollinger
    • 1
  1. 1.Arcus SportklinikARCUS KlinikenPforzheimDeutschland
  2. 2.Universität zu KölnKölnDeutschland
  3. 3.Universität Witten/HerdeckeWittenDeutschland
  4. 4.Unfall‑, Hand- und Ellenbogenchirurgie, Klinik für Orthopädie und UnfallchirurgieUniversitätsklinikum KölnKölnDeutschland

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