Skip to main content

Advertisement

SpringerLink
Log in

Efficacy, usability and tolerability of a dynamic elbow orthosis after collateral ligament reconstruction: a prospective randomized study

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

To assess the efficacy, usability and tolerability of a dynamic orthosis compared with a standard plaster splint after the reconstruction of elbow medial or lateral collateral ligaments (MCL, LCL).

Methods

Twenty-six subjects undergoing MCL (n = 23) or LCL (n = 3) reconstruction were randomly assigned to immobilization with an orthosis (n = 13; group A “Innovator X”) or with a plaster splint (n = 13; group B “Plaster splint”). Outcome measures were visual analogue scale pain score, mid-arm (MA) circumference, grip strength, Oxford elbow score (OES) and range of motion (ROM). Patients were assessed at baseline and at 2, 6, 12 and 24 weeks.

Results

Significant pain reduction was reported by all patients at 6, 12 and 24 weeks (p < 0.05). Mean MA circumference was significantly higher in group A at all time points (all p < 0.05). Mean grip strength was greater in group A on weeks 2 and 6 (p < 0.05), whereas the difference found on weeks 12 and 24 was not significant. The OES and passive ROM values of the two groups were not significantly different at any time point.

Conclusions

The dynamic orthosis and the plaster splint both provided effective and safe elbow immobilization after MCL or LCL reconstruction. The orthosis provided greater pain reduction, faster recovery of muscle trophism and grip strength, and was better tolerated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Richard MJ, Aldridge JM 3rd, Wiesler ER, Ruch DS (2009) Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. Surgical technique. J Bone Joint Surg Am 91 Supplement: 2:191–199

    Google Scholar 

  2. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 87:54–61

    CAS  PubMed  Google Scholar 

  3. 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 Should Elbow Surg 21:1656–1663

    Article  Google Scholar 

  4. Morrell NT, Mercer DM, Moneim MS (2012) Late reconstruction of chronic distal biceps tendon ruptures using fascia lata autograft and suture anchor fixation. Tech Hand Up Extrem Surg 16:141–144

    Article  PubMed  Google Scholar 

  5. Bosman HA, Fincher M, Saw N (2012) Anatomic direct repair of chronic distal biceps brachii tendon rupture without interposition graft. J Should Elbow Surg 21:1342–1347

    Article  Google Scholar 

  6. Marinelli A, Bettelli G, Guerra E, Nogrisoli M, Rotini R (2010) Mobilization brace in post-traumatic elbow stiffness. Musculoskelet Surg 94:S37–S45

    Article  PubMed  Google Scholar 

  7. Osborne G, Cotterill P (1966) Recurrent dislocation of the elbow. J Bone Joint Surg Br 48:340–346

    CAS  PubMed  Google Scholar 

  8. Durig M, Muller W, Reudi TP, Gauer EE (1979) The operative treatment of elbow dislocation in the adult. J Bone Joint Surg Am 61:239–244

    CAS  PubMed  Google Scholar 

  9. Abe M, Ishizu T, Nagaoka T, Onomura T (1995) Recurrent posterior dislocation of the head of the radius in post-traumatic cubitus varus. J Bone Joint Surg Br 77:582–585

    CAS  PubMed  Google Scholar 

  10. Dugas JR, Bilotta J, Watts CD, Crum JA, Fleisig GS, McMichael CS, Cain EL Jr, Andrews JR (2012) Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision: technique and results. Am J Sports Med 40:1578–1582

    Article  PubMed  Google Scholar 

  11. Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Jenkinson C, Carr AJ (2008) The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br 90:466–473

    Article  CAS  PubMed  Google Scholar 

  12. Large TM, Coley ER, Paindl RD, Fleischli JE (2007) A biomechanical comparison of 2 ulnar collateral ligament reconstruction techniques. Arthroscopy 23:141–150

    Article  PubMed  Google Scholar 

  13. Oxford Elbow Score. http://www.orthopaedicscore.com/scorepages/oxford_elbow_score.html. Accessed March 2013 to July 2013

  14. Gibson BW, Webner D, Huffman GR, Sennett BJ (2007) Ulnar collateral ligament reconstruction in major league baseball pitchers. Am J Sports Med 35:575–581

    Article  PubMed  Google Scholar 

  15. Kesmezacar H, Sarıkaya IA (2010) The results of conservatively treated simple elbow dislocations. Acta Orthop Traumatol Turc 44:199–205

    Article  PubMed  Google Scholar 

  16. Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988) Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg Am 70:244–249

    CAS  PubMed  Google Scholar 

  17. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF (1995) Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 23:233–239

    Article  CAS  PubMed  Google Scholar 

  18. Hotchkiss RN, Weiland AJ (1987) Valgus stability of the elbow. J Orthop Res 5:372–377

    Article  CAS  PubMed  Google Scholar 

  19. Miller JE (1960) Javelin thrower’s elbow. J Bone Joint Surg Br 42:788–792

    Google Scholar 

  20. Schwab GH, Bennett JB, Woods GW, Tullos HS (1980) Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res 146:42–52

    PubMed  Google Scholar 

  21. Søjbjerg JO, Ovesen J, Nielsen S (1987) Experimental elbow instability after transection of the medial collateral ligament. Clin Orthop Relat Res 218:186–190

    PubMed  Google Scholar 

  22. Jobe FW, Stark H, Lombardo SJ (1986) Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 68:1158–1163

    CAS  PubMed  Google Scholar 

  23. Koh JL, Schafer MF, Keuter G, Hsu JE (2006) Ulnar collateral ligament reconstruction in elite throwing athletes. Arthroscopy 22:1187–1191

    Article  PubMed  Google Scholar 

  24. O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73-A:440–446

    Google Scholar 

  25. Cohen MS, Hastings H 2nd (1997) Rotatory instability of the elbow: the anatomy and role of the lateral stabilizers. J Bone Joint Surg Am 79-A:225–233

    Google Scholar 

  26. Di Gennaro GL, Spina M, Fosco M, Antonioli D, Donzelli O (2013) Dislocation of the elbow in children: long-term follow-up. Musculoskelet Surg 97:S3–S7

    Article  Google Scholar 

  27. Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW, Allen AA (2012) The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Should Elbow Surg 21:389–395

    Article  Google Scholar 

  28. Abe T, Kawakami Y, Gunji A, Fukunaga T (1997) Effects of 20 days’ bed rest on muscle morphology. J Gravit Physiol 4:10–14

    Google Scholar 

  29. Akima H, Kubo K, Imai M, Kanehisa H, Suzuki Y, Gunji A, Fukunaga T (2001) Inactivity and muscle: effect of resistance training during bed rest on muscle size in the lower limb. Acta Physiol Scand 172:269–278

    Article  CAS  PubMed  Google Scholar 

  30. Convertino VA, Doerr DF, Mathes KL, Stein SL, Buchanan P (1989) Changes in volume, muscle compartment, and compliance of the lower extremities in man following 30 days of exposure to simulated microgravity. Aviat Space Environ Med 60:653–658

    CAS  PubMed  Google Scholar 

  31. Trappe SW, Trappe TA, Lee GA, Widrick JJ, Costill DL, Fitts RH (2001) Comparison of a space shuttle flight (STS-78) and bed rest on human muscle function. J Appl Physiol 91:57–64

    CAS  PubMed  Google Scholar 

  32. Akima H, Kawakami Y, Kubo K, Sekiguchi C, Ohshima H, Miyamoto A, Fukunaga T (2000) Effect of short-duration spaceflight on thigh and leg muscle volume. Med Sci Sports Exerc 32:1743–1747

    Article  CAS  PubMed  Google Scholar 

  33. Kitahara A, Hamaoka T, Murase N, Homma T, Kurosawa Y, Ueda C, Nagasawa T, Ichimura S, Motobe M, Yashiro K, Nakano S, Katsumura T (2003) Deterioration of muscle function after 21-day forearm immobilization. Med Sci Sports Exerc 35:1697–1702

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Dr S. Modena for the language revision (www.silviamodena.com).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Unit of Shoulder and Elbow Surgery, “D. Cervesi” Hospital, L.V Beethowen 46, Code:47841, Cattolica, RN, Italy

    G. Merolla & G. Porcellini

  2. Department of Orthopaedics, Traumatology, Rehabilitation and Plastic Surgery, Second University of Naples, Naples, Italy

    P. Bianchi

Authors
  1. G. Merolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Porcellini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Merolla.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Merolla, G., Bianchi, P. & Porcellini, G. Efficacy, usability and tolerability of a dynamic elbow orthosis after collateral ligament reconstruction: a prospective randomized study. Musculoskelet Surg 98, 209–216 (2014). https://doi.org/10.1007/s12306-013-0301-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-013-0301-0

Keywords

Search

Navigation