Lateral collateral ligament complex insufficiency in recalcitrant lateral epicondylitis: MRI evaluation with arthroscopic findings.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2024-09-09 DOI:10.1007/s00264-024-06305-2

Jae-Man Kwak, Erica Kholinne, In-Ho Jeon

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Abstract

Purpose: To evaluate the concomitant pathology in recalcitrant LE using MRI with arthroscopic finding correlation.

Methods: A total of 49 patients were diagnosed with chronic recalcitrant LE and divided into two: LCL complex-intact and LCL complex-involved groups by evaluating MRI as confirmed by a radiologist. Patient information for the history of steroid injection and symptom duration was extracted from the medical records. Arthroscopic images taken during arthroscopic extensor carpi radialis brevis release were evaluated to assess the quality of lateral capsule and concomitant plica.

Results: A total of 24 and 25 patients were included in the LCL-intact and LCL-involved groups, respectively. Among them, seven had complete RCL tears recorded in the LCL-involved group. Symptom duration (15 ± 9 vs. 22 ± 13, p = 0.029) and the number of steroid injections (3 ± 2 vs. 5 ± 3, p = 0.040) were significantly higher in the LCL-involved group than that in the LCL-intact group. A capsular tear was detected for 5 (20%) patients in the LCL-intact and 14 (56%) in the LCL-involved group (p = 0.027). Concomitant plica was observed in 15 (62%) patients in LCL-intact and seven (28%) in the LCL-involved group (p = 0.015). RC joint widening was observed in four patients in the LCL-involved group.

Conclusion: The recalcitrant LE is highly a concomitant pathology including LCL complex insufficiency and pathologic elbow plica lesion. The risk factors of LCL insufficiency associated with refractory LE may include multiple steroid injections. Arthroscopic finding such as capsular tears and elbow drive-through signs can be suspected signs for LCL complex insufficiency.

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顽固性外上髁炎的侧副韧带复合体功能不全：核磁共振成像评估与关节镜检查结果。

目的：通过磁共振成像与关节镜检查结果的相关性，评估难治性LE的并发病变：方法：共诊断出 49 例慢性难治性 LE 患者，并将其分为两组：方法：共有49名患者被诊断为慢性顽固性LE，并通过放射科医生确认的核磁共振成像评估将其分为两组：LCL复合体未触及组和LCL复合体受累组。患者的类固醇注射史和症状持续时间等信息均来自病历。在关节镜下进行桡侧腕伸肌松解术时，对关节镜图像进行评估，以评估外侧囊的质量和伴随的骨板：LCL未受损组和LCL受损组分别有24名和25名患者。其中，LCL受累组中有7名患者的RCL完全撕裂。LCL受累组的症状持续时间（15 ± 9 vs. 22 ± 13，p = 0.029）和类固醇注射次数（3 ± 2 vs. 5 ± 3，p = 0.040）明显高于LCL未受累组。LCL未受损伤组有5名患者（20%）发现关节囊撕裂，LCL受累组有14名患者（56%）发现关节囊撕裂（p = 0.027）。LCL未受损伤组中有15名患者（62%）和LCL受累组中有7名患者（28%）被观察到并发斑块（P = 0.015）。LCL受累组有4名患者出现RC关节增宽：结论：LE顽固性病变是一种高度并发症，包括LCL复合体功能不全和病理性肘板病变。与难治性LE相关的LCL功能不全的风险因素可能包括多次类固醇注射。关节镜下的发现，如关节囊撕裂和肘关节穿梭征，可能是LCL复合体功能不全的可疑征兆。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.