Application of screw displacement axes to quantify elbow instability.
OBJECTIVE
To determine if screw displacement axis patterns describing elbow joint motion: (1) change after ligament transection in vitro; (2) can reflect subtle changes in stability as a function of forearm position; (3) can reflect dynamic stabilization of the ligament insufficient elbow provided by muscle activity.Design. An in vitro kinematic study of eighteen cadaveric specimens tested in a joint simulator.


BACKGROUND
In the elbow joint, screw displacement axes have been employed for proper positioning and design of endoprostheses. The effect of instability on screw displacement axes has not been previously reported.


METHODS
Passive and simulated active flexion, with the forearm maintained in both pronation and supination, was performed on eighteen intact and ligament insufficient elbows. Instability was produced by transection of the medial collateral or lateral collateral ligament complexes. Kinematics were recorded using an electromagnetic tracking device and analyzed with a repeated measures design.


RESULTS
During passive motion, division of either ligament caused deviation of screw displacement axes compared to the intact state (P<0.05). Transection of the medial/lateral collateral ligament generated greater instability with the forearm maintained in pronation/supination compared to supination/pronation (P<0.05). Muscle activation increased stability similar to the intact state (P>0.05).


CONCLUSIONS
These results are consistent with observations determined using traditional kinematic descriptors. Screw displacement axes can readily detect changes in stability due to ligament sectioning.


CONCLUSIONS
Clinicians can employ the screw displacement axis technique as a succinct descriptor of motion to readily detect elbow instability.
Duck
Teresa R
TR
Bioengineering Research Laboratory, Hand and Upper Limb Centre, St. Joseph's Health Care London, 268 Grosvenor St., Ont., London, Canada N6A 4L6.
Dunning
Cynthia E
CE
Armstrong
April D
AD
Johnson
James A
JA
King
Graham J W
GJ
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D017885:Collateral Ligaments / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007593:Joint Instability / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012016:Reference Values; D012399:Rotation