title: Arthroscopic, macroscopic, and microscopic anatomy of the synovial fold of the elbow joint in correlation with the common extensor origin.
abstract: OBJECTIVE
  The objective of our study was to clarify the arthroscopic, macroscopic, and microscopic anatomy of the radiocapitellar synovial fold of the elbow joint in correlation with the common extensor origin.
  
  
  METHODS
  We performed arthroscopy in 14 fresh-frozen cadaveric elbows and found the synovial fold covering the radial head or interposing in the radiocapitellar joint in 6. The fold was tagged with loop suture under arthroscopy to identify its exact location in gross anatomy. The radiocapitellar joint capsule was then resected without disturbing the continuity of the common extensor and lateral epicondyle. Macroscopic and histologic evaluation was performed for the lateral elbow capsular complex.
  
  
  RESULTS
  The synovial fold was found to be a triangular-shaped thickening of the capsule located on the proximal edge of the annular ligament. The mean distance between the lateral epicondyle and the base of the fold at the anterior edge, middle part, and posterior edge was 23 mm, 8 mm, and 13 mm, respectively. This structure was distinct from the annular ligament but was continuous with the radiocapitellar joint capsule. The joint capsule and the common extensor tendon blended with each other imperceptibly and formed a single enthesis at the lateral epicondyle.
  
  
  CONCLUSIONS
  The synovial fold identified by arthroscopy is a physiologic capsular tissue located on the proximal edge of the annular ligament. It is distinct from the annular ligament but has a close correlation with the common extensor tendon enthesis at the lateral epicondyle.
  
  
  CONCLUSIONS
  The synovial fold belongs to the lateral epicondyle enthesis, which is a composite of the common extensor tendon, undersurface capsule, and bone. Therefore, lateral epicondylitis with degenerative lesions in the area of the common extensor origin may involve the synovial fold and induce hypertrophic changes.
authors.affiliation: Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsuji
authors.forename: Takuro
authors.initials: T
authors.lastname: Wada
authors.forename: Takashi
authors.initials: T
authors.lastname: Oda
authors.forename: Kosuke
authors.initials: K
authors.lastname: Iba
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Aoki
authors.forename: Gen
authors.initials: G
authors.lastname: Murakami
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002102:Cadaver; D004551:Elbow Joint / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D008853:Microscopy; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000601:surgery; D000074402:Synovectomy; D013583:Synovial Membrane / Q000033:anatomy & histology*