title: Biomechanical considerations in the pathogenesis of osteoarthritis of the elbow.
abstract: Osteoarthritis is the most common joint disease and a major cause of disability. Distinct biological processes are considered crucial for the development of osteoarthritis and are assumed to act in concert with additional risk factors to induce expression of the disease. In the classical weightbearing joints, one such risk factor is an unfavourable biomechanical environment about the joint. While the elbow has long been considered a non-weightbearing joint, it is now assumed that the tissues of the upper extremity may be stressed to similar levels as those of the lower limb, and that forces across the elbow are in fact very high when the joint is extended from a flexed position. This review examined the available basic science, preclinical and clinical evidence regarding the role of several unfavourable biomechanical conditions about the elbow on the development of osteoarthritis: post-traumatic changes, osteochondritis dissecans, instability or laxity and malalignment. Post-traumatic osteoarthritis following fractures is well recognized, however, the role of overload or repetitive microtrauma as risk factors for post-traumatic osteoarthritis is unclear. The natural course of untreated cartilage defects in general, and osteochondritis dissecans at the elbow in particular, remains incompletely understood to date. However, larger lesions and older age seem to be associated with more symptoms and radiographic changes in the long term. Instability seems to play a role, although the association between instability and osteoarthritis is not yet clearly defined. No data are available on the association of malalignment and osteoarthritis, but based on force estimations across the elbow joint, it seems reasonable to assume an association.
authors: Department of Orthopaedic Surgery, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. aheijink@yahoo.com.
authors: Andras
authors: A
authors: Heijink
authors: Department of Orthopaedic Surgery, AZ Monica, Antwerp, Belgium.
authors: Matthias
authors: M
authors: Vanhees
authors: Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Kimberly
authors: K
authors: van den Ende
authors: Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors: Michel P
authors: MP
authors: van den Bekerom
authors: Department of Orthopaedic Surgery, AZ Monica, Antwerp, Belgium.
authors: Roger P
authors: RP
authors: van Riet
authors: Department of Orthopaedic Surgery, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: C Niek
authors: CN
authors: Van Dijk
authors: Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Denise
authors: D
authors: Eygendaal
mesh_terms: D001696:Biomechanical Phenomena; D017760:Bone Malalignment / Q000150:complications*; D002357:Cartilage Diseases; D004550:Elbow; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D007593:Joint Instability / Q000150:complications*; D010003:Osteoarthritis / Q000209:etiology*; D010008:Osteochondritis Dissecans / Q000150:complications*; D016059:Range of Motion, Articular; D000092464:Elbow Injuries
keywords: Aetiology; Cartilage; Instability; Malalignment; Osteochondritis dissecans; Pathology; Post-traumatic