Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE).
OBJECTIVE
Lateral epicondylitis is generally considered an extra-articular condition. The role of minor instability in the aetiology of lateral elbow pain has rarely been considered. The aim of this study was to evaluate the correlation of lateral ligamentous laxity with aspects of intra-articular lateral elbow pathology and investigate the role of minor instability in lateral elbow pain.


METHODS
Thirty-five consecutive patients aged between 20 and 60 years with recalcitrant lateral epicondylitis who had failed conservative therapy and had no previous trauma or overt instability, were included. The presence of three signs of lateral ligamentous patholaxity and five intra-articular findings were documented during arthroscopy. The relative incidence of each of these was calculated, and the correlation between patholaxity and intra-articular pathology was evaluated.


RESULTS
At least one sign of lateral ligamentous laxity was observed in 48.6% of the studied cohort, and 85.7% demonstrated at least one intra-articular abnormal finding. Radial head ballottement was the most common sign of patholaxity (42.9%). Synovitis was the most common intra-articular aspect of pathology (77.1%), followed by lateral capitellar chondropathy (40.0%). A significant correlation was found between the presence of lateral ligamentous patholaxity signs and capitellar chondropathy (p = 0.0409), as well as anteromedial synovitis (p = 0.0408).


CONCLUSIONS
Almost one half of patients suffering from recalcitrant lateral epicondylitis display signs of lateral ligamentous patholaxity, and over 85% demonstrate at least one intra-articular abnormality. The most frequent intra-articular findings are synovitis and lateral capitellar chondropathy, which correlate significantly with the presence of lateral ligamentous patholaxity. The fact that several patients demonstrated multiple intra-articular findings in relation to laxity provides support to a sequence of pathologic changes that may result from a symptomatic minor instability of the lateral elbow (SMILE) condition.


METHODS
III.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy.
Paolo
P
Arrigoni
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. d.cucchi@gmail.com.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy. d.cucchi@gmail.com.
Davide
http://orcid.org/0000-0001-6284-7977
D
Cucchi
IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy.
Riccardo
R
D'Ambrosi
Salford Royal NHS Foundation Trust, Salford, UK.
Usman
U
Butt
Stanford University, 450 Broadway, M/C 6342 Redwood City, Stanford, CA, 94063, USA.
Marc R
MR
Safran
Southern Oregon Orthopedics, 2780 E Barnett Rd, Suite 200, Medford, OR, 97504, USA.|Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA.
Patrick
P
Denard
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.|U.O. Ortopedia II, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy.
Pietro
P
Randelli
D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001182:Arthroscopy; D002357:Cartilage Diseases / Q000473:pathology / Q000503:physiopathology; D017885:Collateral Ligaments / Q000473:pathology* / Q000503:physiopathology; D004550:Elbow; D004551:Elbow Joint / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013585:Synovitis / Q000473:pathology / Q000503:physiopathology; D013716:Tennis Elbow / Q000473:pathology* / Q000503:physiopathology
Elbow arthroscopy; Elbow instability; Lateral elbow pain; Lateral epicondylitis; Laxity