Salma Otayek1, Abd-el-Kader Ait Tayeb2, Bouchra Assabah1, Brice Viard1,2, Romain Dayan1, Thierry Lazure3, Marc Soubeyrand4,5. 1. Department of Orthopaedic Surgery, Universitary Hospital of Bicetre (Public Assistance Hospital of Paris), Le Kremlin-Bicêtre, France. 2. Faculty of Medecine Paris Sud, University Paris Sud, Le Kremlin-Bicetre, France. 3. Department of Pathology, Universitary Hospital of Bicetre (Public Assistance Hospital of Paris), Le Kremlin-Bicêtre, France. 4. Department of Orthopaedic Surgery, Universitary Hospital of Bicetre (Public Assistance Hospital of Paris), Le Kremlin-Bicêtre, France. soubeyrand.marc@gmail.com. 5. Faculty of Medecine Paris Sud, University Paris Sud, Le Kremlin-Bicetre, France. soubeyrand.marc@gmail.com.
Abstract
OBJECTIVE: The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. MATERIALS AND METHODS: Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. RESULTS: Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. CONCLUSION: The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.
OBJECTIVE: The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. MATERIALS AND METHODS: Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. RESULTS: Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. CONCLUSION: The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.
Entities:
Keywords:
Elbow; Forearm instability; Forearm rotation; Forearm stability; Squared ligament of the elbow
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