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The role of the joint capsule in the stability of the elbow joint

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Abstract

Existing studies lack a clear understanding of the interaction of the joint capsule with surrounding tissues and the local mechanical environment. Particularly, a finite element model of human elbow joint incorporating active behavior of muscle was constructed. The simulation was performed during the elbow joint flexion movement under different injury conditions of capsule (anterior capsule, posterior capsule, medial anterior capsule, lateral anterior capsule, medial posterior capsule, and lateral posterior capsule). The stress distribution and transfer of the joint capsule, ulnar cartilage, and ligaments were obtained under different injuries and flexion angles, to explore the influence of capsule injures on the stability of the elbow joint. In medial injury posterior capsule, the peak stress of the ulnar cartilage occurred at 60° flexion and shifted from posteromedial to anteromedial. And the stress was about 1.8 times that of no injury capsule. In several cases of posterior capsule injury, the stress of capsule decreased significantly and the peak stress was 40% of that in no injury joint capsule. In the case of anterior capsular injury, the cartilage stress did not change significantly, and the stress of anterior bundle and annular ligament changed slightly in the late flexion movement. These findings provide some help for doctors to treat elbow injury and understand the interaction of tissues around the joint after trauma.

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References

  1. Stoneback JW, Owens BD, Sykes J, Athwal GS, Pointer L, Wolf JM (2012) Incidence of elbow dislocations in the united states population. Jbjs 94:240. https://doi.org/10.2106/JBJS.J.01663

    Article  Google Scholar 

  2. Sanchez-Sotelo Joaquín, Morrey Mark (2016) Complex elbow instability: surgical management of elbow fracture dislocations. Instr Lect: Shoulder & Elbow 1:183–190. https://doi.org/10.1302/2058-5241.1.000036

    Article  Google Scholar 

  3. Castelli A, D’Amico S, Combi A, Benazzo F (2016) Hinged external fixation for regan–morrey type i and ii fractures and fracture-dislocations. J Orthop Traumatol 17(2):175–179. https://doi.org/10.1007/s10195-016-0395-x

    Article  PubMed  PubMed Central  Google Scholar 

  4. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG (2014) Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res 472(7):2084. https://doi.org/10.1007/s11999-014-3471-7

    Article  PubMed  PubMed Central  Google Scholar 

  5. Antoni M, Eichler D, Kempf JF et al (2019) Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture. Orthop Traumatol: Surg Res 105:1575–1583. https://doi.org/10.1016/j.otsr.2019.09.024

    Article  PubMed  Google Scholar 

  6. Ward LD, Ambrose CG, Masson MV, Levaro F (2000) The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg 25A:341–351

    Article  Google Scholar 

  7. Shimura H, Nimura A, Nasu H, Fujishiro H, Imatani J, Okawa A, et al (2016) Joint capsule attachment to the coronoid process of the ulna: an anatomic study with implications regarding the type 1 fractures of the coronoid process of the o'driscoll classification. Journal of Shoulder and Elbow Surgery 25:1517–1522. https://doi.org/10.1016/j.jse.2016.01.024

  8. Wilps T, Kaufmann RA, Yamakawa S, Fowler JR (2020) Elbow biomechanics: bony and dynamic stabilizers. J Hand Surg 45:528–535. https://doi.org/10.1016/j.jhsa.2020.01.016

  9. Jung SW, Kim DH, Kang SH, Eho YJ, Yang SW, Lee GE (2019) Risk factors that influence subsequent recurrent instability in terrible triad injury of the elbow. J Orthop Trauma 33:250–255. https://doi.org/10.1097/BOT.0000000000001425

    Article  PubMed  Google Scholar 

  10. McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder & Elbow Surg 12:391–396. https://doi.org/10.1016/S1058-2746(03)00027-2

    Article  Google Scholar 

  11. Edwards DS, Arshad MS, Luokkala T, Kedgley AE, Watts AC (2018) The contribution of the posterolateral capsule to elbow joint stability: a cadaveric biomechanical investigation. Journal of shoulder and elbow surgery 27:1178–1184. https://doi.org/10.1016/j.jse.2018.02.045

  12. Kc A, Sh A, Gm A, Aa B (2021) Clinical anatomy and biomechanics of the elbow. J Clin Orthop Trauma 20:101485. https://doi.org/10.1016/j.jcot.2021

  13. Giannicola G, Polimanti D, Sacchetti FM, Scacchi M, Cinotti G (2012) Soft tissue constraint injuries in complex elbow instability: surgical techniques and clinical outcomes. Orthopedics 35:e1746–e1753. https://doi.org/10.3928/01477447-20121120-19

    Article  PubMed  Google Scholar 

  14. Bendjaballah MZ, Shirazi-Adl A, Zukor DJ (1997) Finite element analysis of human knee joint in varus-valgus. Clin Biomech 12:139–148. https://doi.org/10.1016/S0268-0033(97)00072-7

    Article  CAS  Google Scholar 

  15. Zhang JG, Wang F, Xue ZQ (2011) A three-dimensional finite element model of the cervical spine: an investigation of whiplash injury. Med Biol Eng Comput. https://doi.org/10.1007/s11517-010-0708-9

    Article  PubMed  Google Scholar 

  16. Büchler P, Ramaniraka NA, Rakotomanana LR, Iannotti JP, Farron A (2002) A finite element model of the shoulder: application to the comparison of normal and osteoarthritic joints. Clin Biomech 17:630–639. https://doi.org/10.1016/S0268-0033(02)00106-7

    Article  Google Scholar 

  17. Quapp KM, Weiss JA (1998) Material characterization of human medial collateral ligament. J Biomech Eng 120:757. https://doi.org/10.1115/1.2834890

    Article  CAS  PubMed  Google Scholar 

  18. Myers BS, Woolley CT, Slotter TL, Garrett WE, Best TM (1998) The influence of strain rate on the passive and stimulated engineering stress–large strain behavior of the rabbit tibialis anterior muscle. J Biomech Eng 120:126. https://doi.org/10.1115/1.2834292

    Article  CAS  PubMed  Google Scholar 

  19. Hedenstierna S, Halldin P, Brolin K (2008) Evaluation of a combination of continuum and truss finite elements in a model of passive and active muscle tissue. Comp Methods Biomech Biomed Eng 11:627–639. https://doi.org/10.1080/17474230802312516

    Article  CAS  Google Scholar 

  20. Winters J M (1990) Hill-based muscle models: a systems engineering perspective. Multiple Muscle Systems Biomech & Movem.organiz 5:69–93. https://doi.org/10.1007/978-1-4613-9030-5_5

  21. Winters F, Shin P, Jorgensen TM, Djurhuus JC, Constantinou CE (2002) Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function. J Urol 168:1458–1463. https://doi.org/10.1016/S0022-5347(05)64473-4

    Article  Google Scholar 

  22. Wang F, Jia S, Li M, Pan K, Fan Y (2021) Effect of the medial collateral ligament and the lateral ulnar collateral ligament injury on elbow stability: a finite element analysis. Comp Methods Biomech Biomed Eng 201:1–13. https://doi.org/10.1080/10255842.2021.1898601

    Article  Google Scholar 

  23. Koo T, Mak A (2006) A neuromusculoskeletal model to simulate the constant angular velocity elbow extension test of spasticity. Med Eng Physics 28:60–69. https://doi.org/10.1016/j.medengphy.2005.03.012

    Article  Google Scholar 

  24. Kodek T, Munih M (2003) An analysis of static and dynamic joint torques in elbow flexion-extension movements. Simul Model Pract Theory 11:297–311. https://doi.org/10.1016/S1569-190X(03)00063-7

    Article  Google Scholar 

  25. O'Driscoll SW (1994) Elbow instability. Hand Clin 10:405–415. https://doi.org/10.1016/S0749-0712(21)01179-3

  26. Capo J, Collins C, Beutel B, Danna N, Manigrasso M, Uko L et al (2014) Three-dimensional analysis of elbow soft tissue footprints and anatomy. J Should Elbow Surg 11:1618–1623. https://doi.org/10.1016/j.jse.2014.05.003

    Article  Google Scholar 

  27. Morrey BF, An KN (1983) Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 11:315–319. https://doi.org/10.1177/036354658301100506

    Article  CAS  PubMed  Google Scholar 

  28. King G, Morrey BF, An KN (1993) Stabilizers of the elbow. J Shoulder & Elbow Surg 2:165. https://doi.org/10.1016/S1058-2746(09)80053-0

    Article  CAS  Google Scholar 

  29. Watanabe H, Berger RA, An KN, Berglund LJ, Zobitz ME (2004) Stability of the distal radioulnar joint contributed by the joint capsule. J Hand Surg 29:1114–1120. https://doi.org/10.1016/j.jhsa.2004.06.005

    Article  Google Scholar 

  30. Matsuura AY, Mb TT, Ss C, Matsuyama AY, Suzuki DT, Mori DC et al (2021) Evaluation of anterior oblique ligament tension at the elbow joint angle—a cadaver study. J Shoulder and Elbow Surg 30:359–364. https://doi.org/10.1016/j.jse.2020.05.033

    Article  Google Scholar 

  31. Tashjian RZ, Wolf BR, Riet R, Steinmann SP (2016) The unstable elbow: current concepts in diagnosis and treatment. Instr Course Lect 65:55–82

    PubMed  Google Scholar 

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Funding

This research is supported by the funds from National Natural Science Foundation of China (NSFC) Research Grants (Project Ref. No. 12102301; 31871212; 51975411).

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Correspondence to Fang Wang.

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Mingxin Li has contributed equally to this work, should be regarded as co-first authorship.

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Wang, F., Wang, H., Li, M. et al. The role of the joint capsule in the stability of the elbow joint. Med Biol Eng Comput 61, 1439–1448 (2023). https://doi.org/10.1007/s11517-023-02774-6

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