Background:Osteochondritis dissecans (OCD) of the capitellum is a cartilage and subchondral bone disorder predominantly affecting young, physically active individuals. While established surgical techniques such as microfracturing and osteochondral autograft transfer offer acceptable outcomes, limitations in cartilage quality or procedural invasiveness remain. Autologous chondrocyte implantation (ACI) has been proposed as a less invasive, biologically restorative alternative, though clinical data on its use in the elbow are not available. Therefore, the aim of this pilot study was to evaluate the feasibility of ACI for the treatment of elbow OCD in a case series. Methods:In this prospective observational study, 6 male patients (20.5 ± 5.2 years) with centralized International Cartilage Research Society grade IV OCD lesions of the capitellum were included and treated with ACI. Clinical evaluations were performed at 6 months (T1), 12 months (T2), and 34.8 ± 7.9 months (T3) post-operatively, including assessment of range of motion, subjective elbow value, visual analog scale for pain, Mayo Elbow Performance Score, Kerlan-Jobe Orthopaedic Clinic score, and return to sport. Magnetic resonance imaging was conducted at T2 and T3, and cartilage repair tissue was analyzed using the magnetic resonance observation of cartilage repair tissue 2.0 Ankle Score. Results:Improvements were observed across all clinical outcome measures. Subjective elbow value increased from 59 ± 18.5% pre-operatively to 91.2 ± 4.2% at final follow-up, while visual analog scale under load decreased from 6.5 ± 1.6 to 0.8 ± 0.7. Mayo Elbow Performance Score and Kerlan-Jobe Orthopaedic Clinic improved from 70.6 ± 17.7 to 97.5 ± 6 and from 38.3 ± 10 to 88.5 ± 8.4, respectively. Magnetic resonance imaging demonstrated defect filling and integration in all individuals, as assessed by the magnetic resonance observation of cartilage repair tissue score, which showed no deterioration between T2 and T3. The mean return to sport time was 6.8 ± 3 months. No complications or need for revision surgery were recorded. Conclusion:This pilot feasibility study provides preliminary insights into the treatment of centralized capitellar OCD lesion with ACI in a case series of young, active patients, with clinical and radiological findings at a mean 3-year follow-up (range, 25-42 months). These exploratory findings suggest that ACI may warrant further investigation for focal, symptomatic elbow defects with minimal or limited involvement of the subchondral bone. Larger controlled studies are needed to define the role of ACI relative to established treatment options.

Background Medial and posterolateral rotational instability of the elbow, often resulting from collateral ligament insufficiency, can lead to pain and functional impairment. Surgical reconstruction is indicated when conservative treatment fails, yet complications such as graft failure and donor site morbidity persist. This study investigates the anatomical and biomechanical feasibility of the Shark Screw® Tendon as a representative human allogeneic bone screw for humeral ligament fixation in elbow instability. Methods Eight fresh-frozen cadaveric specimens were used to evaluate the feasibility of the Shark Screw® Tendon for humeral fixation on both medial and lateral sides. Cyclic loading and failure testing were performed to assess time-zero fixation characteristics and failure load. Results A total of sixteen testing scenarios were conducted on the specimens. Implantation was technically feasible without anatomical limitations related to implant size or positioning. Six graft failures occurred (38%), all attributable to poor tissue quality. Tendon slippage was observed in 9/16 cases (56%) under progressively increasing axial load, while the Shark Screw® Tendon remained seated. The mean failure load was 101 N (± 50) for medial insertions, 118 N (± 77) for lateral insertions and 110 N (± 64) overall. After 100 cycles, tendon displacement averaged 1.1mm (± 0.4) during extension-flexion on the medial side, 1.0 mm (± 1.0) on the lateral side, and 1.0 mm (± 0.7) overall. During supination-pronation, displacement was 0.8 mm (± 0.7) medially, 1.0 mm (± 0.8) laterally and 0.9 mm (± 0.7) overall. No anchor pullout was observed, although one anchor tip fractured during insertion. Conclusion The Shark Screw® Tendon appears to be a feasible biologically integrative alternative for humeral fixation in medial and posterolateral elbow ligament reconstruction, demonstrating preliminary time-zero fixation characteristics in a cadaveric model. Further biomechanical and clinical studies are needed to confirm long-term outcomes.

Abstract Background Arthroscopy of the elbow joint is usually performed with a 30° view. Stability tests, structural assessments and pathologies are described with this scope. Due to the anatomy of the distal humerus and the arthroscopic accessibility, the assessment of the capitellum, particularly with regard to cartilage damage, is limited in terms of dimension and depth. Arthroscopy with flexible optics in the range of 15° to 90° has not been routinely performed. The aim of the study was to investigate whether the use of flexible optics offers advantages in the assessment of the capitellum. Methods Eleven fresh-frozen human cadaveric elbows were examined in a standardized free-hanging position with the elbow flexed to 90°. Arthroscopy was performed through the proximal posterolateral portal using a rigid 30° arthroscope and a flexible 15°–90° arthroscope. The most anterior visible margin of the capitellar articular surface was identified and marked arthroscopically for each optic. Following open surgical dislocation of the elbow, the distance between the two markings was measured in millimeters. Paired comparisons were performed using a paired t-test, and effect size was calculated using Cohen’s d. Results In all specimens, the flexible 15°–90° arthroscope provided greater anterior visualization of the capitellum compared with the 30° arthroscope. The mean additional visible distance was 7.0 ± 2.5 mm (95% CI 5.3–8.7 mm). This difference was statistically significant (p < 0.001) with a large effect size (Cohen’s d = 2.654). Conclusions A flexible 15°–90° arthroscope significantly increased anterior visualization of the capitellum compared with a conventional 30° arthroscope in this cadaveric model. Whether this anatomical visualization gain translates into clinical diagnostic or therapeutic benefit requires further investigation.

Pathologies of the long head of the biceps (LHB) tendon are frequently seen as concomitant pathologies during arthroscopic surgery for rotator cuff injuries or the labroligamentous complex of the shoulder. Currently, there are two treatment options: Tenotomy is quick and easy to perform with low complications rates, but has limited functional results, especially in demanding patients; tenodesis of the tendon has shown beneficial cosmetic and functional results, but usually requires an implant for tendon-to-bone attachment and, therefore, carries the risk of implant-related complications. The implant-free loop tenodesis (LT) procedure was developed to combine the advantages of both treatment modalities and has shown promising functional and cosmetic results in a prospective pilot study. This study aims to establish the implant-free LT procedure versus arthroscopic anchor tenodesis (AAT) for the treatment of LHB pathologies during shoulder arthroscopy in terms of structural and functional outcome. A national multi-center, two-arm, parallel-group, randomized, controlled, non-inferiority trial will be conducted. Patients are eligible for trial participation if they are at least 18 years of age and present to one of the five enrolling centers with LHB tendon-associated complaints and MRI-confirmed LHB tendinopathy, instability due to SLAP or pulley lesions, or partial rupture. Patients with current or previous shoulder injury that would interfere with post-treatment rehabilitation or study assessment will be excluded from study participation. Participating patients will be randomized 1:1 to receive either LT or AAT and will be followed up for 24 months after surgery. The primary endpoint will be the functional and cosmetic outcome as assessed by the biceps-specific LHB score at 12 months after surgery. Secondary outcomes include assessment of surgery-related complications, overall shoulder and arm function, and structural outcome as evaluated by ultrasound and an additional MRI scan at the final study visit. The study will evaluate whether the implant-free loop tenodesis procedure is non-inferior to arthroscopic implant-based tenodesis in terms of functional and cosmetic results at 12 months post-treatment. Trial was prospectively registered at the German Clinical Trials Register (DRKS) on 12th June 2024, Registration-ID DRKS00034361, https://drks.de/search/de/trial/DRKS00034361 .

Failure of healing or retear after surgical repair of the rotator cuff tendons are still a problem and can cause ongoing shoulder pain and dysfunction. Compromised microcirculation as seen in regular alcohol consumption may lead to poor healing. To compare the clinical outcomes and tendon integrity of patients after rotator cuff repair with and without regular alcohol intake. Case control matched cohort study; Level of evidence, 3. Patients who underwent arthroscopic rotator cuff repair (ARCR), had regular alcohol intake (according to world health organization (WHO) definition of harmful alcohol consumption) and were at least 2 years postoperative were included, and matched according to age, sex, involved tendon, and tear size with patients who underwent ARCR without regular alcohol intake. Patient-reported outcome (PRO) scores were collected at final follow-up including the Constant Murley Score (CMS), Western Ontario Rotator Cuff Score (WORC), Simple Shoulder Test (SST), and visual analog scale (VAS). Tendon integrity (maintained continuity: yes/no = full thickness) was assessed by ultrasound examination at final follow-up. Complications and revision surgeries are reported. Twenty-two patients (versus twenty-two matched—controls) were available for follow-up. There were two female (9

Pain and stiffness are common symptoms that occur in many elbow pathologies. In the diagnostic algorithm for non-specific elbow pain, benign tumour lesions should be ruled out in rare cases. The following case presentations demonstrate that rare entities such as osteoid osteoma (OO) can be the cause for unclear elbow complaints.Three male patients presented with non-traumatic elbow pain over several months before seeking medical help for the first time. Their main concern was restricted Range of Motion (ROM). The plain radiographs were normal in ⅔ cases, and the CT-scans showed unspecific signs of free joint bodies in the area of the incisura trochlearis of the proximal ulna in the initial stages. Either arthroscopic or open excision was performed as based on CT and/or MRI scans. The decision on the appropriate approach of treatment depends on the localisation of the OO. In particular, the medial ulnohumeral joint section cannot be completely visualised and remains reserved for the open procedure, with the associated disadvantages. Histopathological preparation confirmed the diagnosis. Overall, both techniques seem to reduce the patient's pain immediately, restore ROM with a slight delay, and show almost no recurrence rates of the tumorous lesions.Patients presented with elbow pain and restricted ROM with no history of elbow trauma; plain radiographs as well as nocturnal pain are highly indicative of OO. Even though this is rare, we should always keep it in mind in order to protect the patient from wrong or delayed diagnosis and treatment. A surgical approach is to be preferred, particularly in the case of intra-articular localisation.

BACKGROUND:Various surgical approaches and fixation methods are available for distal biceps tendon repair. Although all-suture anchors offer theoretical advantages and are widely used in orthopedic surgery, clinical data on their use in distal biceps tendon repairs remain limited. This study aims to evaluate the clinical and functional outcomes of distal biceps tendon repair using two all-suture anchors via a single-incision approach. We hypothesized that this technique would result in effective restoration of supination strength, excellent patient-reported outcomes, and a low rerupture rate. METHODS:A retrospective analysis was conducted on patients who underwent distal biceps tendon repair using all-suture anchors between September 2016 and September 2022. A total of 40 patients were included. At clinical follow-up, range of motion, elbow flexion, and forearm supination strength were measured and compared to the contralateral side. Subjective outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire, Subjective Elbow Value, Mayo Elbow Performance Score, American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire, and visual analog scale for pain. Complications were recorded. RESULTS:The mean age at the time of injury was 51.9 ± 9.2 years. The mean follow-up duration was 4.8 ± 2 years, and the mean time between injury and surgery was 14.2 ± 11.9 days. Median Disabilities of the Arm, Shoulder and Hand, Subjective Elbow Value, Mayo Elbow Performance Score, and American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire scores were 2.3 (range, 0-31.8), 100 (range, 50-100), 100 (range, 70-100), and 98 (range, 53-100), respectively. The median pain level on the visual analog scale was 0 (range, 0-7), with only one patient reporting pain at rest. Mean relative elbow flexion strength compared to the uninjured side was 99.5 ± 23.3%, and forearm supination strength was 88.7 ± 28.2%. The rerupture rate was 2.5%, with 1 case occurring within the first postoperative week. All patients returned to work after an average of 8.7 ± 8.4 weeks, and 96.9% (31/32) returned to sports, with 81.3% (26/32) returning to >90% of their preinjury activity level. CONCLUSIONS:Our findings demonstrate that distal biceps tendon repair using two all-suture anchors via a single-incision approach yields excellent patient-reported outcomes. With a low rerupture rate as well as high return-to-work and return-to-sport rates, this technique appears to be a reliable treatment option. However, the observed reduction of forearm supination strength underscores the need for further research to optimize anatomical footprint coverage.

Background: The severity of acromioclavicular (AC) joint dislocation is evaluated through bilateral anterior-posterior radiographs of the AC joint. AC joint dislocations are graded based on the classification system of Rockwood, which is the foundation for further decision-making regarding therapy regimen. Purpose/Hypothesis: The purpose of this study was to simulate technical irregularities in obtaining panoramic views and the effect they might have on the measured coracoclavicular (CC) distance. It was hypothesized that vertical tilt and horizontal rotation of the radiographic panoramic view of the AC joints affect the measured CC distance and, therefore, the Rockwood classification and reliability of the measurement method. Study Design: Level IV, Diagnosis Study, Case Series. Methods: A retrospective analysis including 14 patients with AC joint dislocations and available computed tomography scans of the upper body was conducted. Three-dimensional models of a simulated bilateral panoramic view were tilted and rotated from −15° to 15° in 5° increments around the vertical and horizontal axes. Three raters with different experience levels independently measured the CC distance and repeated this process with a minimum 6-week interval. The intra- and interclass correlation coefficients for intra- and interrater reliability were calculated. Changes in CC distance and Rockwood classification due to rotation or tilt were reported. Results: The measurements of intra- and interclass correlation coefficients in the neutral (0° position) showed a high intra- and interrater reliability (0.878 and 0.952 for intrarater reliability; 0.851 and 0.952 for interrater reliability). By adding vertical tilt and horizontal rotation to simulated panoramic views, the intra- and interreliability of the 3 raters decreased. Vertical tilt showed a higher impact on the measurement reliability than horizontal rotation. In 10 of 14 cases, the initially determined Rockwood classification changed through adding tilt (9/14) or rotation (5/14). In 5 cases, the injury was graded more severe. In 3 cases, the classification was changed to a milder grade according to Rockwood. In 2 cases, the injury was changed to a higher or a lower type in the Rockwood classification, respectively, depending on the amount of tilt or rotation. Of the 10 cases that were reclassified by tilt and rotation, 5 were Rockwood type 3 injuries. Conclusion: Vertical tilt and horizontal rotation in simulated panoramic views of the AC joints were demonstrated to have a significant influence on CC distances and Rockwood classification as well as intra- and interrater reliability. This effect was more pronounced with a higher degree of tilt/rotation. This may affect clinical decision-making, whether to treat this injury nonoperatively or operatively. Clinical Relevance: The panoramic view is widely used as the gold standard for diagnosing and classifying AC joint dislocations according to Rockwood. Thus, it is a decisive criterion to choose the best treatment. This study investigates the reliability of the radiographic diagnosis of AC joint dislocations when adding tilt and rotation, which may occur in clinical practice while obtaining the panoramic view.

BACKGROUND:The ABC classification has recently been proposed as a comprehensive classification system for posterior shoulder instability (PSI). The purpose of this study was to analyze the comprehensiveness as well as inter-rater and intrarater reliability of the ABC classification. METHODS:All consecutive patients presenting with unidirectional PSI from June 2019 to June 2021 were included in a prospective study. No patients were excluded, leaving a consecutive series of 100 cases of PSI in 91 patients. All recorded clinical and imaging data were used to create anonymized clinical case vignettes, which were evaluated twice according to the ABC classification at the end of the recruitment period in random sequential order by 4 independent raters (2 experienced shoulder surgeons and 2 orthopedic residents) to analyze the comprehensiveness as well as inter-rater and intrarater reliability of the ABC classification for PSI and to describe differences in characteristics among subtypes. Group A was defined as a first-time singular PSI event <3 months in the past regardless of etiology and is further subdivided into type 1 and type 2 depending on the occurrence of a subluxation (A1) or dislocation (A2). Group B comprises recurrent dynamic PSI regardless of time since onset and is further subdivided by the cause of instability into functional (B1) and structural (B2) dynamic PSI. Group C includes chronic static PSI with posterior humeral decentering that can be either constitutional (C1) or acquired (C2). RESULTS:None of the cases was deemed unsuitable to be classified based on the proposed system by the observers. After consensus agreement between the 2 expert raters, 16 cases were attributed to group A (8 type A1 and 8 type A2); 64, to group B (33 type B1 and 31 type B2); and 20, to group C (11 type C1 and 9 type C2). The expert raters agreed on the classification subtypes in 99% and 96% of the cases during the first rating and second rating, respectively (intraclass correlation coefficients [ICCs], 0.998 and 0.99, respectively). The intraobserver reliability was excellent for both raters. The beginners reached the same conclusion as the consensus agreement in 94% of the cases (ICC, 0.99) and 89% of the cases (ICC, 0.97) during the first round and 94% each (ICC, 0.97) during the second round. The intraobserver reliability was excellent for both beginners. Overall, discrepancies between raters were found between groups B1 and B2 (n = 14), groups B2 and C2 (n = 4), groups B1 and C1 (n = 1), and groups A1 and B2 (n = 1). In general, each subtype showed distinctive clinical and imaging characteristics that facilitated the diagnosis. CONCLUSION:The presented ABC classification for PSI is a comprehensive classification with a high reliability and reproducibility. However, a gradual transition and potential progression between the subtypes of PSI must be considered. The reliable distinction between different subtypes of PSI based on etiology and pathomechanism provides a standardized basis for future investigations on treatment recommendations.

Background:Up to now, there is no gold standard concerning the optimal graft choice in the surgical therapy of chronic elbow instability. As donor site morbidity represents a rare (1%-4%) but severe complication of graft harvest, using an allograft seems favorable. Fascia lata mimics the anatomy through its fan-shaped configuration of the ligamentous complex of the elbow joint, making it questionable for use as a graft. The aims of the study are (1) to evaluate the biomechanical suitability of fascia lata allograft and (2) to compare clinical and radiological outcome between ligament reconstruction of the lateral collateral ligament complex using either FiberTape augmented triceps autograft or FibreTape augmented fascia lata allograft. Methods:Biomechanical testing of fascia lata was performed using a 10 kN uniaxial test system with a 1 kN load cell. The retrospective cohort study evaluated all patients who received a ligament reconstruction of the elbow due to chronic instability with allogenic fascia lata or autologous triceps tendon. Exclusion criteria were any type of coexisting fracture or nerval injury. Demographic parameters, patient-reported outcome parameters and radiological stability parameters (sonography and fluoroscopy) were evaluated. Results:Tensile testing of 39 fascia lata allografts revealed an ultimate load of 234.8 ± 23.1 N and ultimate strength of 33.4 ± 4.4 MPa. Twenty one patients were included in the clinical substudy (57.1% men, 42.9% women, age 41.0 ± 12.2 years, body mass index 24.9 ± 4.1 kg/m2) with average follow-up of 21.6 ± 17.1 months. No significant differences were found concerning pain level, patient-reported outcome measures, or range of motion, between fascia lata and triceps group. There was also no difference concerning sonographic stability of lateral ulnar collateral ligament between the 2 groups (P = .14). One revision occurred in fascia lata allograft group and 2 in triceps autograft group due to graft elongation. Conclusion:Currently, there is no clinical evidence demonstrating the superiority of either autograft or allograft tissue. Due to its demonstration of sufficient biomechanical properties, fascia lata allograft seems an appropriate treatment option for ligamentous reconstruction of chronic elbow instability.

BACKGROUND:Treatment of acromioclavicular joint (ACJ) separations remains controversial. Yet, conservative treatment has become more common even for high-grade injuries. Available conservative treatment does currently however not address the loss of anatomical joint integrity in Rockwood (RW) III and V injuries. In a recent case report, we outlined the concept of restoring ACJ integrity by noninvasively bracing a RW V injury. AIM:The purpose of this study was to prospectively evaluate the clinical and radiological efficacy of a modern Kenny-Howard splint like brace and compare it to early functional rehabilitation or surgery in RW III and V injuries after a minimum of 12 months. METHODS:Patients with acute RW III injuries (n = 18) and patients with RW V injuries who refused surgery (n = 7) were prospectively enrolled and treated with an ACJ brace and followed up clinically and radiologicalally for 12 months. Endpoint results were compared to injury grade-, sex-, age-, and follow-up-period-matched patients treated with early functional rehabilitation (n = 23) or surgical TightRope stabilization (n = 23). Clinical outcomes included Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TS), and modified Acromioclavicular Joint Instability Score (mAJIS) and radiological outcome included coracoclavicular index. RESULTS:CS, SSV, TS, and mAJIS improved in RW III and CS and SSV in RW V patients over time, when treated with the ACJ brace. Significance was only reached in RW III patients (P < .001). Radiological indices did not improve over time in RW III and V patients. No differences were found when comparing functional and cosmetic outcomes (CS, SSV, TS, mAJIS) after a minimum of 12 months between bracing, surgery, and early functional rehabilitation in RW III and V patients. The coracoclavicular index was most improved in patients treated with surgery compared to bracing after a minimum of 12 months (P = .0011 for RW III). CONCLUSION:Brace treatment led to comparable clinical and cosmetic outcomes as early functional rehabilitation or surgery in patients with high grade ACJ injuries after a minimum of 12 months. However, no sustainably improved reduction of the ACJ resulted from bracing, when compared to early functional rehabilitation, thus questioning its utility. While surgery ensured radiological improvement compared to bracing, no benefit was seen over early functional rehabilitation.

Patienten mit rezidivierenden, anteroinferioren Schulterluxationen und bipolarem Knochendefekt lassen sich zum Teil nicht mit reinen Weichteilstabilisierungen erfolgreich behandeln und benötigen oftmals knöcherne Augmentationen. Insbesondere Patienten mit Epilepsie oder fraglichen Krampfanfällen in der Vorgeschichte stellen aufgrund der oftmals massiven humeralen knöchernen Defekte eine Herausforderung dar. Zudem sollten mögliche weitere Luxationsereignisse bei einem erneuten Krampfanfall vom behandelnden Chirurgen antizipiert werden. Im Falle einer erneuten Luxation könnte es zu Implantat-assoziierten Komplikationen kommen. In diesem Fallbericht wird ein Patient mit bilateraler anteriorer Schulterinstabilität mit großem bipolarem Knochendefekt vorgestellt. Rechts wurde zweifach erfolglos eine weichteilige Stabilisierungsoperation durchgeführt. Als Stabilisierungsverfahren wurde glenoidal eine implantatfreie, knöcherne Rekonstruktion mittels J‑Span-Plastik und humeral eine metallfreie Defektauffüllung mittels Fresh-Frozen-Femurkopf-Allograft sowie Biokompressionsschrauben beidseits durchgeführt. Im 2‑Jahres-Follow-up zeigte sich beidseits eine stabile Schulter sowie eine gute Einheilung der knöchernen Rekonstruktion glenoidal und humeral mit entsprechender Remodelierung. Die kombinierte glenoidale Augmentation mit J‑Span-Plastik und der humerale Aufbau mittels Femurkopf-Allograft stellt eine gute Therapieoption für Patienten mit anteriorer Schulterinstabilität und großen bipolaren Knochendefekten dar. Insbesondere bei Patienten mit rezidivierenden Krampfanfällen ist diese glenoidal implantatfreie und humeral metallfreie operative Option erstrebenswert.

Funktionseinschränkungen im Ellenbogengelenk wie im Falle der Arthrofibrose können zu weitreichenden negativen Auswirkungen im Alltag und Beruf führen. Frühzeitige Diagnostik und Therapieeinleitung spielen eine wichtige Rolle, das Risiko der Ellenbogensteife zu minimieren. Die nachfolgende Arbeit thematisiert Möglichkeiten der konservativen Therapie bei vorliegender Ellenbogensteife und deren assoziiertes Outcome. Die Publikation gliedert sich in zwei Hauptthemenkomplexe. Im ersten Teil erfolgt eine systemische Literaturrecherche in gängigen Literaturverzeichnissen bezüglich therapeutischer Optionen mit Schwerpunkt Physiotherapie, Orthesenbehandlung, Einsatz von Motorschienen als auch alternativen Behandlungsmethoden. Im zweiten Teil der Arbeit werden Grundlagen eines physiotherapeutischen Algorithmus vorgestellt, der die Hauptkomponenten eines adäquaten Nachbehandlungsschemas beinhaltet. Myofibroblasten werden als Schlüsselzellen betrachtet, welche die fibrotischen Prozesse initiieren. Ziel der konservativen Therapie ist es, diesen Remodelling-Vorgang zu inhibieren und damit einer Ellenbogensteife vorzubeugen. Zu den konservativen Therapieansätzen zählt die Physiotherapie mit Übungsbehandlungen und Mobilisierungstechniken sowie die Anwendung von CPM-Bewegungsschienen („continuous passive motion“) als auch von statischen und dynamischen Orthesen. Vereinzelt werden in der Literatur auch Injektionstechniken mit Botulinumtoxin A aufgeführt. Der Großteil der PatientInnen ( 80

The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-bystep illustration of the authors' preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.