{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:55:57Z","timestamp":1785801357978,"version":"3.56.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The purpose was to compare the arthroscopic rod technique to stress ultrasound in the dynamic assessment of lateral elbow instabilities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Fifteen elbows of eight specimen with a mean age of 66.4\u2009\u00b1\u200913.3\u00a0years were assessed in a prone position following a defined dissection setup. After evaluation of the native status, an arthroscopic dissection of the radial collateral ligament (RCL) or lateral ulnar collateral ligament (LUCL), and finally of entire capsuloligamentous structures was performed. Three raters examined each state (native, RCL or LUCL lesion, complete lesion) with the arthroscopic rod technique in 90\u00b0 flexion and with stress ultrasound in 30 and 90\u00b0 flexion. The intra-class correlation coefficient (ICC) was calculated to assess the interrater reliability as well as test\u2013retest reliability for each testing modality (arthroscopy and ultrasound).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The arthroscopic rod technique showed a superior interrater and test\u2013retest reliability of 0.953 and 0.959 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), respectively, when compared to stress ultrasound with an ICC of 0.4 and 0.611 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). A joint space opening during arthroscopy of\u2009&gt;\u20096\u00a0mm humero-ulnar or\u2009&gt;\u20097\u00a0mm humero-radial was indicative for a lateral collateral ligament lesion. However, a differentiation between an isolated RCL or LUCL tear was not possible. A lateral joint opening of\u2009\u2265\u20099\u00a0mm was only observed in complete tears of the lateral capsuloligamentous complex.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The arthroscopic rod technique showed a superior interrater and test\u2013retest reliability when compared to stress ultrasound. Arthroscopic assessment for radial elbow instability was found to be reliable and reproducible. A joint gapping\u2009\u2265\u20099\u00a0mm in the arthroscopic evaluation is a sign for a complete insufficiency of the radial capsuloligamentous complex. However, it is not possible to precisely distinguish between a lesion of the RCL or LUCL by arthroscopy.<\/jats:p>\n                <jats:p>On the basis of our results, dynamic ultrasound testing may be inappropriate to objectify lateral elbow instability.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04491-5","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T13:03:07Z","timestamp":1657544587000},"page":"2087-2093","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Arthroscopic rod technique compared to stress ultrasound in the dynamic evaluation of lateral ligament instabilities of the elbow"],"prefix":"10.1007","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6514-8028","authenticated-orcid":false,"given":"Johannes","family":"Plath","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Otto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"F\u00f6rch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Siebenlist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Grosser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas B.","family":"Imhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Lenich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,11]]},"reference":[{"key":"4491_CR1","doi-asserted-by":"publisher","first-page":"240","DOI":"10.2106\/jbjs.j.01663","volume":"94","author":"JW Stoneback","year":"2012","unstructured":"Stoneback JW, Owens BD, Sykes J et al (2012) Incidence of elbow dislocations in the united states population. J Bone Jt Surg 94:240\u2013245. https:\/\/doi.org\/10.2106\/jbjs.j.01663","journal-title":"J Bone Jt Surg"},{"key":"4491_CR2","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1302\/0301-620x.90b3.19868","volume":"90","author":"CP Charalambous","year":"2008","unstructured":"Charalambous CP, Stanley JK (2008) Posterolateral rotatory instability of the elbow. The J Bone Joint Surg. Br Vol 90:272\u2013279. https:\/\/doi.org\/10.1302\/0301-620x.90b3.19868","journal-title":"The J Bone Joint Surg. Br Vol"},{"key":"4491_CR3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5435\/00124635-199605000-00001","volume":"4","author":"BF Morrey","year":"1996","unstructured":"Morrey BF (1996) Acute and chronic instability of the elbow. J Am Acad Orthop Sur 4:117\u2013128. https:\/\/doi.org\/10.5435\/00124635-199605000-00001","journal-title":"J Am Acad Orthop Sur"},{"key":"4491_CR4","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s11678-014-0280-2","volume":"9","author":"B Hollinger","year":"2014","unstructured":"Hollinger B, Dehlinger F, Franke S (2014) Diagnosis and treatment of elbow instability. Obere Extremit\u00e4t 9:147\u2013155. https:\/\/doi.org\/10.1007\/s11678-014-0280-2","journal-title":"Obere Extremit\u00e4t"},{"key":"4491_CR5","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1186\/1471-2474-11-263","volume":"11","author":"J de Haan","year":"2010","unstructured":"de Haan J, den Hartog D, Tuinebreijer WE et al (2010) Functional treatment versus plaster for si mple el bow dislocations (FuncSiE): a randomized trial. Bmc Musculoskelet Di 11:263. https:\/\/doi.org\/10.1186\/1471-2474-11-263","journal-title":"Bmc Musculoskelet Di"},{"key":"4491_CR6","doi-asserted-by":"publisher","first-page":"440","DOI":"10.2106\/00004623-199173030-00015","volume":"73","author":"SW O\u2019Driscoll","year":"1991","unstructured":"O\u2019Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73:440\u2013446","journal-title":"J Bone Joint Surg Am"},{"key":"4491_CR7","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1007\/s00590-020-02846-5","volume":"31","author":"S Geyer","year":"2021","unstructured":"Geyer S, Aspang JS, Geyer M, Schoch C (2021) Hidden instability in posttraumatic stiff elbows. Eur J Orthop Surg Traumatol 31:1135\u20131141. https:\/\/doi.org\/10.1007\/s00590-020-02846-5","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"4491_CR8","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.jse.2004.08.003","volume":"14","author":"TR McAdams","year":"2005","unstructured":"McAdams TR, Masters GW, Srivastava S (2005) The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability. J Shoulder Elbow Surg 14:298\u2013301. https:\/\/doi.org\/10.1016\/j.jse.2004.08.003","journal-title":"J Shoulder Elbow Surg"},{"key":"4491_CR9","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1007\/s11678-020-00614-9","volume":"15","author":"N Ott","year":"2020","unstructured":"Ott N, Hackl M, Wegmann K et al (2020) Lateral epicondylitis. Obere Extremit\u00e4t 15:284\u2013288. https:\/\/doi.org\/10.1007\/s11678-020-00614-9","journal-title":"Obere Extremit\u00e4t"},{"key":"4491_CR10","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jse.2005.03.009","volume":"15","author":"W Regan","year":"2006","unstructured":"Regan W, Lapner PC (2006) Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elb Surg 15:344\u2013346. https:\/\/doi.org\/10.1016\/j.jse.2005.03.009","journal-title":"J Shoulder Elb Surg"},{"key":"4491_CR11","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.rcl.2016.04.005","volume":"54","author":"CN Gustas","year":"2016","unstructured":"Gustas CN, Lee KS (2016) Multimodality imaging of the painful elbow current imaging concepts and image-guided treatments for the injured thrower\u2019s elbow. Radiol Clin N Am 54:817\u2013839. https:\/\/doi.org\/10.1016\/j.rcl.2016.04.005","journal-title":"Radiol Clin N Am"},{"key":"4491_CR12","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.csm.2020.02.002","volume":"39","author":"MC Ciccotti","year":"2020","unstructured":"Ciccotti MC, Ciccotti MG (2020) Ulnar collateral ligament evaluation and diagnostics. Clin Sport Med 39:503\u2013522. https:\/\/doi.org\/10.1016\/j.csm.2020.02.002","journal-title":"Clin Sport Med"},{"key":"4491_CR13","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.jse.2003.12.013","volume":"13","author":"N Terada","year":"2004","unstructured":"Terada N, Yamada H, Toyama Y (2004) The appearance of the lateral ulnar collateral ligament on magnetic resonance imaging. J Shoulder Elb Surg 13:214\u2013216. https:\/\/doi.org\/10.1016\/j.jse.2003.12.013","journal-title":"J Shoulder Elb Surg"},{"key":"4491_CR14","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/j.jse.2020.11.023","volume":"30","author":"S Kirschbaum","year":"2021","unstructured":"Kirschbaum S, Plachel F, Kerschbaum M et al (2021) Does sonography allow an objective and reproducible distinction between stable, hypermobile, and unstable elbow joints? J Shoulder Elb Surg 30:1142\u20131151. https:\/\/doi.org\/10.1016\/j.jse.2020.11.023","journal-title":"J Shoulder Elb Surg"},{"key":"4491_CR15","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.pmrj.2016.06.014","volume":"9","author":"CL Camp","year":"2017","unstructured":"Camp CL, O\u2019Driscoll SW, Wempe MK, Smith J (2017) The sonographic posterolateral rotatory stress test for elbow instability: a cadaveric validation study. Pm&r 9:275\u2013282. https:\/\/doi.org\/10.1016\/j.pmrj.2016.06.014","journal-title":"Pm&r"},{"key":"4491_CR16","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.ejrad.2014.12.007","volume":"84","author":"MD Maeseneer","year":"2015","unstructured":"Maeseneer MD, Brigido MK, Antic M et al (2015) Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol 84:671\u2013681. https:\/\/doi.org\/10.1016\/j.ejrad.2014.12.007","journal-title":"Eur J Radiol"},{"key":"4491_CR17","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1016\/j.arthro.2013.08.016","volume":"29","author":"D Goodwin","year":"2013","unstructured":"Goodwin D, Dynin M, Macdonnell JR, Kessler MW (2013) The role of arthroscopy in chronic elbow instability. Arthrosc J Arthrosc Relat Surg 29:2029\u20132036. https:\/\/doi.org\/10.1016\/j.arthro.2013.08.016","journal-title":"Arthrosc J Arthrosc Relat Surg"},{"key":"4491_CR18","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.1007\/s00167-017-4530-x","volume":"25","author":"P Arrigoni","year":"2017","unstructured":"Arrigoni P, Cucchi D, D\u2019Ambrosi R et al (2017) Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc 25:2255\u20132263. https:\/\/doi.org\/10.1007\/s00167-017-4530-x","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4491_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00132-016-3324-z","volume":"45","author":"T Leschinger","year":"2016","unstructured":"Leschinger T, M\u00fcller LP, Wegmann K (2016) Chronic ligamentous instability of the elbow. Orthopade 45:1\u201313. https:\/\/doi.org\/10.1007\/s00132-016-3324-z","journal-title":"Orthopade"},{"key":"4491_CR20","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1177\/036354659602400210","volume":"24","author":"LD Field","year":"1996","unstructured":"Field LD, Altchek DW (1996) Evaluation of the arthroscopic valgus instability test of the elbow. The Am J Sports Med 24:177\u2013181","journal-title":"The Am J Sports Med"},{"key":"4491_CR21","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.ocl.2007.12.007","volume":"39","author":"EV Cheung","year":"2008","unstructured":"Cheung EV (2008) Chronic lateral elbow instability. Orthop Clin N Am 39:221\u2013228. https:\/\/doi.org\/10.1016\/j.ocl.2007.12.007","journal-title":"Orthop Clin N Am"},{"key":"4491_CR22","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.hcl.2009.05.010","volume":"25","author":"FH Savoie","year":"2009","unstructured":"Savoie FH, Field LD, Gurley DJ (2009) Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Hand Clin 25:323\u2013329. https:\/\/doi.org\/10.1016\/j.hcl.2009.05.010","journal-title":"Hand Clin"},{"key":"4491_CR23","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.csm.2010.06.008","volume":"29","author":"III Fhs","year":"2010","unstructured":"Fhs III, O\u2019Brien MJ, Field LD, Gurley DJ (2010) Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Clin Sport Med 29:611\u2013618. https:\/\/doi.org\/10.1016\/j.csm.2010.06.008","journal-title":"Clin Sport Med"},{"key":"4491_CR24","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1177\/036354659502300404","volume":"23","author":"LD Field","year":"1995","unstructured":"Field LD, Callaway GH, O\u2019Brien SJ, Altchek DW (1995) Arthroscopic assessment of the medial collateral ligament complex of the elbow. Am J Sports Medicine 23:396\u2013400. https:\/\/doi.org\/10.1177\/036354659502300404","journal-title":"Am J Sports Medicine"},{"key":"4491_CR25","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s00132-018-3597-5","volume":"47","author":"K Schmidt-Horloh\u00e9","year":"2018","unstructured":"Schmidt-Horloh\u00e9 K, Klug A, Wei\u00dfenberger M et al (2018) Acute and chronic instability of the elbow joint. Orthopade 47:695\u2013708. https:\/\/doi.org\/10.1007\/s00132-018-3597-5","journal-title":"Orthopade"},{"key":"4491_CR26","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1148\/radiol.2015141950","volume":"275","author":"AS Tagliafico","year":"2015","unstructured":"Tagliafico AS, Bignotti B, Martinoli C (2015) Elbow US: anatomy, variants, and scanning technique. Radiology 275:636\u2013650. https:\/\/doi.org\/10.1148\/radiol.2015141950","journal-title":"Radiology"},{"key":"4491_CR27","doi-asserted-by":"publisher","first-page":"124","DOI":"10.23750\/abm.v89i1-s.7016","volume":"89","author":"EA Nocerino","year":"2018","unstructured":"Nocerino EA, Cucchi D, Arrigoni P et al (2018) Acute and overuse elbow trauma: radio-orthopaedics overview. Acta Bio-medica Atenei Parmensis 89:124\u2013137. https:\/\/doi.org\/10.23750\/abm.v89i1-s.7016","journal-title":"Acta Bio-medica Atenei Parmensis"},{"key":"4491_CR28","doi-asserted-by":"publisher","first-page":"e407","DOI":"10.1016\/j.eats.2016.10.012","volume":"6","author":"CL Camp","year":"2017","unstructured":"Camp CL, Smith J, O\u2019Driscoll SW (2017) Posterolateral rotatory instability of the elbow: part ii. supplementary examination and dynamic imaging techniques. Arthrosc Tech 6:e407\u2013e411. https:\/\/doi.org\/10.1016\/j.eats.2016.10.012","journal-title":"Arthrosc Tech"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04491-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04491-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04491-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T18:08:15Z","timestamp":1679422095000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04491-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,11]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["4491"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04491-5","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,11]]},"assertion":[{"value":"29 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Sebastian Siebenlist reports personal fees from Arthrex GmbH (Munich, Germany), Martin GmbH & Co. KG (Tuttlingen, Germany), Medi GmbH & Co. KG (Bayreuth, Germany) and Medartis AG (Basel, Switzerland), outside the submitted work. Edgar Mayr reports personal fees from Marquardt Medizintechnik Europe, outside the submitted work. Andreas Imhoff reports personal fees from Arthrex (Naples, FL, USA), Medi GmbH & Co. KG (Bayreuth, Germany) and Arthrosurface (Franklin, MA, USA), outside the submitted work. All other authors declare no potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was reviewed and approved by the ethical board of the University Hospital of Augsburg (IRB No. 2017\u201326).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"There were no patients involved as for informed consent statement.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}