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Medial Epicondyle Morphology in Elite Overhead Athletes: A Closer Look Using 3-Dimensional Computer Simulation.

Makhni EC, Khanna K, Simpson MT, Redler LH, Anakwenze OA, Li R, Ahmad CS - Orthop J Sports Med (2014)

Bottom Line: The medial epicondyle in overhead athletes was significantly larger than that found in nonathlete controls (4976 vs 3682 mm(3); P = .001).There was no significance between the 2 cohorts in medial-lateral width (16.8 vs 16.6 mm; P = .68), but there was a difference in anterior-posterior thickness (16.96 vs 14.40 mm; P = .001) and superior-inferior height (39.55 vs 35.86 mm; P = .09) in athletes versus controls.These quantitative findings support the theory of adaptive remodeling in skeletally immature overhead athletes.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Columbia Presbyterian Medical Center, New York, New York, USA.

ABSTRACT

Background: Prior studies have attempted to determine morphological characteristics of the medial epicondyle in overhead athletes, but no study has reported on precise quantitative differences between elite overhead athletes and control patients.

Hypothesis: The medial epicondyle in overhead athletes is larger in volume than those of control patients.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Computer simulation modeling from advanced (computed tomography/magnetic resonance imaging) imaging of the elbow of 37 patients (22 elite overhead athletes, 15 control patients) was performed to provide detailed assessment of the morphological characteristics of the medial epicondyle. Several quantitative metrics regarding the medial epicondyle were measured and compared across both cohorts, including that of epicondyle width (medial-lateral), height (superior-inferior), thickness (anterior-posterior), volume, percentage cortical volume, and morphology of the inferior slope of the epicondyle.

Results: The medial epicondyle in overhead athletes was significantly larger than that found in nonathlete controls (4976 vs 3682 mm(3); P = .001). There was no significance between the 2 cohorts in medial-lateral width (16.8 vs 16.6 mm; P = .68), but there was a difference in anterior-posterior thickness (16.96 vs 14.40 mm; P = .001) and superior-inferior height (39.55 vs 35.86 mm; P = .09) in athletes versus controls. The epicondyle volume was 97.9% cortical bone in athletes compared with 82.3% in control patients (P < .001). There were no differences in the morphology of the inferior epicondyle slope between the 2 groups.

Conclusion: The medial epicondyle in overhead athletes is larger in volume and anterior-posterior thickness than those of control patients. Additionally, the medial epicondyle is comprised nearly entirely of cortical bone in overhead athletes.

Clinical relevance: These quantitative findings support the theory of adaptive remodeling in skeletally immature overhead athletes.

No MeSH data available.


Extrusion angle of the medial epicondyle. The extrusion angle of the medial epicondyle was defined as the angle formed by the vertical line extending superiorly from the intersection of the medial aspect of the trochlea and the inferior aspect of the epicondyle at the distal humerus cortex along with a line originating from this point on the distal humerus extending to the most medial aspect of the medial epicondyle.
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fig4-2325967113517211: Extrusion angle of the medial epicondyle. The extrusion angle of the medial epicondyle was defined as the angle formed by the vertical line extending superiorly from the intersection of the medial aspect of the trochlea and the inferior aspect of the epicondyle at the distal humerus cortex along with a line originating from this point on the distal humerus extending to the most medial aspect of the medial epicondyle.

Mentions: Measurements of the medial epicondyle included medial-lateral width along the x-axis, superior-inferior height along the y-axis, and anterior-posterior thickness along the z-axis (Figure 3). The volume of the separated medial epicondyle was also measured using the software’s ability to calculate volume. The angle at which the medial epicondyle extrudes from the humerus was termed the “extrusion angle” and was measured in the coronal (x-y) plane. The extrusion angle was defined as the angle formed between the vertical line that separates the medial epicondyle from the humerus and the line connecting the superior-most point of the medial epicondyle to the medial-most point of the medial epicondyle (Figure 4). Finally, the morphology of the medial epicondyle—with respect to the slope of the inferior aspect—was assessed. This region of the epicondyle corresponds to the site of tunnel drilling during reconstruction of the ulnar collateral ligament. Three morphology types were defined, including “mostly flat” (type A), “gently superiorly sloped” (type B), and “sharply sloped” (type C) (Figure 5).


Medial Epicondyle Morphology in Elite Overhead Athletes: A Closer Look Using 3-Dimensional Computer Simulation.

Makhni EC, Khanna K, Simpson MT, Redler LH, Anakwenze OA, Li R, Ahmad CS - Orthop J Sports Med (2014)

Extrusion angle of the medial epicondyle. The extrusion angle of the medial epicondyle was defined as the angle formed by the vertical line extending superiorly from the intersection of the medial aspect of the trochlea and the inferior aspect of the epicondyle at the distal humerus cortex along with a line originating from this point on the distal humerus extending to the most medial aspect of the medial epicondyle.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555523&req=5

fig4-2325967113517211: Extrusion angle of the medial epicondyle. The extrusion angle of the medial epicondyle was defined as the angle formed by the vertical line extending superiorly from the intersection of the medial aspect of the trochlea and the inferior aspect of the epicondyle at the distal humerus cortex along with a line originating from this point on the distal humerus extending to the most medial aspect of the medial epicondyle.
Mentions: Measurements of the medial epicondyle included medial-lateral width along the x-axis, superior-inferior height along the y-axis, and anterior-posterior thickness along the z-axis (Figure 3). The volume of the separated medial epicondyle was also measured using the software’s ability to calculate volume. The angle at which the medial epicondyle extrudes from the humerus was termed the “extrusion angle” and was measured in the coronal (x-y) plane. The extrusion angle was defined as the angle formed between the vertical line that separates the medial epicondyle from the humerus and the line connecting the superior-most point of the medial epicondyle to the medial-most point of the medial epicondyle (Figure 4). Finally, the morphology of the medial epicondyle—with respect to the slope of the inferior aspect—was assessed. This region of the epicondyle corresponds to the site of tunnel drilling during reconstruction of the ulnar collateral ligament. Three morphology types were defined, including “mostly flat” (type A), “gently superiorly sloped” (type B), and “sharply sloped” (type C) (Figure 5).

Bottom Line: The medial epicondyle in overhead athletes was significantly larger than that found in nonathlete controls (4976 vs 3682 mm(3); P = .001).There was no significance between the 2 cohorts in medial-lateral width (16.8 vs 16.6 mm; P = .68), but there was a difference in anterior-posterior thickness (16.96 vs 14.40 mm; P = .001) and superior-inferior height (39.55 vs 35.86 mm; P = .09) in athletes versus controls.These quantitative findings support the theory of adaptive remodeling in skeletally immature overhead athletes.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Columbia Presbyterian Medical Center, New York, New York, USA.

ABSTRACT

Background: Prior studies have attempted to determine morphological characteristics of the medial epicondyle in overhead athletes, but no study has reported on precise quantitative differences between elite overhead athletes and control patients.

Hypothesis: The medial epicondyle in overhead athletes is larger in volume than those of control patients.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Computer simulation modeling from advanced (computed tomography/magnetic resonance imaging) imaging of the elbow of 37 patients (22 elite overhead athletes, 15 control patients) was performed to provide detailed assessment of the morphological characteristics of the medial epicondyle. Several quantitative metrics regarding the medial epicondyle were measured and compared across both cohorts, including that of epicondyle width (medial-lateral), height (superior-inferior), thickness (anterior-posterior), volume, percentage cortical volume, and morphology of the inferior slope of the epicondyle.

Results: The medial epicondyle in overhead athletes was significantly larger than that found in nonathlete controls (4976 vs 3682 mm(3); P = .001). There was no significance between the 2 cohorts in medial-lateral width (16.8 vs 16.6 mm; P = .68), but there was a difference in anterior-posterior thickness (16.96 vs 14.40 mm; P = .001) and superior-inferior height (39.55 vs 35.86 mm; P = .09) in athletes versus controls. The epicondyle volume was 97.9% cortical bone in athletes compared with 82.3% in control patients (P < .001). There were no differences in the morphology of the inferior epicondyle slope between the 2 groups.

Conclusion: The medial epicondyle in overhead athletes is larger in volume and anterior-posterior thickness than those of control patients. Additionally, the medial epicondyle is comprised nearly entirely of cortical bone in overhead athletes.

Clinical relevance: These quantitative findings support the theory of adaptive remodeling in skeletally immature overhead athletes.

No MeSH data available.