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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.


Cortical fraction of the medial epicondyle. (A) A 3-dimensional model was created that only included cortical bone. (B) The cortical fraction was defined as the volume of this cortical model divided by the volume of the total medial epicondyle.
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fig6-2325967113517211: Cortical fraction of the medial epicondyle. (A) A 3-dimensional model was created that only included cortical bone. (B) The cortical fraction was defined as the volume of this cortical model divided by the volume of the total medial epicondyle.

Mentions: The portion of the medial epicondyle volume that was comprised of cortical bone (as opposed to trabecular bone) was measured by creating 3D models of the medial epicondyle for a small subset of patients with CT imaging that showed adequate detail to differentiate cortical from trabecular bone. There were 9 throwing athletes and 4 controls in this subset. By setting the Hounsfeld unit threshold to 300, as described by Schreiber et al,9 only cortical bone voxels were included in the models. The medial epicondyle's fractional volume was obtained by dividing the volume of this cortical model of the medial epicondyle by the total volume (cortical + trabecular) of the medial epicondyle (Figure 6). The medial epicondyle volume that was derived from cortical bone was compared between overhead athletes and control patients.


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)

Cortical fraction of the medial epicondyle. (A) A 3-dimensional model was created that only included cortical bone. (B) The cortical fraction was defined as the volume of this cortical model divided by the volume of the total 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

fig6-2325967113517211: Cortical fraction of the medial epicondyle. (A) A 3-dimensional model was created that only included cortical bone. (B) The cortical fraction was defined as the volume of this cortical model divided by the volume of the total medial epicondyle.
Mentions: The portion of the medial epicondyle volume that was comprised of cortical bone (as opposed to trabecular bone) was measured by creating 3D models of the medial epicondyle for a small subset of patients with CT imaging that showed adequate detail to differentiate cortical from trabecular bone. There were 9 throwing athletes and 4 controls in this subset. By setting the Hounsfeld unit threshold to 300, as described by Schreiber et al,9 only cortical bone voxels were included in the models. The medial epicondyle's fractional volume was obtained by dividing the volume of this cortical model of the medial epicondyle by the total volume (cortical + trabecular) of the medial epicondyle (Figure 6). The medial epicondyle volume that was derived from cortical bone was compared between overhead athletes and control patients.

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.