Partial posteromedial olecranon resection: A kinematic study

S. Kamineni, H. Hirahara, S. Pomianowski, P. G. Neale, S. W. O'Driscoll, N. S. Elattrache, K. N. An, B. F. Morrey

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: The posteromedial aspect of the olecranon process is a site of impingement and subsequent osteophyte development in throwing athletes. Treatment with débridement, with resection of osteophytes and varying amounts of normal olecranon bone, is common. We found no reports in the literature concerning the effects of resecting different amounts of normal bone from the posteromedial aspect of the olecranon. We hypothesized that excessive resection would increasingly alter elbow kinematics and that an optimum amount of olecranon resection could be identified. Methods: We investigated the kinematic effects of increasing valgus and varus torques and posteromedial olecranon resections, in twelve cadaveric elbows, with use of an electromagnetic tracking device. Two valgus and two varus torques were applied, and three sequential resections were performed in 3-mm steps from 0 mm to 9 mm. Statistical analyses included paired t tests, 95% confidence intervals, a one-factor analysis of variance with repeated measures, and a post hoc test when significance was established. Results: Sequential partial resection of the posteromedial aspect of the olecranon resulted in stepwise increases in valgus angulation with valgus torque. Clear differences were seen at each level of resection. A pattern of increased valgus angulation also was seen in association with increased valgus torque. Increased valgus torque resulted in a trend toward increased axial internal rotation of the ulna, whereas increased osseous resection resulted in a decrease in the absolute degree of internal rotation or, in some specimens, increased external rotation. Conclusions: Although no single critical amount of olecranon resection was identified, valgus angulation of the elbow increased in association with all resections, with a marked increase occurring in association with a 9-mm resection. Our findings challenge the rationale of removing any amount of normal olecranon bone in throwing athletes as doing so may increase strain on the medial collateral ligament. The implications for the professional throwing athlete are important, and we recommend that bone removal from the olecranon be limited to osteophytes, without the removal of normal bone.

Original languageEnglish (US)
Pages (from-to)1005-1011
Number of pages7
JournalJournal of Bone and Joint Surgery - Series A
Volume85
Issue number6
StatePublished - Jun 1 2003

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Olecranon Process
Biomechanical Phenomena
Torque
Osteophyte
Bone and Bones
Elbow
Athletes
Collateral Ligaments
Ulna
Electromagnetic Phenomena
Statistical Factor Analysis
Analysis of Variance
Confidence Intervals

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Kamineni, S., Hirahara, H., Pomianowski, S., Neale, P. G., O'Driscoll, S. W., Elattrache, N. S., ... Morrey, B. F. (2003). Partial posteromedial olecranon resection: A kinematic study. Journal of Bone and Joint Surgery - Series A, 85(6), 1005-1011.

Partial posteromedial olecranon resection : A kinematic study. / Kamineni, S.; Hirahara, H.; Pomianowski, S.; Neale, P. G.; O'Driscoll, S. W.; Elattrache, N. S.; An, K. N.; Morrey, B. F.

In: Journal of Bone and Joint Surgery - Series A, Vol. 85, No. 6, 01.06.2003, p. 1005-1011.

Research output: Contribution to journalArticle

Kamineni, S, Hirahara, H, Pomianowski, S, Neale, PG, O'Driscoll, SW, Elattrache, NS, An, KN & Morrey, BF 2003, 'Partial posteromedial olecranon resection: A kinematic study', Journal of Bone and Joint Surgery - Series A, vol. 85, no. 6, pp. 1005-1011.
Kamineni S, Hirahara H, Pomianowski S, Neale PG, O'Driscoll SW, Elattrache NS et al. Partial posteromedial olecranon resection: A kinematic study. Journal of Bone and Joint Surgery - Series A. 2003 Jun 1;85(6):1005-1011.
Kamineni, S. ; Hirahara, H. ; Pomianowski, S. ; Neale, P. G. ; O'Driscoll, S. W. ; Elattrache, N. S. ; An, K. N. ; Morrey, B. F. / Partial posteromedial olecranon resection : A kinematic study. In: Journal of Bone and Joint Surgery - Series A. 2003 ; Vol. 85, No. 6. pp. 1005-1011.
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abstract = "Background: The posteromedial aspect of the olecranon process is a site of impingement and subsequent osteophyte development in throwing athletes. Treatment with d{\'e}bridement, with resection of osteophytes and varying amounts of normal olecranon bone, is common. We found no reports in the literature concerning the effects of resecting different amounts of normal bone from the posteromedial aspect of the olecranon. We hypothesized that excessive resection would increasingly alter elbow kinematics and that an optimum amount of olecranon resection could be identified. Methods: We investigated the kinematic effects of increasing valgus and varus torques and posteromedial olecranon resections, in twelve cadaveric elbows, with use of an electromagnetic tracking device. Two valgus and two varus torques were applied, and three sequential resections were performed in 3-mm steps from 0 mm to 9 mm. Statistical analyses included paired t tests, 95{\%} confidence intervals, a one-factor analysis of variance with repeated measures, and a post hoc test when significance was established. Results: Sequential partial resection of the posteromedial aspect of the olecranon resulted in stepwise increases in valgus angulation with valgus torque. Clear differences were seen at each level of resection. A pattern of increased valgus angulation also was seen in association with increased valgus torque. Increased valgus torque resulted in a trend toward increased axial internal rotation of the ulna, whereas increased osseous resection resulted in a decrease in the absolute degree of internal rotation or, in some specimens, increased external rotation. Conclusions: Although no single critical amount of olecranon resection was identified, valgus angulation of the elbow increased in association with all resections, with a marked increase occurring in association with a 9-mm resection. Our findings challenge the rationale of removing any amount of normal olecranon bone in throwing athletes as doing so may increase strain on the medial collateral ligament. The implications for the professional throwing athlete are important, and we recommend that bone removal from the olecranon be limited to osteophytes, without the removal of normal bone.",
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AU - O'Driscoll, S. W.

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AU - An, K. N.

AU - Morrey, B. F.

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