Review Question - QID 4450

The medial collateral ligament provides valgus stability to the elbow and can be damaged with excessive resection of posteromedial olecranon osteophytes.

Valgus extension overload syndrome is seen in overhead throwing athletes and is a constellation of chondrosis, posteromedial olecranon and humerus osteophyte formation, and loose bodies. Excessive olecranon resection increases valgus angulation and MCL strain during valgus stressing.

Kamineni et al. performed a cadaveric biomechanical experiment utilizing electromagnetic tracking devices to measure the strain in the anterior bundle of the medial collateral ligament. Strain in the anterior bundle of the medial collateral ligament was found to increase with increasing flexion angle, valgus torque, and olecranon resection beyond 3 mm.

Bell et al. also conducted a biomechanical experiment using electromagnetic tracking devices on 8 cadaveric elbows. They found that elbow stability is progressively lost with sequential excision of the olecranon, with gross instability noted at resection of > or = 87.5% of the olecranon.

Figure A demonstrates an axial cut of a right elbow MRI with arrow pointing to a posteromedial olecranon osteophyte. Illustration A is a drawing describing the valgus extension overload syndrome.