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Biomechanical testing of the reconstructed ulnar collateral ligament: a systematic review of the literature

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Abstract

Purpose

The purpose was to perform a systematic review of the literature investigating biomechanical studies of ulnar collateral ligament reconstruction (UCLR) techniques to summarize the most commonly analyzed methods of fixation (at both the ulna and humerus), the degree of elbow flexion at the time of fixation, graft characteristics, and modes of failure with these techniques.

Materials and methods

A systematic review was performed. All cadaveric biomechanical studies that tested a reconstruction method for UCLR were included. Descriptive statistics were calculated for each study and parameter/variable analyzed.

Results

Twenty-three studies were included with a total of 397 elbows in 242 cadavers (mean age 54.8 ± 20 years, range 16–96). The majority of studies (65 %) used a palmaris longus graft. The docking technique (37.2 %) was the most commonly tested reconstruction method. Significant heterogeneity between studies precluded assimilation of specific techniques (each of the 23 studies utilized a unique technique). Fixation was performed at 30°–90° of elbow flexion. The most common mode of failure was suture failure (51 %), followed by midsubstance rupture (27.00 %), and bone tunnel fracture (14.00 %). No significant differences were observed amongst techniques for all measures analyzed.

Conclusion

This study found the docking technique to be the most commonly tested technique, while the mode of reconstruction failure was most commonly at the suture interface. If the graft failed at the bone interface, it was most likely to occur at the ulna. Surgeon preference and comfort level with a specific technique should dictate choice.

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Funding

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA

    B. M. Saltzman, B. J. Erickson, G. P. Nicholson, B. R. Bach, N. N. Verma & A. A. Romeo

  2. Division of Sports Medicine, The Steadman Clinic, 181 W Meadow Dr., Vail, CO, 81657, USA

    J. M. Frank

  3. Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6550 Fannin, Smith Tower, Suite 2500, Houston, TX, 77030, USA

    J. D. Harris

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  1. B. M. Saltzman
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Corresponding author

Correspondence to B. M. Saltzman.

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Conflict of interest

There are no conflicts of interest or disclosures of or pertaining to the completion of this manuscript. Beyond the scope of this manuscript, the following disclosures are noted for the authors: Bryan M. Saltzman receives publishing royalties, financial or material support from Nova Science Publishers and Postgraduate institute for Medicine. Brandon Erickson declares that he has no conflict of interest. Jonathan Frank declares that he has no conflict of interest. Joshua Harris is a board or committee member of AAOS and AOSSM and AANA, is on the editorial board of Arthroscopy and Frontiers in Surgery, receives research support from DePuy A Johnson & Johnson Company, is a paid consultant for NIA Magellan, receives publishing royalties/financial/material support from SLACK Incorporated, and a paid presented or speaker with research support for Smith & Nephew. Gregory Nicholson receives IP royalties from Innomed, receives Publishing royalties, financial or material support from SLACK Incorporated, is a paid consultant with research support from Tornier, and receives stock options from Zimmer. Bernard Bach is on the board of AOSSM, receives research support from Arthrex, Inc, CONMED Linvatec, DJ Orthopaedics, Ossur, Smith & Nephew, and Tornier, and receives publishing royalties from SLACK Incorporated. Nikhil Verma is on the board of AOSSM and ASES and AANA and Arthroscopy and Journal of Knee Surgery, receives publishing royalties from Arthroscopy, receives research support from Arthrex Inc and Arthrosurface and DJ Orthopaedics, receives stock options from Cymedica, is a paid consultant with stock options for Minivasive, is a paid consultant for Orthospace, receives stock options for Omeros, receives research support from Ossur, is on the governing board of SLACK Incorporated, receives IP royalties, is a paid consultant for Smith & Nephew, receives research support from Smith & Nephew, Athletico, ConMed Linvatec, Miomed, Mitek, and receives publishing royalties from Vindico Medical-Orthopedics Hyperguide. Anthony Romeo is on the board of AOSSM and ASES, receives royalties, is a paid consultant and presenter for Arthrex, Inc., receives research support from DJO Surgical, is on the editorial or governing board of Orthopedics and Orthopedics Today, receives research support from Ossur, is on the editorial board of SAGE, receives publishing royalties from Saunders/Mosby-Elseview, is on the editorial or governing board with publishing royalties from SLACK Incorporated, receives research support from Smith & Nephew, and is on editorial board of Wolters Kluwer Health–Lippincott Williams & Wilkins.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Saltzman, B.M., Erickson, B.J., Frank, J.M. et al. Biomechanical testing of the reconstructed ulnar collateral ligament: a systematic review of the literature. Musculoskelet Surg 100, 157–163 (2016). https://doi.org/10.1007/s12306-016-0426-z

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