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Laterale ulnare Kollateralbandplastik

Biomechanische Untersuchung zur posterolateralen Rotationsinstabilität des Ellenbogens

Lateral ulnar collateral ligament reconstruction

A biomechanical analysis of posterolateral rotatory instability of the elbow

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Zusammenfassung

Hintergrund

Die chronische posterolaterale Rotationsinstabilität (PLRI) des Ellenbogens resultiert aus einer Insuffizienz des lateralen Kollateralbands (LCL). Die laterale ulnare Kollateralband(LUCL)-Plastik stellt ein etabliertes Therapieverfahren bei PLRI dar, rezidivierende Instabilitäten sind jedoch nicht selten.

Ziel der Arbeit

Das Ziel dieser In-vitro-Studie war es, die posterolaterale Rotationsstabilität des Ellenbogens bei intaktem LCL, nach Durchtrennung des LCL und nach LUCL-Plastik mittels autologem Trizepssehnengraft und Doppel-BicepsButtonTM-Fixierung zu analysieren.

Material und Methoden

Die posterolaterale Rotation von 6 unfixierten Ellenbogenpräparaten bei einem Drehmoment von 3 Nm in 0°, 45°, 90° und 120° Flexion wurde bei intaktem LCL, nach Durchtrennung des LCL und nach LUCL-Plastik untersucht. Zudem erfolgte eine zyklische Belastung (1000 Zyklen) bei intaktem LCL und nach LUCL-Plastik.

Ergebnisse

Das intakte LCL und die LUCL-Plastik zeigten eine vergleichbare Primärstabilität (0,250 ≤ p ≤ 0,888). Die Durchtrennung des LCL führte zu einer ausgeprägten PLRI (p < 0,001). Nach zyklischer Belastung unterschied sich die Stabilität des intakten LCL nicht von der LUCL-Plastik (p = 0,218). Die posterolaterale Rotation nahm im Laufe der zyklischen Belastung bei der LUCL-Plastik (3,2° ± 0,8°) deutlicher zu als beim intakten LCL (2,0° ± 0,7°; p = 0,020).

Diskussion

Die LUCL-Plastik mit BicepsButtonTM-Fixierung weist eine dem nativen LCL vergleichbare biomechanische Stabilität auf. Klinische Studien müssen zeigen, ob sich durch diese Technik die Komplikationsrate senken lässt.

Abstract

Background

Chronic posterolateral rotatory instability (PLRI) of the elbow is the result of an insufficiency of the lateral collateral ligament (LCL). Lateral ulnar collateral ligament (LUCL) reconstruction represents a well-established treatment method for PLRI. However, recurrent instability remains a problem.

Objectives

The goal of this in-vitro study was to evaluate the posterolateral rotatory stability of the intact elbow, after sectioning of the LCL and after LUCL reconstruction with a triceps tendon autograft and double BicepsButtonTM fixation.

Materials and methods

Posterolateral rotatory stability of 6 fresh-frozen elbow specimens at a torque of 3 Nm was analyzed at 0, 45, 90 and 120° of flexion for the intact LCL, after sectioning of the LCL and after LUCL reconstruction. Moreover, cyclic loading (1000 cycles) of the intact specimens and after LUCL reconstruction was performed.

Results

The intact LCL and the LUCL reconstruction provided equal primary stability (0.250 ≤ p ≤ 0.888). Sectioning of the LCL significantly increased PLRI (p < 0.001). The stability of the intact specimens and after LUCL reconstruction did not differ after cyclic loading (p = 0.218). During cyclic loading, posterolateral rotation increased significantly more after LUCL reconstruction (3.2 ± 0.8°) when compared to the native LCL (2.0 ± 0.7°, p = 0.020).

Conclusions

LUCL reconstruction with BicepsButtonTM fixation provides comparable stability to the native LCL. Further clinical results are necessary to evaluate whether this technique can decrease the complication rate.

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Authors and Affiliations

  1. Institut I für Anatomie, Universität zu Köln, Köln, Deutschland

    M. Hackl & W. F. Neiss

  2. Schwerpunkt für Unfall-, Hand- und Ellenbogenchirurgie, Universitätsklinik zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    M. Hackl, T. Leschinger, C. Ries, L. P. Müller & K. Wegmann

  3. Cologne Center for Musculoskeletal Biomechanics (CCMB), Universität zu Köln, Köln, Deutschland

    M. Hackl, T. Leschinger, C. Ries, L. P. Müller & K. Wegmann

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  1. M. Hackl
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Correspondence to M. Hackl.

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Interessenkonflikt

M. Hackl, T. Leschinger, K. Wegmann und L.P. Müller weisen auf folgende Beziehung hin: Unterstützung durch die Arthrex GmbH (München, Deutschland) für Forschungsprojekte. C. Ries und W.F. Neiss erklären, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Hackl, M., Leschinger, T., Ries, C. et al. Laterale ulnare Kollateralbandplastik. Orthopäde 45, 895–900 (2016). https://doi.org/10.1007/s00132-016-3321-2

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  • DOI: https://doi.org/10.1007/s00132-016-3321-2

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