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Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study

  • Elbow
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Posterolateral rotatory instability (PLRI) of the elbow is the result of an insufficient lateral collateral ligament complex (LCLC). Single-bundle reconstruction of the lateral ulnar collateral ligament (LUCL) represents the standard treatment method for chronic PLRI. However, cases of recurrent instability after LUCL reconstruction have been reported. The dual-reconstruction procedure has been described to anatomically restore the LUCL as well as the radial collateral ligament (RCL). It was hypothesized that anatomic reconstruction of the LCLC provides increased stability compared with the conventional technique.

Methods

Posterolateral rotatory displacement was assessed in eight fresh-frozen human elbows with a maximum load of 20 N. Data were obtained in 0°, 30°, 60°, 90° and 120° of elbow flexion for native specimens, dissected LCLC and three reconstruction methods: (1) single-bundle LUCL reconstruction, (2) single-bundle LUCL reconstruction with RCL augmentation, (3) dual-reconstruction technique (LUCL + RCL).

Results

All reconstruction methods were able to sufficiently restore posterolateral rotatory stability of the elbow over the full range of motion. There were no significant differences between the intact specimens and either reconstruction method. Dissection of the LCLC significantly increased PLRI compared with the other groups (p < 0.001).

Conclusion

The less invasive dual-reconstruction technique is confirmed as a safe procedure for anatomic LCLC reconstruction. Primary stability is equal, yet not superior to conventional LUCL reconstruction. Hence, this biomechanical study does not confirm the hypothesis that more anatomic reconstruction techniques could reduce the risk of recurrent instability when compared to conventional LUCL reconstruction.

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References

  1. Ahmad CS, Lee TQ, ElAttrache NS (2003) Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med 31:332–337

    PubMed  Google Scholar 

  2. Anakwenze OA, Kwon D, O’Donnell E, Levine WN, Ahmad CS (2014) Surgical treatment of posterolateral rotatory instability of the elbow. Arthroscopy 30:866–871

    Article  PubMed  Google Scholar 

  3. Beckett KS, McConnell P, Lagopoulos M, Newman RJ (2000) Variations in the normal anatomy of the collateral ligaments of the human elbow joint. J Anat 197:507–511

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cohen MS (2006) Lateral collateral ligament instability of the elbow. In: Trumble T, Budoff J (eds) Wrist and elbow reconstruction & arthroscopy. American Society for Surgery of the Hand, Rosemont, pp 453–460

    Google Scholar 

  5. Cohen MS, Hastings H 2nd (1997) Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am 79:225–233

    Article  CAS  PubMed  Google Scholar 

  6. Crenshaw AH (1998) Surgical techniques and approaches. In: Canale S, Beaty J (eds) Campbell’s operative orthopaedics, 9th edn. Mosby, St. Louis, pp 126–130

    Google Scholar 

  7. Dargel J, Burkhart K, Pennig D, Stein G, Eysel P, Muller LP (2013) Percutaneous lateral ulnar collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:450–455

    Article  PubMed  Google Scholar 

  8. Dehlinger FI, Ries C, Hollinger B (2014) LUCL reconstruction using a triceps tendon graft to treat posterolateral rotatory instability of the elbow. Oper Orthop Traumatol 26(414–427):429

    Google Scholar 

  9. Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 83-A:1823–1828

    Article  CAS  PubMed  Google Scholar 

  10. Eygendaal D (2004) Ligamentous reconstruction around the elbow using triceps tendon. Acta Orthop Scand 75:516–523

    Article  PubMed  Google Scholar 

  11. Furukawa K, Pichora J, Steinmann S, Faber KJ, Johnson JA, King GJ (2007) Efficacy of interference screw and double-docking methods using palmaris longus and GraftJacket for medial collateral ligament reconstruction of the elbow. J Shoulder Elb Surg 16:449–453

    Article  Google Scholar 

  12. Hollinger B, Dehlinger F, Franke S (2014) Diagnostik und Therapie der ligamentären Ellenbogeninstabilitäten. Obere Extremität 9:147–155

    Article  Google Scholar 

  13. Imatani J, Ogura T, Morito Y, Hashizume H, Inoue H (1999) Anatomic and histologic studies of lateral collateral ligament complex of the elbow joint. J Shoulder Elb Surg 8:625–627

    Article  CAS  Google Scholar 

  14. Jackson A, Maerz T, Koueiter DM, Andrecovich CJ, Baker KC, Anderson K (2012) Strength of ulnar fixation in ulnar collateral ligament reconstruction: a biomechanical comparison of traditional bone tunnels to the tension-slide technique. J Shoulder Elb Surg 21:1674–1679

    Article  Google Scholar 

  15. Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW et al (2012) The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elb Surg 21:389–395

    Article  Google Scholar 

  16. King GJ, Dunning CE, Zarzour ZD, Patterson SD, Johnson JA (2002) Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow. J Shoulder Elb Surg 11:60–64

    Article  Google Scholar 

  17. Lin KY, Shen PH, Lee CH, Pan RY, Lin LC, Shen HC (2012) Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury 43:1657–1661

    Article  PubMed  Google Scholar 

  18. McAdams TR, Masters GW, Srivastava S (2005) The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability. J Shoulder Elb Surg 14:298–301

    Article  Google Scholar 

  19. Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K (2007) The in vivo isometric point of the lateral ligament of the elbow. J Bone Joint Surg Am 89:2011–2017

    PubMed  Google Scholar 

  20. Nestor BJ, O’Driscoll SW, Morrey BF (1992) Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 74:1235–1241

    Article  CAS  PubMed  Google Scholar 

  21. Nord RM, Safran MR (2010) Posterolateral rotatory instability. In: Fu F (ed) Master techniques in orthopaedic surgery: sports medicine. Lippincott Williams & Wilkins, Philadelphia, pp 23–32

    Google Scholar 

  22. O’Driscoll SW (2000) Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 370:34–43

    Article  Google Scholar 

  23. O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73:440–446

    Article  PubMed  Google Scholar 

  24. Olsen BS, Sojbjerg JO (2003) The treatment of recurrent posterolateral instability of the elbow. J Bone Joint Surg Br 85:342–346

    Article  CAS  PubMed  Google Scholar 

  25. Olsen BS, Sojbjerg JO, Nielsen KK, Vaesel MT, Dalstra M, Sneppen O (1998) Posterolateral elbow joint instability: the basic kinematics. J Shoulder Elb Surg 7:19–29

    Article  CAS  Google Scholar 

  26. Rhyou IH, Park MJ (2011) Dual reconstruction of the radial collateral ligament and lateral ulnar collateral ligament in posterolateral rotator instability of the elbow. Knee Surg Sports Traumatol Arthrosc 19:1009–1012

    Article  PubMed  Google Scholar 

  27. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 87:54–61

    CAS  PubMed  Google Scholar 

  28. Savoie FH III, O’Brien MJ, Field LD, Gurley DJ (2010) Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Clin Sports Med 29:611–618

    Article  PubMed  Google Scholar 

  29. Schmidt T, Stangl R (2013) Indikationen, Komplikationen und Ergebnisse der Ellenbogenarthroskopie. Obere Extremität 8:220–225

    Article  Google Scholar 

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Acknowledgments

The authors wish to thank Arthrex® Germany for providing the implants for this study.

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Authors and Affiliations

  1. Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany

    Jens Dargel, Evelyn Boomkamp, Kilian Wegmann, Peer Eysel, Lars Peter Müller & Michael Hackl

  2. Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany

    Jens Dargel, Kilian Wegmann, Peer Eysel, Lars Peter Müller & Michael Hackl

Authors
  1. Jens Dargel
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  2. Evelyn Boomkamp
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  3. Kilian Wegmann
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  4. Peer Eysel
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  5. Lars Peter Müller
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  6. Michael Hackl
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Correspondence to Michael Hackl.

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Dargel, J., Boomkamp, E., Wegmann, K. et al. Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study. Knee Surg Sports Traumatol Arthrosc 25, 943–948 (2017). https://doi.org/10.1007/s00167-015-3627-3

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  • DOI: https://doi.org/10.1007/s00167-015-3627-3

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