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

  • Jens Dargel
  • Evelyn Boomkamp
  • Kilian Wegmann
  • Peer Eysel
  • Lars Peter Müller
  • Michael Hackl
Elbow

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.

Keywords

Posterolateral rotatory instability Lateral collateral ligament Lateral ulnar collateral ligament LUCL reconstruction Dual-reconstruction Biomechanical analysis 

Notes

Acknowledgments

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

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  1. 1.Center for Orthopedic and Trauma SurgeryUniversity Medical CenterCologneGermany
  2. 2.Cologne Center for Musculoskeletal Biomechanics, Medical FacultyUniversity of CologneCologneGermany

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