Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study
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.
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).
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).
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.
KeywordsPosterolateral rotatory instability Lateral collateral ligament Lateral ulnar collateral ligament LUCL reconstruction Dual-reconstruction Biomechanical analysis
The authors wish to thank Arthrex® Germany for providing the implants for this study.
- 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 453–460Google 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 126–130Google 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):429Google 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 23–32Google Scholar