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Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation

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Abstract

Purpose

The purpose of this study was to perform biomechanical testing of annular ligament (AL) reconstruction using the superficial head of the brachialis tendon (SHBT) as a distally based tendon graft. We hypothesized that posterior translation of the radial head following AL reconstruction with an SHBT graft does not significantly differ from intact specimens.

Methods

Six fresh-frozen elbow specimens were used. The stability of the radial head against posterior translation forces (30 N) was evaluated in 0°, 45°, 90° and 120° of elbow flexion. Posterior translation was obtained for the intact AL, the sectioned AL and the reconstructed AL. Cyclic loading (100 cycles) in 90° of elbow flexion was performed for the intact and the reconstructed AL.

Results

Posterior translation of the radial head decreased during elbow flexion in native specimens. Sectioning of the AL significantly increased instability over the full range of motion. AL reconstruction with the SHBT restored the stability of the proximal radius but—other than the native AL—was not influenced by elbow flexion. In 120° of flexion the native AL provided significantly more stability when compared to the reconstructed AL. Cyclic loading did not provide significant differences between native and reconstructed specimens.

Conclusions

We provide a feasible technique for AL reconstruction using the SHBT. The biomechanical results obtained in this study confirm the efficacy of the procedure. AL reconstruction restores the stability of the proximal radius, yet it cannot fully mimic the complex features of the intact AL.

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Acknowledgements

We would like to thank A. Rowlin (AVMZ, University of Magdeburg) for the schematic drawings presented in this article.

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Authors and Affiliations

  1. Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Michael Hackl, Kilian Wegmann, Christian Ries, Sebastian Lappen & Lars Peter Müller

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

    Michael Hackl, Kilian Wegmann, Christian Ries, Sebastian Lappen, Martin Scaal & Lars Peter Müller

  3. Department of Anatomy II, University of Cologne, Cologne, Germany

    Martin Scaal

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  1. Michael Hackl
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  2. Kilian Wegmann
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Correspondence to Michael Hackl.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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All named authors hereby declare that they have no conflicts of interest to disclose.

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Hackl, M., Wegmann, K., Ries, C. et al. Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat 39, 585–591 (2017). https://doi.org/10.1007/s00276-016-1774-y

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  • DOI: https://doi.org/10.1007/s00276-016-1774-y

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