Effect of ulnar tunnel location on elbow stability in double-strand lateral collateral ligament reconstruction

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Background

Double-strand lateral ulnar collateral ligament (LUCL) reconstruction is an effective treatment for posterolateral rotatory instability (PLRI) of the elbow, but anatomic landmarks for ulnar tunnel placement are often difficult to identify intraoperatively, which potentially can result in a nonanatomic LUCL reconstruction. This study investigated the effect of ulnar tunnel location on joint stability in double-strand LUCL reconstruction.

Methods

PLRI was artificially created in 7 cadaveric elbows, and double-strand LUCL reconstruction was performed. Five different ulnar tunnels were made along the length of the ulna. In each specimen, each possible pair of 2 tunnels (10 total) were used for graft passage. Varus and posterolateral joint gapping was measured after joint loading using a 3-dimensional digitizer system and X-ray image intensifier.

Results

No significant gapping was observed at the posterolateral ulnohumeral joint regardless of the location of the ulnar tunnels (P > .05). In contrast, the lateral radiocapitellar joint showed statistically significant varus gapping when both ulnar tunnels were placed proximal to the radial head-neck junction (P < .05).

Discussion

This findings of study suggest that the location of the ulnar tunnels may not be as critical as that of the humeral tunnel during double-strand LUCL reconstruction and that posterolateral rotatory elbow stability can be achieved reasonably well as long as at least 1 of the 2 ulnar tunnels is located at or distal to the radial head-neck junction level.

Section snippets

Specimen preparation and LUCL reconstruction

Seven nonpaired fresh frozen elbow cadaveric specimens from seven donors (5 men; mean age, 50 ± 12; range, 35-63 years) with no evidence of previous surgery, trauma, or arthritis were dissected using the Kocher lateral approach. The lateral collateral ligament complex and anconeus were detached from the proximal and distal attachment sites (Fig. 1, A). Part of the extensor origin and part of the flexor digitorum profundus origin were detached from the lateral epicondyle and the medial aspect of

Gapping measurement using MicroScribe

The MicroScribe data for gapping measurement are presented in Table I as distance differences from the baseline. The distance from point 1 to point 2 that represents the gapping of the lateral radiocapitellar joint was significantly increased after loading compared with the baseline when the graft was passed through 2 of the proximal ulnar tunnels (tunnel A-B, A-C, A-D, and B-C with 10° elbow flexion; tunnel A-B and A-C with 45° elbow flexion, P < .05; Figure 4, Figure 5). In contrast, the

Discussion

Anatomic reconstruction of the LUCL requires accurate identification of the bony attachment sites of the ligament. Humeral tunnel placement for anatomic LUCL reconstruction has been studied well enough to render a consensus that the isometric point on the lateral epicondyle should be made at the geometric center of the capitellar articular surface,2, 11, 15 which corresponds to the base of the lateral epicondyle where the epicondyle flattens onto the lateral aspect of the capitellum.2 A

Conclusions

In this in vitro study, we investigated the effect of various ulnar tunnel locations during LUCL reconstruction on elbow joint stability. Our study findings suggest that the location of the ulnar tunnels may not be as critical as the location of the humeral tunnel during double-strand LUCL reconstruction and that posterolateral rotatory elbow stability can be achieved reasonably well as long as at least 1 of the 2 ulnar tunnels is located at or distal to the radial head-neck junction level.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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