Effect of ulnar tunnel location on elbow stability in double-strand lateral collateral ligament reconstruction
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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Cited by (6)
Risk factors associated with atraumatic posterolateral rotatory instability
2021, JSES InternationalCitation Excerpt :However, 8 of the 44 patients did not have a clear history of instability or dislocation. Other risk factors for atraumatic PLRI were not assessed in this subgroup of patients; however, patients did well with a ligament reconstruction.10,14,22,24 A short-term benefit of corticosteroid injections in the treatment of ECRB has been demonstrated.27
Three-dimensional computed tomography modeling for kinematic analysis of double-strand lateral ulnar collateral ligament reconstruction
2019, Journal of Shoulder and Elbow SurgeryCitation Excerpt :The landmark for the ulnar insertion footprint was also chosen based on previous computer model studies, which located it at the supinator crest, at the level of the radial head junction.2,26 This acted as a reference point to register other ulnar insertion footprints (Fig. 2).18 Each of the 3 configurations had 5 subconfigurations.
Radiographic Description of Soft Tissue Attachments around the Elbow
2023, Archives of Bone and Joint SurgeryLateral ulnar collateralligament reconstruction (Double docking technique)
2019, Surgical Techniques for Trauma and Sports Related Injuries of the ElbowPosterolateral rotatory reconstruction
2018, Illustrated Tips and Tricks in Sports Medicine SurgerySecondary ligament reconstruction of the elbow: Which technique should be used?
2017, Trauma und Berufskrankheit
No Institutional Review Board or Ethical Committee review was needed for this cadaveric biomechanical study.