Purpose
To assess simulated ulnar collateral ligament (UCL) graft length change, using surgically
dissected anatomic landmarks, between multiple combinations of humeral and ulnar bone
tunnels.
Methods
Three equidistant humeral and ulnar tunnels were created at each UCL footprint of
10 cadaveric elbows. Suture was passed between 9 possible tunnel combinations for
each elbow and affixed to an isometry gauge. Each elbow was moved through an arc of
0, 30, 60, 90, and 120° for each tunnel combination. Changes in isometry gauge spring
displacement (and, in effect, tension) were recorded.
Results
There was an overall significant effect (P < .0001) of tunnel placement at all degrees of flexion. Pairwise comparisons revealed
increases in displacement between the central and posterior tunnel positions of the
medial epicondyle, with significant differences (P = .0009) occurring when paired with both the central and posterior aspect of the
sublime tubercle. Significant differences (P < .0001) were noted between the anterior and posterior humeral tunnel positions.
Conclusions
Simulated UCL graft isometry is dependent upon optimal bone tunnel placement. No significant
differences were noted between ulnar tunnel locations when paired with any given humeral
tunnel. Conversely, deviation anterior or posterior from the centroid of the UCL footprint
on the medial epicondyle significantly affected isometry at all degrees of flexion
recorded with the greatest amount of displacement occurring with pairi4ng of posterior
tunnels on both the humeral and ulnar footprints.
Clinical Relevance
This anatomic study highlights the importance of medial elbow bone tunnel placement
and its effect on simulated UCL graft isometry.
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Article Info
Publication History
Published online: April 23, 2019
Accepted:
December 7,
2018
Received:
July 10,
2018
Footnotes
See commentary on page 2035
The authors report the following potential conflicts of interest or sources of funding: This research was sponsored by Arthrex ( ST657 ) in the form of direct funding, procurement of cadaveric specimens, and in-kind donation of surgical supplies. This study was presented at the 2018 Annual Meeting of the American Orthopaedic Society for Sports Medicine in poster form. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Perfect Tunnel Position in Tommy John Surgery Is Critical for SuccessArthroscopyVol. 35Issue 7
- PreviewThe number of primary ulnar collateral ligament reconstructions (UCLRs) has been increasing at an alarming rate, and so has the number of revision UCLRs. Malpositioned tunnels are a technical surgical factor that causes graft failure and need for revision. Malpositioned tunnels result in a nonisometric graft. A common malposition error is to place the inferior humeral tunnel too far posterior, which causes the graft to be tight in flexion; therefore, elbow flexion will be restricted or, if flexion is forcibly obtained, the graft will be loose and nonfunctional.
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