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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Valgus stability of the elbow. A definition of primary and secondary constraints.Clin Orthop Relat Res. 1991; 265: 187-195
- Articular and ligamentous contributions to the stability of the elbow joint.Am J Sports Med. 1983; 11: 315-319
- Imaging of posttraumatic and soft tissue dysfunction of the elbow.Clin Orthop Relat Res. 2000; 370: 9-18
- Biomechanical evaluation of the medial collateral ligament of the elbow.J Bone Joint Surg Am. 1997; 79: 1223-1231
- Biomechanical study of ligaments around the elbow joint.Clin Orthop Relat Res. 1991; 271: 170-179
- Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.Am J Sports Med. 2000; 28: 16-23
- Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up.Am J Sports Med. 2010; 38: 2426-2434
- Epidemiology of medial ulnar collateral ligament reconstruction: A 10-year study of New York State.Am J Sports Med. 2016; 44: 729-734
- Medial elbow injuries in the throwing athlete.Hand Clin. 2017; 33: 47-62
- Reconstruction of the ulnar collateral ligament in athletes.J Bone Jt Surg. 1986; 68: 1158-1163
- The medial collateral ligament of the elbow is not isometric.Am J Sports Med. 2004; 32: 85-90
- A biomechanical comparison of 2 ulnar collateral ligament reconstruction techniques.Arthrosc J Arthrosc Relat Surg. 2007; 23: 141-150
- A biomechanical study of stability of the elbow to valgus stress before and after reconstruction of the medial collateral ligament.J Shoulder Elb Surg. 2002; 11: 259-264
- Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow.Am J Sports Med. 2006; 34: 1599-1603
- Revision ulnar collateral ligament reconstruction using a suspension button fixation technique.Am J Sports Med. 2010; 38: 575-580
- Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow.Am J Sports Med. 1998; 26: 620-624
- In vivo and 3-dimensional functional anatomy of the anterior bundle of the medial collateral ligament of the elbow.J Shoulder Elb Surg. 2012; 21: 1006-1012
- Isometric tunnel placement in ulnar collateral ligament reconstruction with single CT scan.Biomed Res Int. 2017; 2017: 5128639
- Comparison of anterior cruciate ligament graft isometry between paired femoral and tibial tunnels.J Knee Surg. 2017; 30: 960-964
- Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation.Am J Sports Med. 2003; 31: 332-337
- Biomechanical comparison of ulnar collateral ligament reconstruction techniques.Am J Sports Med. 2008; 36: 1565-1570
- Ulnar collateral ligament repair: An old idea with a new wrinkle.Am J Orthop (Belle Mead NJ). 2016; 45: 124-127
- The in vivo isometric point of the lateral ligament of the elbow.J Bone Joint Surg Am. 2007; 89: 2011-2017
- Restoring isometry in lateral ulnar collateral ligament reconstruction.J Hand Surg Am. 2015; 40: 1421-1427
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.
- Full-Text
- Preview
