Functional Anatomy of the Lateral Collateral Ligament Complex of the Elbow: Morphology and Strain

The anatomy of the lateral ulnar collateral ligament (LUCL) of the elbow was investigated in 26 fresh frozen cadavers. Two types of insertion of the LUCL were originally described but we found another type which is characterized by a broad single expansion along with a thin membranous fibre. Strain on the LUCL was measured in situ during extension and flexion with the forearm in supination, pronation and neutral. Strain in the proximal fibres started to occur at around 32° flexion and peaked at between 50° and 60° flexion. Strains measured in the distal fibres were smaller in magnitude. Forearm rotation had little effect on strain during extension to flexion. Based on these results, we conclude that the LUCL functions in unison with the annular ligament.

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Reefing Procedure for Lateral Collateral Ligament Attenuation during Ligamentous Repair for Elbow Trauma

Shoulder & Elbow ◽

10.1111/j.1758-5740.2012.00197.x ◽

2012 ◽

Vol 4 (4) ◽

pp. 277-281

Author(s):

Benjamin W. Sears ◽

Grant E. Garrigues ◽

Dan Witmer ◽

Matthew L Ramsey

Keyword(s):

Surgical Repair ◽

Lateral Collateral Ligament ◽

Ulnar Collateral Ligament ◽

Current Procedural Terminology ◽

Collateral Ligament ◽

Elbow Trauma ◽

Code Search ◽

Lateral Ulnar Collateral Ligament ◽

Humeral Condyle ◽

A Current

Background Injury to the lateral soft tissue structures is common after complex elbow trauma and instability. Typically, this consists of lateral collateral ligamentous complex avulsion from the lateral distal humeral condyle. However, in some cases, attenuation of the ligament midsubstance may also occur, potentially resulting in residual ligamentous laxity after repair. Methods From 2007 to 2011, 37 patients were identified through a current procedural terminology code search as having undergone lateral ulnar collateral ligament (LUCL) repair during surgery for trauma to their elbow and were retrospectively reviewed. Results Attenuation of the ligament midsubstance was found in 19% (seven of 37) patients who underwent surgical repair of the LUCL for injuries to the elbow. In these patients, direct repair of the ligament with additional reefing of the ligament midsubstance was performed. Retrospective review of this population revealed no postsurgical instability or need for subsequent stabilizing procedures. Conclusions These findings demonstrate that, in select patients, repair with reefing of an attenuated LUCL ligament promotes stability to the elbow.

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Lateral ulnar collateral ligament (LUCL) reconstruction for the treatment of recalcitrant lateral epicondylitis of the elbow: a comparison with open débridement of the extensor origin

JSES International ◽

10.1016/j.jseint.2020.12.006 ◽

2021 ◽

Author(s):

Young Min Noh ◽

Gyu Min Kong ◽

Sang Won Moon ◽

Hyo Seok Jang ◽

Seungchul Kim ◽

...

Keyword(s):

Lateral Epicondylitis ◽

Ulnar Collateral Ligament ◽

Collateral Ligament ◽

Lateral Ulnar Collateral Ligament ◽

Open Debridement

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Surgical Treatment for Malunion of the Lateral Humeral Epicondyle with Posterior Subluxation of the Radial Head: A Case Report and Literature Review

Case Reports in Orthopedics ◽

10.1155/2018/1901235 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Koichi Yano ◽

Yasunori Kaneshiro ◽

Hideki Sakanaka

Keyword(s):

Lateral Collateral Ligament ◽

High Energy ◽

Limited Range ◽

Forearm Rotation ◽

Collateral Ligament ◽

Lateral Epicondyle ◽

Limited Range Of Motion ◽

Contracture Release ◽

Normal Congruence ◽

The Right

A 24-year-old right-handed man suffered right olecranon and lateral epicondylar fracture from high energy trauma. Fixation of olecranon was performed by a previous doctor. Three months after operation, he presented with limited range of motion (ROM) of the right elbow caused by malunion of the lateral epicondylar fracture and subluxation of the radiohumeral joint. Preoperative ROM of the right elbow was flexion 110° and extension −75°. Forearm rotation was pronation 85° and supination 65°. Fragment excision of the lateral epicondyle, which was 27 mm in length, and lateral collateral ligament repair using anchors were performed. Fourteen months postoperatively, contracture release of the elbow was performed. Twenty-four months postoperatively, radiograph of the elbow showed normal congruence without osteoarthritic changes and the ROM of the right elbow was flexion 120° and extension −35°. Forearm rotation was pronation 90° and supination 70°. In the surgical setting, in case of the size of the lateral epicondylar fragment is relatively large, the fragment should be fixed or lateral collateral ligament should be repaired when the instability of the elbow is found.

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Arthroscopically-assisted fixation of anteromedial coronoid facet fracture and lateral ulnar collateral ligament repair for acute posteromedial rotatory fracture dislocation of the elbow

Shoulder & Elbow ◽

10.1177/1758573217738138 ◽

2017 ◽

Vol 11 (5) ◽

pp. 378-383 ◽

Cited By ~ 2

Author(s):

Abbas Rashid ◽

David Copas ◽

Jeremy Granville-Chapman ◽

Adam Watts

Keyword(s):

Articular Surface ◽

Ulnar Collateral Ligament ◽

Fracture Dislocation ◽

Ligament Repair ◽

Collateral Ligament ◽

Coronoid Fracture ◽

Elbow Arthroscopy ◽

Lateral Ulnar Collateral Ligament ◽

Arthroscopically Assisted ◽

Facet Fracture

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.

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Anatomic and Biomechanical Evaluation of Ulnar Tunnel Position in Medial Ulnar Collateral Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546519880182 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3491-3497 ◽

Cited By ~ 1

Author(s):

Pascual H. Dutton ◽

Michael B. Banffy ◽

Trevor J. Nelson ◽

Melodie F. Metzger

Keyword(s):

Motion Tracking ◽

Full Range ◽

Ulnar Collateral Ligament ◽

Elbow Flexion ◽

Joint Line ◽

Collateral Ligament ◽

Proximal Ulna ◽

Tunnel Position ◽

Fresh Frozen ◽

Ulnar Tunnel

Background: Although numerous techniques of reconstruction of the medial ulnar collateral ligament (mUCL) have been described, limited evidence exists on the biomechanical implication of changing the ulnar tunnel position despite the fact that more recent literature has clarified that the ulnar footprint extends more distally than was appreciated in the past. Purpose: To evaluate the size and location of the native ulnar footprint and assess valgus stability of the medial elbow after UCL reconstruction at 3 ulnar tunnel locations. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. The anatomic footprint of the ulnar attachment of the mUCL was measured with a digitizing probe. The area of the ulnar footprint and midpoint relative to the joint line were determined. Medial elbow stability was tested with the mUCL in an intact, deficient, and reconstructed state after the docking technique, with ulnar tunnels placed at 5, 10, or 15 mm from the ulnotrochlear joint line. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion-tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: The mean ± SD length of the mUCL ulnar footprint was 27.4 ± 3.3 mm. The midpoint of the anatomic footprint was located between the 10- and 15-mm tunnels across all specimens at a mean 13.6 mm from the joint line. Sectioning of the mUCL increased elbow valgus rotation throughout all flexion angles and was statistically significant from 30° to 100° of flexion as compared with the intact elbow ( P < .05). mUCL reconstruction at all 3 tunnel locations restored stability to near intact levels with no significant differences among the 3 ulnar tunnel locations at any flexion angle. Conclusion: Positioning the ulnar graft fixation site up to 15 mm from the ulnotrochlear joint line does not significantly increase valgus rotation in the elbow. Clinical Relevance: A more distal ulnar tunnel may be a viable option to accommodate individual variation in morphology of the proximal ulna or in a revision setting.

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Clinical Outcomes of Lateral Ulnar Collateral Ligament Repair of the Elbow Using a Cortical Button

Techniques in Shoulder & Elbow Surgery ◽

10.1097/bte.0000000000000178 ◽

2019 ◽

Vol 20 (4) ◽

pp. 109-115

Author(s):

Connor Zale ◽

H. Mike Kim

Keyword(s):

Clinical Outcomes ◽

Ulnar Collateral Ligament ◽

Ligament Repair ◽

Collateral Ligament ◽

Lateral Ulnar Collateral Ligament ◽

Cortical Button

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Autologous Osteoligamentous Reconstruction of Scaphoid Proximal Pole With Metatarsal Head and Collateral Ligament: Cadaver Anatomic Description of Novel Surgical Technique

Hand ◽

10.1177/1558944719895616 ◽

2020 ◽

pp. 155894471989561

Author(s):

Christopher G. Larkins ◽

Shruti C. Tannan ◽

Alison E. Burkett ◽

Suhail K. Mithani ◽

Ramesh C. Srinivasan ◽

...

Keyword(s):

Lateral Collateral Ligament ◽

Metatarsal Head ◽

Cadaver Study ◽

Scaphoid Nonunion ◽

Proximal Pole ◽

Collateral Ligament ◽

Cadaveric Specimen ◽

Simultaneous Reconstruction ◽

Second Metatarsal ◽

Fresh Frozen

Background: Historically, scaphoid nonunion has been surgically treated with vascularized bone graft taken from multiple different anatomic sites. However, none of these grafts fully recapitulate the unique osteoligamentous anatomy of the proximal pole of the scaphoid and the attachment of the scapholunate ligament (SLIL). We studied the anatomy of the vascularized second metatarsal head with its lateral collateral ligament as a potential novel treatment of proximal pole scaphoid nonunion with collapse. Methods: Scaphoids and second metatarsal heads were harvested from bilateral upper and lower extremities of 18 fresh frozen cadavers (10 male, 8 female) for a total of 36 scaphoids and 36 second metatarsal heads. The ipsilateral second metatarsal head was harvested with its lateral collateral ligament and its blood supply from the second dorsal metatarsal artery (SDMA). Measurements of the scaphoid, the SLIL, the second metatarsal head, and lateral collateral ligaments were compared to matched limbs from the same cadaver. Results: The anatomic dimensions of the second metatarsal head with its lateral collateral ligament are similar to the scaphoid proximal pole and the SLIL in matched cadaveric specimen. Conclusions: This anatomic cadaver study reveals that the second metatarsal head with its associated lateral collateral ligament is a well-matched donor to reconstruct the proximal pole of the scaphoid and SLIL. This anatomic similarity may be well suited to treat nonunion of the scaphoid proximal pole with or without avascular necrosis with simultaneous reconstruction of the SLIL. The authors describe a technique of vascularized reconstruction of the osteoligamentous proximal pole of the scaphoid with its attached SLIL utilizing autologous second metatarsal head with its attached lateral collateral ligament. Based on this cadaver study, this technique merits consideration.

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Minimally Invasive Treatment of Lateral Ulnar Collateral Ligament Injury

Minimally Invasive Surgery in Orthopedics ◽

10.1007/978-3-319-34109-5_28 ◽

2016 ◽

pp. 243-253

Author(s):

Steven J. Lee ◽

Matthew Mendez-Zfass

Keyword(s):

Minimally Invasive ◽

Ulnar Collateral Ligament ◽

Minimally Invasive Treatment ◽

Ligament Injury ◽

Collateral Ligament ◽

Invasive Treatment ◽

Lateral Ulnar Collateral Ligament ◽

Ulnar Collateral Ligament Injury

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Quantitative Anatomic Analysis of the Medial Ulnar Collateral Ligament Complex of the Elbow

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118762751 ◽

2018 ◽

Vol 6 (3) ◽

pp. 232596711876275 ◽

Cited By ~ 13

Author(s):

Christopher L. Camp ◽

Hamidreza Jahandar ◽

Alec M. Sinatro ◽

Carl W. Imhauser ◽

David W. Altchek ◽

...

Keyword(s):

Surface Area ◽

Ulnar Collateral Ligament ◽

Surgical Reconstruction ◽

Collateral Ligament ◽

3 Dimensional ◽

Visual Center ◽

Bony Landmarks ◽

Fresh Frozen ◽

Detailed Assessment ◽

The Mean

Background: A more detailed assessment of the anatomy of the entire medial ulnar collateral ligament complex (MUCLC) is desired as the rate of medial elbow reconstruction surgery continues to rise. Purpose: To quantify the anatomy of the MUCLC, including the anterior bundle (AB), posterior bundle (PB), and transverse ligament (TL). Study Design: Descriptive laboratory study. Methods: Ten unpaired, fresh-frozen cadaveric elbows underwent 3-dimensional (3D) digitization and computed tomography with 3D reconstruction. Ligament footprint areas and geometries, distances to key bony landmarks, and isometry were determined. A surgeon digitized the visual center of each footprint, and this location was compared with the geometric centroid calculated from the outline of the digitized footprint. Results: The mean surface area of the AB was 324.2 mm2, with an origin footprint of 32.3 mm2 and an elongated insertional footprint of 187.6 mm2 (length, 29.7 mm). The mean area of the PB was 116.6 mm2 (origin, 25.9 mm2; insertion, 15.8 mm2), and the mean surface area of the TL was 134.5 mm2 (origin, 21.2 mm2; insertion, 16.7 mm2). The geometric centroids of all footprints could be predicted within 0.8 to 1.3 mm, with the exception of the AB insertion centroid, which was 7.6 mm distal to the perceived center at the apex of the sublime tubercle. While the PB remained relatively isometric from 0° to 90° of flexion ( P = .606), the AB lengthened by 2.2 mm ( P < .001). Conclusion: Contrary to several historical reports, the insertional footprint of the AB was larger, elongated, and tapered. The TL demonstrated a previously unrecognized expansive soft tissue insertion directly onto the AB, and additional analysis of the biomechanical contribution of this structure is needed. Clinical Relevance: These findings may serve as a foundation for future study of the MUCLC and help refine current surgical reconstruction techniques.

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