scholarly journals The Middle and Distal Aspects of the Ulnar Footprint of the Medial Ulnar Collateral Ligament of the Elbow Do Not Provide Significant Resistance to Valgus Stress: A Biomechanical Study

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882529 ◽  
Author(s):  
Brandon J. Erickson ◽  
Michael Fu ◽  
Kate Meyers ◽  
Christopher L. Camp ◽  
David W. Altchek ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Biomechanical Study ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
3 Dimensional ◽  
The Sublime ◽  
Intact Condition ◽  
Load Frame ◽  
Distal Aspect ◽  
Joint Gapping

Background: The medial ulnar collateral ligament (UCL) insertion of the elbow has been shown to extend distally beyond the sublime tubercle. The contribution to valgus stability of the distal aspect of the footprint is unknown. Purpose/Hypothesis: The purpose of this study was to determine the contribution of each part of the UCL footprint to the elbow valgus stability provided by the UCL. It was hypothesized that the distal two-thirds of the ulnar UCL footprint would not contribute significantly to valgus stability provided by the UCL. Study Design: Descriptive laboratory study. Methods: Fifteen cadaveric arms were dissected to the capsuloligamentous elbow structures and potted. A servohydraulic load frame was used to place 5 N·m of valgus stress on the intact elbow at 30°, 60°, 90°, and 120° of flexion. The UCL insertional footprint was measured and divided into thirds (proximal, middle, and distal). One-third of the UCL footprint was elevated off the bone (leaving the ligament in continuity), and the elbow was retested at the same degrees of flexion. This was repeated until the entire UCL footprint on the ulna was sectioned. Each elbow was randomized for how the UCL would be sectioned (sectioning the proximal, then middle, and then distal third or sectioning the distal, then middle, and then proximal third). Ulnohumeral joint gapping (millimeters) was recorded with a 3-dimensional motion capture system using physical and virtual markers. Two-group comparisons were made between each sectioned status versus the intact condition for each flexion angle. Results: When the UCL was sectioned from distal to proximal, none of the ligaments failed prior to complete sectioning. When the UCL was sectioned from proximal to distal, 3 of the 6 ligaments failed after sectioning of the proximal third, while 2 more failed after the proximal and middle thirds were sectioned. Of the specimens with the distal third of the ligament sectioned first, no significant differences were found between intact, distal third cut, and distal plus middle thirds cut at all flexion angles. Conclusion: The middle and distal thirds of the insertional footprint of the UCL on the ulna did not significantly contribute to gap resistance at 5 N·m of valgus load. The proximal third of the footprint is the primary resistor of valgus load. Clinical Relevance: This cadaveric biomechanical study demonstrated that the middle and distal thirds of the native UCL insertion onto the ulna did not significantly contribute to valgus resistance at the elbow. When a UCL reconstruction is performed, the proximal third of the UCL insertion may be the most clinically important portion of the ligament to reconstruct.

The moving valgus stress test produces more ulnar collateral ligament change in length during extension than during flexion: a biomechanical study

2020 ◽  
Vol 29 (6) ◽  
pp. 1230-1235
Author(s):  
Michael D. Wigton ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
Mark Carl Miller ◽  
Darren A. Frank ◽  
...  
Keyword(s):  
Stress Test ◽  
Ulnar Collateral Ligament ◽  
Biomechanical Study ◽  
Collateral Ligament ◽  
Valgus Stress

Qualitative and Quantitative Analyses of the Dynamic and Static Stabilizers of the Medial Elbow: An Anatomic Study

2017 ◽  
Vol 46 (3) ◽  
pp. 687-694 ◽  
Author(s):  
Salvatore J. Frangiamore ◽  
Gilbert Moatshe ◽  
Bradley M. Kruckeberg ◽  
David M. Civitarese ◽  
Kyle J. Muckenhirn ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Medial Epicondyle ◽  
Valgus Stress ◽  
Measuring Device ◽  
3 Dimensional ◽  
Qualitative And Quantitative ◽  
The Sublime ◽  
Bony Landmarks ◽  
Fresh Frozen ◽  
The Difference

Background: The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide primary static and dynamic stability to valgus stress of the elbow in overhead-throwing athletes. Quantitative anatomic relationships between the dynamic and static stabilizers have not been described. Purpose: To perform qualitative and quantitative anatomic evaluations of the medial elbow-UCL complex with specific attention to pertinent osseous and soft tissue landmarks. Study Design: Descriptive laboratory study. Methods: Ten nonpaired, fresh-frozen human cadaveric elbows (mean age, 54.1 years [range, 42-64 years]; all male) were utilized for this study. Quantitative analysis was performed with a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks and tendon and ligament footprints on the humerus, ulna, and radius. Results: The anterior bundle of the UCL attached 8.5 mm (95% CI, 6.9-10.0) distal and 7.8 mm (95% CI, 6.6-9.1) lateral to the medial epicondyle, 1.5 mm (95% CI, 0.5-2.5) distal to the sublime tubercle, and 7.3 mm (95% CI, 6.1-8.5) distal to the joint line on the ulna along the ulnar ridge. The flexor digitorum superficialis (FDS) ulnar tendinous insertion was closely related and interposed within the anterior bundle of the UCL, overlapping with 45.6% (95% CI, 38.1-53.6) of the length of the anterior bundle of the UCL. The flexor carpi ulnaris (FCU) attached 1.9 mm (95% CI, 0.8-2.9) posterior and 1.3 mm (95% CI, 0.6-3.2) proximal to the sublime tubercle and overlapped with 20.9% (95% CI, 7.2-34.5) of the area of the distal footprint of the anterior bundle of the UCL. Conclusion: The anterior bundle of the UCL had consistent attachment points relative to the medial epicondyle and sublime tubercle. The ulnar limb of the FDS and FCU tendons demonstrated consistent insertions onto the ulnar attachment of the anterior bundle of the UCL. These anatomic relationships are important to consider when evaluating distal UCL tears both operatively and nonoperatively. Excessive stripping of the sublime tubercle should be avoided during UCL reconstruction to prevent violation of these tendinous attachments. Clinical Relevance: The findings of this study enhance the understanding of valgus restraint in throwing athletes and provide insight into the difference in nonoperative outcomes between proximal and distal tears of the UCL.

scholarly journals Relationship between ulnar collateral ligament thickness and joint hypermobility in young adults

2021 ◽  
Vol 2 (2) ◽  
pp. 24-29
Author(s):  
Peter R. Reuter ◽  
Arie J. van Duijn ◽  
Kaylee R. Fichthorn ◽  
Lacy Mroz
Keyword(s):  
Undergraduate Students ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Joint Hypermobility ◽  
Ultrasound Images ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Cross Sectional ◽  
Significant Difference ◽  
Joint Gapping

Joint hypermobility is largely understood as a dysfunction of collagen fibers within connective tissues, allowing for a range of motion markedly increased over validated normal values. The ulnar collateral ligament (UCL) of the elbow provides stability to the elbow during valgus stress and, thus, has great significance in overhead throwing sports due to its susceptibility to injury. Our cross-sectional study explored the relationship between the length and width of the anterior bundle of the ulnar collateral ligament of the elbow and joint hypermobility. Two hundred and eighty-four undergraduate students completed a Beighton score assessment. Ultrasound images of the participants’ UCL were obtained in both arms at rest and under gravity induced valgus force. Sixty-one participants reported hypermobility in at least one elbow joint, and hypermobility in one elbow joint was correlated with hypermobility in the other. There were moderate correlations between UCL thickness and joint gapping between left and right elbow joints. However, there was no significant difference in UCL anterior bundle thickness or medial elbow joint gapping at rest or under valgus stress between those with and without hypermobile elbow joints. The thickness of the anterior bundle of the UCL and humeroulnar joint gap at rest moderately correlates to corresponding thickness and width under valgus stress. There is no significant difference in UCL anterior bundle thickness or joint width in people with elbow hypermobility and those without.

The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study

2019 ◽  
Vol 47 (12) ◽  
pp. 2827-2835
Author(s):  
Ranita H.K. Manocha ◽  
James A. Johnson ◽  
Graham J.W. King
Keyword(s):  
Medial Collateral Ligament ◽  
Muscle Activation ◽  
Mechanical Stability ◽  
Biomechanical Study ◽  
Return To Play ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Active Motion ◽  
Early Return

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2020 ◽  
Vol 48 (11) ◽  
pp. 2613-2620
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammoud ◽  
Christopher C. Dodson ◽  
Steven B. Cohen ◽  
Levon N. Nazarian ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Diagnostic Modality ◽  
Partial Tear ◽  
Partial Tears ◽  
Early Reconstruction ◽  
Anterior Posterior

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic “T-sign.” Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

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

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876275 ◽  
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.

Comparison of the Biomechanical Profile of the Intact Ulnar Collateral Ligament with the Modified Jobe and the Docking Reconstructed Elbow

2009 ◽  
Vol 37 (5) ◽  
pp. 974-981 ◽  
Author(s):  
Michael G. Ciccotti ◽  
Sorin Siegler ◽  
John A. Kuri ◽  
John H. Thinnes ◽  
Daniel J. Murphy
Keyword(s):  
Degrees Of Freedom ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Anterior Portion ◽  
Reconstructive Procedures ◽  
Kinematic Coupling ◽  
Loading System ◽  
4 Degrees Of Freedom

Background The modified Jobe and Docking techniques are commonly used to reconstruct the elbow's ulnar collateral ligament. Hypothesis Valgus laxity and kinematic coupling after these reconstructive procedures are similar to those of the native ulnar collateral ligament. Study Design Controlled laboratory study. Methods Testing was conducted on 10 pairs of cadaver elbows using a 4 degrees of freedom loading system. Subfailure valgus loads were applied to the native elbows at different flexion angles; motion and ligament elongation were measured. The elbows were then loaded to failure in valgus at 90° of flexion. The reconstructive techniques were then applied and testing was repeated. Results Only the resting length of the anterior portion of the ulnar collateral ligament anterior bundle remained isometric throughout range of motion. Valgus laxity was nearly equal for the native and reconstructed ligaments at flexion angles of 90° or higher. However, both reconstructions provided less valgus stability than the native ulnar collateral ligament at low flexion angles. Kinematic coupling decreased with increased flexion for both native and reconstructed ligaments. Conclusion The modified Jobe and Docking techniques reconstruct restraint of the native ulnar collateral ligament to valgus laxity and kinematic coupling at 90° of flexion and higher angles where peak valgus torque is experienced in the throwing elbow. Clinical Relevance Both reconstructions provide valgus stability comparable to that of the native ulnar collateral ligament at 90° and higher, helping to explain their success in treating throwing athletes. Both reconstructions provide less valgus stability than the native ulnar collateral ligament at low flexion angles, suggesting that patients undergoing ulnar collateral ligament reconstruction should be cautioned against activities that provide valgus stress at low elbow flexion angles, such as side-arm throwing. This study suggests caution against overtightening the reconstructions at the common 30° of flexion.

scholarly journals Elbow valgus stability of the transverse bundle of the ulnar collateral ligament

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Hirotake Yokota ◽  
Ryo Hirabayashi ◽  
Chie Sekine ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Load Condition ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Limb Position ◽  
Intact State ◽  
Significant Difference ◽  
Telos Stress Device

Abstract Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.

Sign in / Sign up

Export Citation Format

Share Document