title: The medial collateral ligament of the elbow is not isometric: an in vitro biomechanical study.
abstract: BACKGROUND
  The anterior bundle of the medial collateral ligament (AMCL) of the elbow has been shown to be the most important valgus stabilizer of the elbow. However, the isometry of this band has not been quantified.
  
  
  OBJECTIVE
  Isometric fibers exist within the AMCL, and these fibers are located within its central region.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Twelve cadaveric elbow specimens were mounted in a testing apparatus in a valgus gravity-loaded orientation. Passive supinated flexion was performed and the motion recorded using an electromagnetic tracking device. Hundreds of attachment points for the AMCL of the elbow were recorded on the medial epicondyle and ulna. The overall change in length between each point on the ulna to every humeral point, throughout the arc of motion, was quantified (DeltaL = Lmax - Lmin). The locations of the smallest DeltaL values were determined relative to the attachment site of the AMCL on the medial epicondyle.
  
  
  RESULTS
  True isometry was not found throughout the arc of flexion. The smallest DeltaL values averaged 2.8 +/- 1.2 mm (range: 0.7 mm to 5.2 mm). Isometric fibers do not exist within the AMCL; however, "nearly" isometric areas are located on the lateral aspect of the attachment site of the AMCL on the medial epicondyle, near the anatomic axis of rotation.
  
  
  CONCLUSIONS
  We postulate that these nearly isometric areas would be the most ideal location for graft attachment during reconstruction of the AMCL.
authors.affiliation: Bioengineering Research Laboratory, Hand and Upper Limb Centre, Lawson Research Institute, St. Joseph's Health Care London, London, Ontario, Canada.
authors.forename: April D
authors.initials: AD
authors.lastname: Armstrong
authors.forename: Louis M
authors.initials: LM
authors.lastname: Ferreira
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Dunning
authors.forename: James A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D017885:Collateral Ligaments / Q000502:physiology*; D004551:Elbow Joint / Q000502:physiology*; D006801:Humans; D066298:In Vitro Techniques; D016018:Least-Squares Analysis; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000502:physiology*