title: Revision ulnar collateral ligament reconstruction using a suspension button fixation technique.
abstract: BACKGROUND
  Revision ulnar collateral ligament reconstruction remains a challenging problem. The objective of this study was to biomechanically evaluate an ulnar collateral ligament reconstruction technique using a suspension button fixation technique that can be used even in the case of ulnar cortical bone loss.
  
  
  OBJECTIVE
  An ulnar suspension fixation technique for ulnar collateral ligament reconstruction can restore elbow kinematics and demonstrate failure strength comparable to that of currently available techniques.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Nine pairs of cadaveric elbows were dissected free of soft tissue and potted. After simulating ulnar cortical bone loss, ulnar collateral ligament reconstruction was performed in 1 elbow of each pair using palmaris longus autograft and a 30-mm RetroButton suspended from the far (lateralmost) ulnar cortex. A docking technique was used for humeral fixation of the graft. Elbow valgus angle was quantified using a Microscribe 3DLX digitizer at multiple elbow flexion angles. Valgus angle was measured with the ulnar collateral ligament intact, transected, and reconstructed. In addition, load-to-failure testing was performed in 1 elbow of each pair.
  
  
  RESULTS
  Release of the ulnar collateral ligament caused a significant increase in valgus angle at each flexion angle tested (P < .002). Reconstructed elbows demonstrated no significant differences in valgus angle from the intact elbow at all flexion angles tested. Load-to-failure tests showed that reconstructed elbows had an ultimate torque (10.3 + or - 5.7 N x m) significantly less than intact elbows (26.4 + or - 10.6 N x m) (P = .001).
  
  
  CONCLUSIONS
  Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. Load-to-failure testing demonstrated comparable fixation strength to several historic controls of primary reconstruction techniques despite the simulated ulnar cortical bone loss.
  
  
  CONCLUSIONS
  Ulnar collateral ligament reconstruction using a suspension button fixation technique can be considered in the case of ulnar cortical bone loss in a primary or revision setting.
authors.affiliation: Atlanta Knee and Shoulder Clinic, Atlanta, GA, USA. gleenwuedu@hotmail.com
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Lee
authors.forename: Orr
authors.initials: O
authors.lastname: Limpisvasti
authors.forename: Maxwell C
authors.initials: MC
authors.lastname: Park
authors.forename: Michelle H
authors.initials: MH
authors.lastname: McGarry
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Yocum
authors.forename: Thay Q
authors.initials: TQ
authors.lastname: Lee
mesh_terms: D000328:Adult; D001862:Bone Resorption / Q000601:surgery; D002102:Cadaver; D017885:Collateral Ligaments / Q000601:surgery*; D004550:Elbow / Q000502:physiology; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D019415:Torque; D014182:Transplantation, Autologous / Q000379:methods; D014457:Ulna / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries