Effect of distal ulnar collateral ligament tear pattern on contact forces and valgus stability in the posteromedial compartment of the elbow.
BACKGROUND
It is not known whether the pattern of ulnar collateral ligament (UCL) tear affects elbow biomechanics.


OBJECTIVE
There will be a significant change in elbow biomechanics with 50% proximal but not 50% distal simulated rupture of the UCL.


METHODS
Controlled laboratory study.


METHODS
Pressure sensors in the posteromedial elbow joint of 25 male cadaveric elbows (average age, 54.9 years; range, 26-66 years) were used to measure contact area, pressure, and valgus torque at 90° and 30° of elbow flexion. Thirteen specimens were tested with the UCL intact, then with proximal-to-distal detachment of 50%, and then with proximal-to-distal detachment of 100% of the anterior band of the UCL from the ulnar attachment. This method was repeated in the remaining 12 specimens in a distal-to-proximal direction.


RESULTS
With 50% proximal-to-distal detachment, contact area decreased significantly versus intact at 90° (91.3 ± 23.6 vs 112.2 ± 26.0 mm(2); P < .001) and 30° (69.3 ± 14.8 vs 83.1 ± 21.6 mm(2); P < .001) of elbow flexion; the center of pressure (COP) moved significantly proximally versus intact at 90° (3.8 ± 2.5 vs 5.4 ± 2.3 mm; P < .001) and 30° (5.9 ± 2.8 vs 7.4±1.9 mm; P < .001). With 50% distal-to-proximal UCL detachment versus intact, no significant change was observed in contact area, movement of the COP, or valgus laxity at either flexion position. With 100% proximal-to-distal and distal-to-proximal detachment, significant change in contact area, movement of the COP, and valgus laxity versus intact was found at 90° and 30° of elbow flexion (P < .05). No significant difference in contact pressure was observed in any test conditions.


CONCLUSIONS
Significant change in contact area and proximal movement of the COP with 50% proximal UCL detachment and the lack of significant change with 50% distal UCL detachment suggest that the proximal half of the UCL ulnar footprint has a primary role in maintaining posteromedial elbow biomechanics.


CONCLUSIONS
The findings suggest that surgical reconstruction should aim to reestablish at least the proximal 50% of the UCL ulnar footprint.
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
Sheref E
SE
Hassan
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
Brent G
BG
Parks
Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington DC, USA.
Wiemi A
WA
Douoguih
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA lyn.camire@medstar.net.
Daryl C
DC
Osbahr
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D017885:Collateral Ligaments / Q000293:injuries*; D004550:Elbow / Q000601:surgery; D004551:Elbow Joint / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006811:Humerus / Q000503:physiopathology; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016059:Range of Motion, Articular; D012421:Rupture / Q000473:pathology / Q000503:physiopathology; D019415:Torque; D014457:Ulna / Q000503:physiopathology; D000092464:Elbow Injuries
elbow biomechanics; elbow valgus instability; throwing athlete; ulnar collateral ligament