title: Reconstruction of the lateral ulnar collateral ligament of the elbow: a comparative biomechanical study.
abstract: OBJECTIVE
  Posterolateral rotatory instability (PLRI) of the elbow is the result of an insufficient lateral collateral ligament complex (LCLC). Single-bundle reconstruction of the lateral ulnar collateral ligament (LUCL) represents the standard treatment method for chronic PLRI. However, cases of recurrent instability after LUCL reconstruction have been reported. The dual-reconstruction procedure has been described to anatomically restore the LUCL as well as the radial collateral ligament (RCL). It was hypothesized that anatomic reconstruction of the LCLC provides increased stability compared with the conventional technique.
  
  
  METHODS
  Posterolateral rotatory displacement was assessed in eight fresh-frozen human elbows with a maximum load of 20 N. Data were obtained in 0°, 30°, 60°, 90° and 120° of elbow flexion for native specimens, dissected LCLC and three reconstruction methods: (1) single-bundle LUCL reconstruction, (2) single-bundle LUCL reconstruction with RCL augmentation, (3) dual-reconstruction technique (LUCL + RCL).
  
  
  RESULTS
  All reconstruction methods were able to sufficiently restore posterolateral rotatory stability of the elbow over the full range of motion. There were no significant differences between the intact specimens and either reconstruction method. Dissection of the LCLC significantly increased PLRI compared with the other groups (p < 0.001).
  
  
  CONCLUSIONS
  The less invasive dual-reconstruction technique is confirmed as a safe procedure for anatomic LCLC reconstruction. Primary stability is equal, yet not superior to conventional LUCL reconstruction. Hence, this biomechanical study does not confirm the hypothesis that more anatomic reconstruction techniques could reduce the risk of recurrent instability when compared to conventional LUCL reconstruction.
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Dargel
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Boomkamp
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Kilian
authors.initials: K
authors.lastname: Wegmann
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Müller
authors.affiliation: Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany. michael.hackl@uk-koeln.de.|Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany. michael.hackl@uk-koeln.de.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-6183-5621
authors.initials: M
authors.lastname: Hackl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D000070637:Collateral Ligament, Ulnar / Q000601:surgery*; D017885:Collateral Ligaments / Q000601:surgery*; D004210:Dissection; D004551:Elbow Joint / Q000502:physiology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular; D012008:Recurrence
keywords: Biomechanical analysis; Dual-reconstruction; LUCL reconstruction; Lateral collateral ligament; Lateral ulnar collateral ligament; Posterolateral rotatory instability