title: Biomechanical testing of the reconstructed ulnar collateral ligament: a systematic review of the literature.
abstract: OBJECTIVE
  The purpose was to perform a systematic review of the literature investigating biomechanical studies of ulnar collateral ligament reconstruction (UCLR) techniques to summarize the most commonly analyzed methods of fixation (at both the ulna and humerus), the degree of elbow flexion at the time of fixation, graft characteristics, and modes of failure with these techniques.
  
  
  METHODS
  A systematic review was performed. All cadaveric biomechanical studies that tested a reconstruction method for UCLR were included. Descriptive statistics were calculated for each study and parameter/variable analyzed.
  
  
  RESULTS
  Twenty-three studies were included with a total of 397 elbows in 242 cadavers (mean age 54.8 ± 20 years, range 16-96). The majority of studies (65 %) used a palmaris longus graft. The docking technique (37.2 %) was the most commonly tested reconstruction method. Significant heterogeneity between studies precluded assimilation of specific techniques (each of the 23 studies utilized a unique technique). Fixation was performed at 30°-90° of elbow flexion. The most common mode of failure was suture failure (51 %), followed by midsubstance rupture (27.00 %), and bone tunnel fracture (14.00 %). No significant differences were observed amongst techniques for all measures analyzed.
  
  
  CONCLUSIONS
  This study found the docking technique to be the most commonly tested technique, while the mode of reconstruction failure was most commonly at the suture interface. If the graft failed at the bone interface, it was most likely to occur at the ulna. Surgeon preference and comfort level with a specific technique should dictate choice.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA. bryan.m.saltzman@gmail.com.
authors.forename: B M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Division of Sports Medicine, The Steadman Clinic, 181 W Meadow Dr., Vail, CO, 81657, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Frank
authors.affiliation: Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6550 Fannin, Smith Tower, Suite 2500, Houston, TX, 77030, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Harris
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Nicholson
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Bach
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
authors.forename: N N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL, 60612, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D000070637:Collateral Ligament, Ulnar / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D012307:Risk Factors; D012421:Rupture / Q000601:surgery; D019737:Transplants
keywords: Biomechanical; Elbow; Systematic review; Tommy John; Ulnar collateral ligament (UCL); Ulnar collateral ligament reconstruction (UCLR)