title: Effect of ulnar tunnel location on elbow stability in double-strand lateral collateral ligament reconstruction.
abstract: BACKGROUND
  Double-strand lateral ulnar collateral ligament (LUCL) reconstruction is an effective treatment for posterolateral rotatory instability (PLRI) of the elbow, but anatomic landmarks for ulnar tunnel placement are often difficult to identify intraoperatively, which potentially can result in a nonanatomic LUCL reconstruction. This study investigated the effect of ulnar tunnel location on joint stability in double-strand LUCL reconstruction.
  
  
  METHODS
  PLRI was artificially created in 7 cadaveric elbows, and double-strand LUCL reconstruction was performed. Five different ulnar tunnels were made along the length of the ulna. In each specimen, each possible pair of 2 tunnels (10 total) were used for graft passage. Varus and posterolateral joint gapping was measured after joint loading using a 3-dimensional digitizer system and X-ray image intensifier.
  
  
  RESULTS
  No significant gapping was observed at the posterolateral ulnohumeral joint regardless of the location of the ulnar tunnels (P > .05). In contrast, the lateral radiocapitellar joint showed statistically significant varus gapping when both ulnar tunnels were placed proximal to the radial head-neck junction (P < .05).
  
  
  CONCLUSIONS
  This findings of study suggest that the location of the ulnar tunnels may not be as critical as that of the humeral tunnel during double-strand LUCL reconstruction and that posterolateral rotatory elbow stability can be achieved reasonably well as long as at least 1 of the 2 ulnar tunnels is located at or distal to the radial head-neck junction level.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA. Electronic address: hkim2@hmc.psu.edu.
authors.forename: H Mike
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Andrews
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Roush
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Pace
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Lewis
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D002102:Cadaver; D000070637:Collateral Ligament, Ulnar / Q000293:injuries / Q000601:surgery*; D004551:Elbow Joint / Q000502:physiology / Q000601:surgery; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000092464:Elbow Injuries
keywords: Lateral ulnar collateral ligament reconstruction; docking technique; double-strand; elbow stability; posterolateral rotatory instability; ulnar tunnels