Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation.
OBJECTIVE
The purpose of this study was to perform biomechanical testing of annular ligament (AL) reconstruction using the superficial head of the brachialis tendon (SHBT) as a distally based tendon graft. We hypothesized that posterior translation of the radial head following AL reconstruction with an SHBT graft does not significantly differ from intact specimens.


METHODS
Six fresh-frozen elbow specimens were used. The stability of the radial head against posterior translation forces (30 N) was evaluated in 0°, 45°, 90° and 120° of elbow flexion. Posterior translation was obtained for the intact AL, the sectioned AL and the reconstructed AL. Cyclic loading (100 cycles) in 90° of elbow flexion was performed for the intact and the reconstructed AL.


RESULTS
Posterior translation of the radial head decreased during elbow flexion in native specimens. Sectioning of the AL significantly increased instability over the full range of motion. AL reconstruction with the SHBT restored the stability of the proximal radius but-other than the native AL-was not influenced by elbow flexion. In 120° of flexion the native AL provided significantly more stability when compared to the reconstructed AL. Cyclic loading did not provide significant differences between native and reconstructed specimens.


CONCLUSIONS
We provide a feasible technique for AL reconstruction using the SHBT. The biomechanical results obtained in this study confirm the efficacy of the procedure. AL reconstruction restores the stability of the proximal radius, yet it cannot fully mimic the complex features of the intact AL.
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. michael.hackl@uk-koeln.de.|Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany. michael.hackl@uk-koeln.de.
Michael
http://orcid.org/0000-0002-6183-5621
M
Hackl
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany.
Kilian
K
Wegmann
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany.
Christian
C
Ries
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany.
Sebastian
S
Lappen
Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany.|Department of Anatomy II, University of Cologne, Cologne, Germany.
Martin
M
Scaal
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Cologne Center for Musculoskeletal Biomechanics, University of Cologne, Cologne, Germany.
Lars Peter
LP
Müller
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D004550:Elbow / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D011884:Radius / Q000033:anatomy & histology / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*
Annular ligament; Brachialis tendon; Ligament reconstruction; Monteggia fracture; Superficial head