Biomechanical comparison of ulnar collateral ligament reconstruction techniques

Robert T. Ruland, Christopher J. Hogan, Craig J. Randall, Andrew Richards, Stephen M. Belkoff

Research output: Contribution to journalArticle

Abstract

Background: Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques. Hypothesis: Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be bio-mechanically superior to previously reported techniques. Study Design: Controlled laboratory study. Methods: Thirty cadaveric elbows were stripped of all medial soft tissue superficial to the UCL. The proximal humeri were mounted on a materials testing system with the elbows flexed 90°. The intact UCL was loaded to failure at 4.5 deg/s. The torsional failure moment, torsional stiffness, and mode of failure were recorded. Three groups of 10 specimens were created. Group 1 underwent reconstruction using a palmaris tendon graft secured with interference knot fixation. Group 2 reconstructions utilized a palmaris graft and the docking technique. Group 3 specimens were reconstructed using a semitendinosus graft and interference knot fixation. All specimens were loaded to failure and the same parameters recorded. Results: The torsional failure moments for group 1 (13.28 N·m) and group 2 (12.81 N·m) reconstructions were significantly (P <.05) inferior to that of their respective native values (21.3 N·m and 23.5 N·m). Semitendinosus reconstructions (20.5 N·m) were not significantly different (P =.24) from their native UCLs (23.0 N·m). All reconstructions were torsionally less stiff (P <.001) than the native UCL. There were no statistically significant differences in stiffness between the groups (P =.4). Conclusion: Ulnar collateral ligament reconstruction utilizing semitendinosus graft and interference knot fixation restores the torsional strength of the intact UCL. Clinical Relevance: Reconstructions using semitendinosus grafts may allow for accelerated rehabilitation and earlier return to competition.

Original languageEnglish (US)
Pages (from-to)1565-1570
Number of pages6
JournalAmerican Journal of Sports Medicine
Volume36
Issue number8
DOIs
StatePublished - Aug 1 2008

Keywords

  • Biomechanics
  • Elbow instability
  • Interference knot
  • Ulnar collateral ligament reconstruction

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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  • Cite this

    Ruland, R. T., Hogan, C. J., Randall, C. J., Richards, A., & Belkoff, S. M. (2008). Biomechanical comparison of ulnar collateral ligament reconstruction techniques. American Journal of Sports Medicine, 36(8), 1565-1570. https://doi.org/10.1177/0363546508319360