Articular and ligamentous contributions to the stability of the elbow joint

Abstract

This preliminary study of four elbow specimens investigates the relationship of articular geometry and ligamentous structures in providing stability to the elbow joint. A technique is presented that describes the constraining features of varus-valgus and distraction in extension and at 90 degree of elbow flexion. Valgus stability is equally divided among the medial collateral ligament, anterior capsule, and bony articulation in full extension; whereas, at 90 degrees of flexion the contribution of the anterior capsule is assumed by the medial collateral ligament which provides approximately 55% of the stabilizing contribution to valgus stress. Varus stress is noted to be resisted primarily by the anterior capsule (32%) and the joint articulation (55%) with only a small (14%) contribution from the radial collateral ligament. At 90 degrees of flexion, little change is noted in the contribution to the radial collateral ligament (9%), but the anterior capsule offers only 13%, with the remaining stability (75%) arising from the joint articulation. In extension, the soft tissue resistance to distraction is provided minimally by either the radial (5%) or the medial (5%) collateral ligaments, and thus primarily originates from the anterior capsule (85%). At 90 degrees of flexion, however, the capsule offers virtually no resistance to distraction (8%). The radial collateral ligament contributes 10% of the stability, while the medial collateral ligament accounts for 78% of the resistance to distraction in this position. Too few specimens have been studied to form any conclusions for direct clinical applications at this time. However, the technique provides a reliable tool with additional studies for different positions and loading conditions underway. These efforts should disclose useful information that might be applied to the management of chronic elbow instability, radial head or olecranon fracture, the design and implantation of elbow prostheses, or provide a rationale for other reconstructive procedures.

Current Concepts Review

“…Biomechanical and kinematic studies have demonstrated the important role of the radial head and of the soft tissues in the proper functioning of the elbow joint (6,17,22,29,37,38,48,51,61,62,63,66,89). Experimental research conducted on human cadaver elbows has shown that, unlike silicone radial head prostheses, metal and plastic radial head implants can assure axial and valgus stability (12,29,32,51,52).…”

“…Clinical (32,40,59,71,80,84) and experimental studies (2,12,20,37,51,63,66) have demonstrated associated complications after radial head resections, such as proximal migration of the radius, elbow instability, wrist problems and altered elbow kinematics.…”

“…In a next stage, Morrey and An (63) and Schwab et al (73) demonstrated the important role of the aMCL in resisting valgus forces on the elbow in 90°flexion. In extension however, the role of the anterior capsule, the bony contours of the joint and the medial collateral ligament appeared to be equivalent.…”

“…In order to gain a clearer understanding of the consequences of radial head resections (1,18,32,59,71,84) (elbow instability, radiocapitellar joint contact loss, proximal migration of the radius) in comminuted radial head fractures, research was carried out on human cadaver elbows in order to examine the function of the radial head (31,51,63,64,66) and the role of the anterior band of the medial collateral ligament (aMCL), the interosseous membrane (MI) and the triangular fibrocartilaginous complex (TFCC) (20,37,38,66,70,74,75).…”

“…It can be concluded that the radial head as well as different ligamentous structures are extremely important for normal functioning of the elbow (17,22,29,37,38,51,61,62,63,66,89). (73,74).…”