Biomechanical Evaluation of a Low-Invasive Elbow Medial Collateral Ligament Reconstruction Technique With Fascia and Tendon Patches

Abstract

Background: Injury to the medial collateral ligament (MCL) of the elbow has become increasingly common in sports, and the elbow is prone to contracture and ossification in trauma. Effective reconstruction of the MCL with reduction of irritation to the elbow has rarely been reported. This study introduces a minimally invasive elbow MCL reconstruction technique and evaluates the valgus stability.Methods: Eight fresh-frozen elbow specimens underwent reconstruction of the anterior bundle of the MCL (AMCL) first with the flexor carpi ulnaris fascia patches, followed by reconstruction of the posterior bundle of the MCL (PMCL) with the triceps tendon patches. The valgus angles of each specimen were examined in three stages as follows: intact MCL, reconstruction of the AMCL alone, and reconstruction of the MCL (including AMCL and PMCL). Finally, specimens were loaded to failure, and failure modes were recorded.Results: AMCL reconstruction alone had similar valgus stability at all testing angles (p = 0.080, 30° flexion; p = 0.064, 60° flexion; p = 0.151, 90° flexion; p = 0.283, 120° flexion) compared with the intact MCL, as did MCL reconstruction (p = 0.951, 30° flexion; p = 0.739, 60° flexion; p = 0.841, 90° flexion; p = 0.538, 120° flexion). More importantly, a significant difference existed between the MCL reconstruction and the AMCL reconstruction alone at 30° flexion (p = 0.043) and 60° flexion (p = 0.013) but not at the 90° flexion (p = 0.369) and 120° flexion (p = 0.879). The mean maximum failure torque of MCL reconstruction was 24.02 Nm at 90° elbow flexion.Conclusion: Both AMCL reconstruction alone and MCL reconstruction provided valgus stability comparable with the native MCL, and importantly, MCL reconstruction provided more valgus stability than AMCL reconstruction alone at 30° flexion and 60° flexion of the elbow. Therefore, the new MCL reconstruction technique might be a useful guide for the treatment of elbow MCL injuries or deficiencies.

Effectiveness and safety of a less-invasive MCL reconstruction technique for contracted or ossified ligaments in patients with elbow stiffness: An open-label, non-randomised, prospective, multicentre trial in China

“…In our study, the MCL reconstruction technique consisted of three strips A, B, and C ( Figure 2 ). 21 This new MCL technique is a modification of the previous fascia reconstruction technique. 17 In the new MCL reconstruction technique, we used a longer fascia patch than before, and the fascia patch passed underneath the ulnar carpal flexor and fitted snugly over the bone surface.…”

“…Additionally, biomechanical studies confirmed that the new technique has certain advantages in maintaining elbow valgus stability. 21 Therefore, from the perspective of structural and biomechanical characteristics, we believe that the new technique has an advantage over the traditional technique in maintaining the valgus stability of the elbow.…”

“…MCL reconstruction included AMCL reconstruction with the flexor carpi ulnaris fascia patch and PMCL reconstruction with the triceps tendon patch. 21 The fascia patch was released from three sides of the muscle surface, retained on the proximal side 2 cm distal to the joint line, and fabricated to be 6 cm long, 1 cm wide, and 2 mm thick. The tendon patch was released from three sides with the distal end at the insertion and fabricated to be 3 cm long, 0·5 cm wide, and 2 mm thick.…”

“… 20 Considering the greater sensitivity of the elbow to trauma and the critical roles of AMCL and PMCL, we propose a minimally invasive anatomical reconstruction technique that has been proven to be effective by biomechanical evaluation. 21 Therefore, this study sought to investigate the clinical effectiveness and safety of the new technique to restore medial stability in patients with elbow stiffness. This study hypothesised that the new MCL reconstruction technique could effectively maintain medial stability in patients with elbow stiffness after an adequate release procedure.…”