Effect of Distal Ulnar Collateral Ligament Tear Pattern on Contact Forces and Valgus Stability in the Posteromedial Compartment of the Elbow

Hassan, Sheref E.; Parks, Brent G.; Douoguih, Wiemi A.; Osbahr, Daryl C.

doi:10.1177/0363546514557239

Cited by 16 publications

(11 citation statements)

References 22 publications

(43 reference statements)

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“…In these scenarios, the presence of periligamentous edema is a useful secondary sign of the presence of a tear. Within the spectrum of partial tears, those of the proximal attachment have a more significant impact on posteromedial elbow biomechanics (21,23).…”

Section: Ulnar Collateral Ligamentmentioning

confidence: 99%

Elbow Imaging in Sport: Sports Imaging Series

2016

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Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.

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Section: Ulnar Collateral Ligamentmentioning

confidence: 99%

Elbow Imaging in Sport: Sports Imaging Series

2016

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“…Previous studies demonstrated that the anterior bundle of the MCL (AMCL) was the primary restraint to valgus stress ( Morrey and An, 1983 ; Hassan et al, 2015 ; Frangiamore et al, 2017 ), the posterior bundle of the MCL (PMCL) could resist motion of the humero-ulnar joint ( Shukla et al, 2016 ), and the transverse bundle of the MCL had little effect on maintaining medial stability ( Morrey and An, 1983 ). Based on the importance of AMCL, many alternative reconstruction techniques for the role of AMCL had been proposed ( Rohrbough et al, 2002 ; Paletta and Wright, 2006 ; Schwartz et al, 2008 ; Cain et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Xiong

Chen

et al. 2022

Front. Bioeng. Biotechnol.

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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.

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“…Elbow joint contact patterns have been considered to reflect pathological conditions such as UCL tears 7 . Based on this theory, Bey et al reported that joint contact patterns are not only a more sensitive measurement than conventional kinematics for detecting subtle differences in joint function but they may also provide a more clinically relevant indication of the extent to which a conservative approach or a surgical procedure has adequately restored normal joint function 8 .…”

Section: Introductionmentioning

confidence: 99%

Changes in elbow joint contact area in symptomatic valgus instability of the elbow in baseball players

Numaguchi

Momma

Matsui

et al. 2021

Sci Rep

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The aim of this study was to evaluate the joint contact area of the dominant side and that of the non-dominant side without valgus instability in symptomatic pitchers. Ten symptomatic elbow medial ulnar collateral ligament (UCL) deficient baseball pitchers participated in this study. Computed tomography (CT) data from the dominant and non-dominant elbows were obtained with and without elbow valgus stress. The CT imaging data of each elbow joint were reconstructed using a 3D reconstruction software package, and the radiocapitellar and ulnohumeral joint contact areas were calculated. The center of the contact area and the translation from the position without stress to the position with valgus stress were also calculated. With elbow valgus stress, the contact area changed, and the center of the radiocapitellar joint contact area translated significantly more laterally in the dominant elbow than in the non-dominant elbow (p = 0.0361). In addition, the center of the ulnohumeral joint contact area translated significantly more posteriorly in the dominant elbow than in the non-dominant elbow (p = 0.0413). These changes in contact areas could be the reason for cartilage injury at the posterior trochlea in pitchers with UCL deficiency.

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Effect of Distal Ulnar Collateral Ligament Tear Pattern on Contact Forces and Valgus Stability in the Posteromedial Compartment of the Elbow

Abstract: The findings suggest that surgical reconstruction should aim to reestablish at least the proximal 50% of the UCL ulnar footprint.

Cited by 16 publications

References 22 publications

Elbow Imaging in Sport: Sports Imaging Series

Elbow Imaging in Sport: Sports Imaging Series

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

Changes in elbow joint contact area in symptomatic valgus instability of the elbow in baseball players

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