Effect of Olecranon Resection on Joint Stability and Strain of the Medial Ulnar Collateral Ligament

Abstract

This study aimed to assess the effect of posteromedial olecranon resection on the stability of the elbow joint, forearm kinematics, and strain in the anterior bundle of the medial ulnar collateral ligament. Seven elbows were tested after resecting all soft tissues except the capsuloligamentous structures. Varus-valgus angulation, forearm rotation, and the length of the anterior bundle of the medial ulnar collateral ligament were measured at 3 posteromedial olecranon resection stages of 0, 4, and 8 mm, and at elbow flexion angles of 30°, 60°, and 90°. Posteromedial olecranon resection significantly increased varus and valgus laxities at 60° and 90° of elbow flexion but had a larger effect on varus motion than valgus movement. With more posteromedial olecranon resection, the valgus angulation and varus-valgus laxity proportionally increased. In most cases, parallel resections of the posteromedial olecranon significantly decreased the functional varus-valgus stiffness. There was no significant effect on strain in the anterior bundle of the medial ulnar collateral ligament due to olecranon resection. When treating an overhead athlete with posteromedial olecranon impingement, the resection should be limited to osteophytic overgrowth. Throwers may be susceptible to ulnar collateral ligament injury following posteromedial olecranon resection due to increased elbow laxity.

Posteromedial Osteophyte Resection in Baseball Players Undergoing Ulnar Collateral Ligament Reconstruction Has no Effect on Return to Play but Decreases Patient-Reported Satisfaction and Throwing Control

“…It is also possible that the adaptive change theory may again be at play, with athletes feeling less satisfied because of removal of adaptive posterior compartment osteophytes. 12 , 13 , 18 , 19 , 20 Ultimately, postoperative PROs were largely the same between the two groups. Despite having identical protocols, two of the PI group athletes mentioned the rehabilitation process as the reason why they would not re-elect for the procedure; thus, patient dissatisfaction may have been secondary to difficulties with rehabilitation rather than the procedure itself.…”

“…Some authors argue that posterior compartment osteophytes, secondary to olecranon fossa shearing, may be adaptive changes to the thrower’s elbow, and that arthroscopic resection may destabilize the elbow. 12 , 13 , 18 , 19 , 20 Kamineni et al., indeed, demonstrated that excessive resection of posteromedial osteophytes leads to increased translation of the olecranon during elbow motion and a resultant increase in strain on the anterior bundle of the UCL. 12 , 13 While there was no difference in mean KJOC or Andrews-Timmerman scores in our analysis, there was a higher mean KJOC-Control score in the no impingement group (9.11 ± 1.32 vs 7.65 ± 2.40; P = .04), which may be explained by this destabilization theory following resection of posteromedial osteophytes.…”

MRI–Arthroscopy Correlation of the Elbow: A Primer for Radiologists

“…10). It is crucial to only resect the osteophyte, since with excessive bone resection, there is potential for developing elbow instability and subsequent ulnar collateral ligament (UCL) tear [10,11].…”