The lateral ulnar collateral ligament: Anatomical and structural study for clinical application in the diagnosis and treatment of elbow lateral ligament injuries

Abstract

The lateral ulnar collateral ligament (LUCL) is considered one of the main stabilizers of the elbow. However, its anatomical description is not well established. Imaging techniques do not always have agreed upon parameters for the study of this ligament. Therefore, herein, we studied the macro and microanatomy of the LUCL to establish its morphological and morphometric characteristics more precisely. Fifty‐five fresh‐frozen human elbows underwent dissection of the lateral collateral ligament. Morphological characteristics were studied in detail. Ultrasound (US) and magnetic resonance (MR) were done before dissection. Two specimens were selected for PGP 9.5 S immunohistochemistry. Ten additional elbows were analyzed by E12 sheet plastination. LUCL was identified in all specimens and clearly defined by E12 semi‐thin sections. It fused with the common extensor tendon and the radial ligament. The total length of the LUCL was 48.50 mm at 90°, 46.76 mm at maximum flexion and 44.10 mm at complete extension. Three morphological insertion variants were identified. Both US and MR identified the LUCL in all cases. It was hypoechoic in the middle and distal third in 85%. The LUCL was hypointense on MR in 95%. Free nerve endings were present on histology. The LUCL is closely related to the anular ligament. It is stretched during flexion and supination. US and MR can reliably identify its fibers. Anatomical data are relevant to the surgeon who repairs the ligaments of the elbow. Also, to the radiologist and pain physician who interpret imaging and treat patients with pain syndromes of the elbow.

A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity

“…Moreover, it is a very useful and inexpensive diagnostic tool to evaluate soft tissue integrity, particularly in lateral epicondylitis, with a reported sensitivity of 80% and a specificity of 50% [31]. According to a cadaveric study, US is superior to MRI in recognizing LUCL, demonstrating higher sensitivity and accuracy [6]. Nonetheless, MRI remains the modality of choice in soft tissue investigation [28].…”

“…Instability arises from the insufficiency of these structures due to trauma or degeneration. A significant lesion that leads to the posterolateral rotatory instability (PLRI) of the elbow is a dysfunction of the ulnar component of the lateral collateral ligamentous complex (LUCL) [3][4][5][6]. PLRI was first described by O'Driscoll et al [7,8], and is the most common form of chronic elbow instability.…”