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Biomechanical comparison of ulnar collateral ligament reconstruction techniques
Robert T Ruland1, Christopher J Hogan, Craig J Randall
1Bone and Joint/Sports Medicine Institute, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
Background:
Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques.
Hypothesis:
Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be biomechanically superior to previously reported techniques.
Study Design:
Controlled laboratory study.
Methods:
Thirty cadaveric elbows were stripped of all medial soft tissue superficial to the UCL. The proximal humeri were mounted on a materials testing system with the elbows flexed 90 degrees . The intact UCL was loaded to failure at 4.5 deg/s. The torsional failure moment, torsional stiffness, and mode of failure were recorded. Three groups of 10 specimens were created. Group 1 underwent reconstruction using a palmaris tendon graft secured with interference knot fixation. Group 2 reconstructions utilized a palmaris graft and the docking technique. Group 3 specimens were reconstructed using a semitendinosus graft and interference knot fixation. All specimens were loaded to failure and the same parameters recorded.
Results:
The torsional failure moments for group 1 (13.28 N x m) and group 2 (12.81 N x m) reconstructions were significantly (P < .05) inferior to that of their respective native values (21.3 N x m and 23.5 N x m). Semitendinosus reconstructions (20.5 N.m) were not significantly different (P = .24) from their native UCLs (23.0 N.m). All reconstructions were torsionally less stiff (P < .001) than the native UCL. There were no statistically significant differences in stiffness between the groups (P = .4).
Conclusion:
Ulnar collateral ligament reconstruction utilizing semitendinosus graft and interference knot fixation restores the torsional strength of the intact UCL.
Clinical Relevance:
Reconstructions using semitendinosus grafts may allow for accelerated rehabilitation and earlier return to competition.
