Ulnar collateral ligament reconstruction using bisuspensory fixation: a biomechanical comparison with the docking...

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Ulnar collateral ligament (UCL) reconstruction is crucial for elbow stability.
• Existing single-bundle techniques aim to replicate the native UCL, but fixation methods vary.
• A novel bisuspensory technique using suspensory fixation on both ulnar and humeral sides for single-bundle UCL reconstruction has not been previously described.

Purpose of the Study:

• To introduce and evaluate a novel single-bundle bisuspensory ulnar collateral ligament (UCL) reconstruction technique.
• To compare the biomechanical properties, specifically valgus laxity and load-to-failure characteristics, of the bisuspensory technique against the established docking technique.

Main Methods:

• A controlled laboratory study was conducted using six matched pairs of fresh-frozen cadaveric elbows.
• Elbows were randomized to undergo UCL reconstruction via either the docking technique or the novel bisuspensory technique.
• Valgus laxity and rotation were measured at various flexion angles, and reconstructions were subjected to load-to-failure testing.

Main Results:

• Both the bisuspensory and docking techniques successfully restored valgus laxity to the native ligament state across all tested flexion angles.
• No significant differences were observed between the two techniques in stiffness, ultimate torque, energy absorbed, or applied moment to achieve 10° of valgus.
• Yield and ultimate torques were comparable, with the bisuspensory technique measuring 18.7 ± 7.8 N·m and 26.5 ± 9.2 N·m, respectively, versus 18.6 ± 4.4 N·m and 25.1 ± 7.1 N·m for the docking technique.

Conclusions:

• The bisuspensory fixation technique provides a reproducible method for single-bundle ulnar collateral ligament (UCL) reconstruction.
• This technique effectively restores native valgus laxity and exhibits biomechanical load-to-failure characteristics similar to the docking technique.
• The bisuspensory technique is a viable option for primary UCL reconstruction or as a salvage fixation method during surgery.