In-Vitro Quantification of Medial Collateral Ligament Tension in the Elbow

The anterior bundle of the medial collateral ligament (AMCL) of the elbow is commonly injured in patients with elbow dislocations and in throwing athletes. This in-vitro study quantified tension in the native AMCL throughout elbow flexion for different arm positions. We conducted passive and simulated active elbow flexion in seven fresh-frozen cadaveric upper extremities using an established motion simulator. Motions were performed in the valgus and vertical positions from 20-120° while measuring AMCL tension using a custom transducer. Average AMCL tension was higher in the valgus compared to vertical position for both active (p = 0.03) and passive (p = 0.01) motion. Peak AMCL tension was higher in the valgus position for active (p = 0.02) and passive (p = 0.01) motion. There was no significant difference in AMCL tension between active and passive motion in the valgus (p = 0.15) or vertical (p = 0.39) positions. In the valgus position, tension increased with elbow flexion from 20-70° for both active (p = 0.04) and passive (p = 0.02) motion, but not from 70-120°. This in-vitro study demonstrated that AMCL tension increases with elbow flexion, and is greater in the valgus position relative to the vertical position. This information has important implications to the desired target strength of repair and reconstruction techniques.