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Establishing Safe Extra-articular Parameters for Cortical Button Distal Fixation During Ulnar Collateral Ligament
Perry O Hooper1, Jared Warren2, Christopher Silko3
1Cleveland Clinic Sports Health, Garfield Heighs, Ohio, USA.
The American Journal of Sports Medicine
|August 7, 2019
Summary
This study defines safe angles for cortical button placement during ulnar collateral ligament (UCL) reconstruction in overhead athletes. Recommended angles of 30° distal and 60° posterior angulation help avoid proximal radioulnar joint (PRUJ) injury.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanics
Background:
- Ulnar collateral ligament (UCL) reconstruction in overhead athletes uses various fixation methods.
- Cortical button fixation may offer advantages over interference screws but requires defined safe placement angles.
- A safe angle for cortical button placement during UCL reconstruction is currently undetermined.
Purpose of the Study:
- To determine safe angles for cortical button placement during UCL reconstruction.
- To prevent violation of the proximal radioulnar joint (PRUJ) during ulnar fixation.
Main Methods:
- A descriptive laboratory study was conducted on 100 cadaveric ulna specimens.
- Measurements were taken to calculate safe distal and posterior angulation for cortical button fixation.
- Interobserver reliability was assessed for all bony measurements.
Main Results:
- The mean distal angle of entry was 11.32°, with outliers up to 24.20°.
- The mean posterior angle of entry was 40.44°, with no outliers.
- Strong interobserver reliability was found for all measurements.
Conclusions:
- Recommended safe angles for ulnar fixation during UCL reconstruction are 30° distal and 60° posterior angulation.
- These angles ensure the cortical button placement is safely outside the PRUJ.
- The study provides clear parameters for safe distal fixation in UCL reconstruction.
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