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Published on: May 20, 2019
Comparing Static Stability of Native Elbow With Static Stability of Novel Bidirectional Ligament Reconstruction at
Dominic V Coutinho1, Amirreza Fatehi1, Ehab M Nazzal1
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Purpose:
The treatment of bidirectional ligament instability is proposed using a method that simultaneously tensions medial and lateral ligaments. Graft tension is maintained via plates that apply compression between the graft and bone.
Methods:
We tested static varus and valgus elbow stability in six cadaver elbows with intact ligaments and capsules at five positions, and then created gross instability by dividing all soft tissue attachments. A ligament reconstruction was subsequently performed with and without nonabsorbable ligament augmentation. Elbow stability was measured and compared with the native state.
Results:
The augmented and the nonaugmented ligament reconstructions provided stability to the lateral side with only 1.0 mm of increased deflection recorded for the augmented ligaments and 0.6 mm for the nonaugmented when compared with the native state. On the medial side, the deflection was greater after reconstruction compared with the native state with the augmented ligaments ranging between 1.0 and 1.8 mm and the nonaugmented ligament reconstruction ranging between 2.4 and 3.3 mm.
Conclusions:
This novel ligament reconstruction maintained secure fixation between ligament and bone and allowed for maintenance of static stability at different degrees of elbow flexion.
Clinical Relevance:
Restoring elbow stability using a method that minimizes ligament graft and which may not need to be removed could benefit management of bidirectionally unstable elbows, such as following interposition arthroplasty or substantial trauma.
