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Annular Ligament Instability in Lateral Elbow Pathology: Objective Confirmation Through a Cadaveric Study.

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The annular ligament shows significant tension variability during forearm rotation, especially in supination. This ligament laxity may contribute to elbow instability and cartilage damage.

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Area of Science:

  • Orthopedic biomechanics
  • Elbow joint anatomy
  • Ligamentous stabilization

Background:

  • The annular ligament is crucial for elbow stability.
  • Its biomechanical behavior during forearm rotation is not well understood.
  • Interindividual variability and association with chondral lesions require investigation.

Purpose of the Study:

  • Quantify annular ligament tension variability during forearm rotation.
  • Validate arthroscopic findings with objective measurements.
  • Explore links between ligament laxity, chondral lesions, and elbow instability.

Main Methods:

  • Cross-sectional anatomical study of 25 cadaveric upper limbs.
  • Standardized dissection preserving ligamentous and muscular integrity.
  • Measurement of ligament displacement using a custom apparatus and micrometer under varying loads and forearm positions (neutral, pronation, supination).

Main Results:

  • Significant interindividual variation in annular ligament displacement, maximal in supination (mean 1.23 mm at 3 kg).
  • Pronounced differences in displacement across all forearm positions and load levels (p < 0.001).
  • Chondral lesions observed in three specimens with ligament laxity and reduced radial head coverage.

Conclusions:

  • First objective evidence of annular ligament tension variability during forearm rotation.
  • Ligament laxity is associated with lateral elbow instability and cartilage degeneration.
  • Reinforces the annular ligament's role as a key secondary elbow stabilizer.