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Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques

Robert T. Ruland, MD^*, Christopher J. Hogan, MD^*,, Craig J. Randall, MD^*, Andrew Richards, MD and Stephen M. Belkoff, PhD

From the ^* Bone and Joint/Sports Medicine Institute, Naval Medical Center, Portsmouth, Virginia, and the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

Address correspondence to Christopher J. Hogan, MD, Bone and Joint/Sports Medicine Institute, 620 John Paul Jones Circle, Portsmouth, VA 23708 (e-mail: christopher.hogan{at}med.navy.mil).

Background: Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques.

Hypothesis: Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be biomechanically superior to previously reported techniques.

Study Design: Controlled laboratory study.

Methods: Thirty cadaveric elbows were stripped of all medial soft tissue superficial to the UCL. The proximal humeri were mounted on a materials testing system with the elbows flexed 90°. The intact UCL was loaded to failure at 4.5 deg/s. The torsional failure moment, torsional stiffness, and mode of failure were recorded. Three groups of 10 specimens were created. Group 1 underwent reconstruction using a palmaris tendon graft secured with interference knot fixation. Group 2 reconstructions utilized a palmaris graft and the docking technique. Group 3 specimens were reconstructed using a semitendinosus graft and interference knot fixation. All specimens were loaded to failure and the same parameters recorded.

Results: The torsional failure moments for group 1 (13.28 N·m) and group 2 (12.81 N·m) reconstructions were significantly (P < .05) inferior to that of their respective native values (21.3 N·m and 23.5 N·m). Semitendinosus reconstructions (20.5 N·m) were not significantly different (P = .24) from their native UCLs (23.0 N·m). All reconstructions were torsionally less stiff (P < .001) than the native UCL. There were no statistically significant differences in stiffness between the groups (P = .4).

Conclusion: Ulnar collateral ligament reconstruction utilizing semitendinosus graft and interference knot fixation restores the torsional strength of the intact UCL.

Clinical Relevance: Reconstructions using semitendinosus grafts may allow for accelerated rehabilitation and earlier return to competition.

Key Words: ulnar collateral ligament reconstruction • elbow instability • interference knot • biomechanics