Ruland Robert T, Hogan Christopher J, Randall Craig J, Richards Andrew, Belkoff Stephen M
Bone and Joint/Sports Medicine Institute, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
Am J Sports Med. 2008 Aug;36(8):1565-70. doi: 10.1177/0363546508319360. Epub 2008 Jul 2.
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.
Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be biomechanically superior to previously reported techniques.
Controlled laboratory study.
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 degrees . 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.
The torsional failure moments for group 1 (13.28 N x m) and group 2 (12.81 N x m) reconstructions were significantly (P < .05) inferior to that of their respective native values (21.3 N x m and 23.5 N x 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).
Ulnar collateral ligament reconstruction utilizing semitendinosus graft and interference knot fixation restores the torsional strength of the intact UCL.
Reconstructions using semitendinosus grafts may allow for accelerated rehabilitation and earlier return to competition.
对于高水平投掷运动员而言，肘部尺侧副韧带（UCL）功能不全可能会对其职业生涯构成威胁。尽管已经描述了多种重建方法，但一种将更大的移植物与改进的固定方式相结合的手术，可能比现有技术具有更有利的负荷特性。
采用半腱肌移植物和干涉结固定的尺侧副韧带重建术在生物力学上优于先前报道的技术。
对照实验室研究。
将30具尸体肘部的UCL表面所有内侧软组织剥离。将肱骨近端安装在材料测试系统上，肘部屈曲90度。完整的UCL以4.5度/秒的速度加载至失效。记录扭转失效力矩、扭转刚度和失效模式。创建三组，每组10个标本。第1组使用掌长肌腱移植物并通过干涉结固定进行重建。第2组重建使用掌长肌腱移植物和对接技术。第3组标本使用半腱肌移植物和干涉结固定进行重建。所有标本均加载至失效，并记录相同参数。
第1组（13.28N·m）和第2组（12.81N·m）重建的扭转失效力矩明显（P < 0.05）低于其各自的原始值（21.3N·m和23.5N·m）。半腱肌重建（20.5N·m）与其原始UCL（23.0N·m）无显著差异（P = 0.24）。所有重建的扭转刚度均低于原始UCL（P < 0.001）。各组之间的刚度无统计学显著差异（P = 0.4）。
采用半腱肌移植物和干涉结固定的尺侧副韧带重建术可恢复完整UCL的扭转强度。
使用半腱肌移植物进行重建可能有助于加速康复并更早重返比赛。
