Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA.
Department of Orthopaedic Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA.
Am J Sports Med. 2018 Dec;46(14):3495-3501. doi: 10.1177/0363546518803771. Epub 2018 Nov 7.
The modified Jobe technique of ulnar collateral ligament (UCL) reconstruction has previously been biomechanically compared with primary repair augmented with internal bracing. However, the docking technique has not been compared with repair with internal bracing.
Load to failure, gapping, and valgus opening angle are similar under valgus loading at 90° of flexion between repair with internal bracing and the docking technique for the UCL.
Controlled laboratory study.
Nine matched pairs of fresh-frozen cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and the bone was sectioned 14 cm proximal and distal to the elbow joint. First, native UCL testing was performed at 90° of flexion with 0.5 N·m preload, followed by a 5 N·m valgus moment to the elbow in cycles of 1, 10, 100, and 1000 at 1 Hz. The specimens were then loaded to failure at a rate of 0.2 mm/s. Next, the elbows were randomly divided into matched pairs to undergo either UCL reconstruction with docking technique or UCL repair augmented with internal bracing. Last, these specimens underwent testing as aforementioned.
Load to failure, gapping, and valgus opening angle did not differ significantly between native ligaments that underwent reconstruction or repair with internal bracing, paired native ligaments and reconstructions, paired native ligaments and repairs augmented with internal bracing, or reconstructions and repairs augmented with internal bracing.
UCL reconstruction with docking technique and repair augmented with internal bracing provides valgus stability to the medial elbow comparable to the native ligament at 90°. No significant differences were noted between docking reconstruction and repair techniques for load to failure, gapping, or valgus opening angle during cyclic loading at time zero.
Our results suggest that UCL repair with internal bracing has a similar biomechanical profile at the time of initial fixation compared with the docking technique of UCL reconstruction.
先前已经从生物力学的角度比较了改良的 Jobe 技术的尺侧副韧带（UCL）重建与内侧支撑物增强的初级修复。然而，尚未比较过对接技术与带内置支撑物的修复。
在 90°弯曲的外翻负载下，带内置支撑物的修复与 UCL 的对接技术之间的失效负载、间隙和外翻开口角度相似。
对照实验室研究。
将 9 对匹配的新鲜冷冻尸体肘部用中立旋转前臂进行盆栽。取出掌长肌腱移植物，然后在肘部近端和远端 14 cm 处将骨切开。首先，在 90°弯曲下进行原生 UCL 测试，施加 0.5 N·m 的预载，然后在 1 Hz 下以 1、10、100 和 1000 个周期向肘部施加 5 N·m 的外翻力矩。然后以 0.2 mm/s 的速率加载至失效。接下来，将肘部随机分为匹配对，进行 UCL 对接技术重建或带内置支撑物的 UCL 修复。最后，对这些标本进行如上所述的测试。
在失效负载、间隙和外翻开口角度方面，经过重建或带内置支撑物修复的原生韧带、配对的原生韧带和重建、配对的原生韧带和带内置支撑物修复以及重建和带内置支撑物修复之间没有显著差异。
在 90°时，UCL 对接技术重建和带内置支撑物的修复为内侧肘部提供了与原生韧带相当的外翻稳定性。在零时间的循环加载中，在失效负载、间隙或外翻开口角度方面，对接重建与修复技术之间没有明显差异。
我们的结果表明，与 UCL 重建的对接技术相比，带内置支撑物的 UCL 修复在初始固定时具有相似的生物力学特征。
