Medial elbow stability assessment after ultrasound-guided ulnar collateral ligament transection in a cadaveric model: ultrasound versus stress radiography.

BACKGROUND

The ulnar collateral ligament (UCL), consisting of 3 bundles, is the primary medial restraint in the elbow. Recent research has demonstrated that ultrasound is an effective modality to evaluate the medial elbow, whereas stress radiography is standard practice in the measurement of medial elbow laxity. This study (1) compared dynamic ultrasound (US) with stress radiography in the evaluation of UCL insufficiency and (2) further evaluated the contribution of the anterior bundle of the UCL to medial elbow stability.

METHODS

Stress radiographs and US were used to obtain coronal plane measurements of the medial joint space of 16 cadaveric elbows before and after US-guided isolated transection of the anterior bundle of the UCL. Measurements were performed with and without a valgus stress applied to the elbows, and gapping of the ulnohumeral joint space was documented.

RESULTS

Transection of the anterior bundle of the UCL resulted in 1.5 mm and 1.7 mm of additional gapping in the ulnohumeral joint as measured with stress radiographs and US, respectively. No differences were recorded in the ulnohumeral gapping measurements between stress radiography and US.

CONCLUSIONS

The lack of difference between measurements reveals US is as reliable as stress radiography in evaluating the medial ulnohumeral joint space and continuity of the UCL while eliminating radiation exposure and minimizing cost of the diagnostic examination. The increase in ulnohumeral gapping with isolated transection of the anterior bundle of the UCL demonstrates its significant contribution to medial elbow stability.