Camp Christopher L, Bernard Christopher, Benavitz Bill, Konicek John, Altchek David W, Dines Joshua S
Arthrex Inc, Naples, Florida, USA.
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2019 Jul 17;7(7):2325967119857592. doi: 10.1177/2325967119857592. eCollection 2019 Jul.
In recent years, understanding of the anatomy of the ulnar collateral ligament (UCL) has evolved, demonstrating that the insertional footprint of the UCL on the ulna is more elongated and distally tapered than previously described. Current UCL reconstruction configurations do not typically re-create this native anatomy, which may represent a potential area for improvement.
PURPOSE/HYPOTHESIS: The purposes of this study were (1) to describe a novel anatomic UCL reconstruction technique designed to better replicate the native UCL anatomy and (2) to biomechanically compare this with the docking technique. The hypothesis was that the ultimate load to failure for the anatomic technique would not be inferior to the docking technique.
Controlled laboratory study.
A total of 16 fresh-frozen cadaveric upper extremities (8 matched pairs) were utilized. One elbow in each pair was randomized to receive UCL reconstruction via the docking technique or the novel anatomic UCL reconstruction technique with palmaris tendon autograft. Following reconstruction, biomechanical testing was performed by applying valgus rotational torque at a constant rate of 5 deg/s until ultimate mechanical failure of the construct occurred. Maximal torque (N·m), rotation stiffness (N·m/deg), and mode/location of failure were recorded for each specimen.
The mean ultimate load to failure for elbows in the docking technique group was 23.8 ± 6.1 N·m, as compared with 31.9 ± 8.4 N·m in the anatomic technique group ( = .045). Mean rotational stiffness was 1.9 ± 0.7 versus 2.3 ± 0.9 N·m/deg for the docking and anatomic groups, respectively ( = .338). The most common mode of failure was suture pullout from the graft, which occurred in all 8 (100%) docking technique specimens and 7 of 8 (88%) specimens that underwent the anatomic UCL reconstruction technique.
Ultimately, the anatomic UCL reconstruction technique demonstrated superior strength and resistance to valgus torque when compared with the docking technique, and this was comparable with that of the native UCL from prior studies. Increased initial strength may allow for earlier initiation of throwing postoperatively and potentially shorten return-to-play times.
Current UCL reconstruction techniques do not accurately reproduce the UCL insertional anatomy on the ulna. The novel anatomic technique described may result in more natural joint kinematics. This study demonstrated load-to-failure rates that are significantly higher than with the docking technique and consistent with the native ligament, as reported from previous studies. These findings may serve as a foundation for future clinical study and optimization of this technique.
近年来，对尺侧副韧带（UCL）解剖结构的认识不断发展，表明UCL在尺骨上的附着足迹比先前描述的更长且向远端逐渐变细。目前的UCL重建构型通常无法重现这种天然解剖结构，这可能是一个有待改进的潜在领域。
目的/假设：本研究的目的是（1）描述一种旨在更好地复制天然UCL解剖结构的新型解剖学UCL重建技术，以及（2）对该技术与对接技术进行生物力学比较。假设是解剖学技术的最终破坏载荷不会低于对接技术。
对照实验室研究。
共使用了16个新鲜冷冻的尸体上肢（8对匹配样本）。每对中的一个肘部随机接受通过对接技术或采用掌长肌腱自体移植的新型解剖学UCL重建技术进行的UCL重建。重建后，以5度/秒的恒定速率施加外翻旋转扭矩进行生物力学测试，直至构建体发生最终机械破坏。记录每个样本的最大扭矩（N·m）、旋转刚度（N·m/度）以及破坏模式/位置。
对接技术组肘部的平均最终破坏载荷为23.8±6.1 N·m，而解剖学技术组为31.9±8.4 N·m（P = 0.045）。对接组和解剖学组的平均旋转刚度分别为1.9±0.7和2.3±0.9 N·m/度（P = 0.338）。最常见的破坏模式是缝线从移植物中拔出，这在所有8个（100%）对接技术样本以及8个接受解剖学UCL重建技术样本中的7个（88%）中发生。
最终，与对接技术相比，解剖学UCL重建技术在抗外翻扭矩方面表现出更强的强度和抵抗力，并且与先前研究中天然UCL的情况相当。增加的初始强度可能允许术后更早开始投掷训练，并可能缩短恢复比赛的时间。
目前的UCL重建技术不能准确重现UCL在尺骨上的附着解剖结构。所描述的新型解剖学技术可能会导致更自然的关节运动学。本研究表明，破坏载荷率明显高于对接技术，且与先前研究报道的天然韧带情况一致。这些发现可为该技术未来的临床研究和优化提供基础。
