Bull Hosp Jt Dis (2013). 2022 Jun;80(2):175-179.
The optimal location to repair the lateral ulnar collateral ligament (LUCL) following placement of the internal joint stabilizer (IJS) has not been defined. The placement of the IJS occupies the ideal native repair site, the isometric point on the lateral epicondyle, necessitating non-anatomic repair of the LUCL. This may lead to a loss of flexion, extension, or both. We present a cadaveric study aimed to determine the ideal non-anatomic repair location that maximizes postoperative range of motion.
Range of motion of 10 cadaveric elbows were tested with the lateral ulnar collateral ligament complex intact. The ligament was then elevated from the capitellum and the IJS device was implanted. Five lateral collateral repair positions were tested using quadrants to classify the repair positions. The ligament was repaired using suture in a Krakow fashion placed through drill holes in the lateral capitellum, then secured against the posterior cortex. Elbow range of motion was documented for both flexion and ex- tension in all repair positions for each of the 10 cadaveric specimens. Statistical analysis was performed using an analysis of variance (ANOVA) and a Tukey-Kramer post hoc analysis to determine statistical significance.
There was a statistically significant difference between elbow range of motion in each repair position and the native elbow in all but position 3, which was anterior and distal to the central IJS axis pin (8° loss of flexion and 6° loss of extension). Flexion was significantly different in only position 2 (15° loss), while extension was different in both position 1 (51° loss) and position 4 (42° loss). Total motion loss was significant for positions 1 (57°), 2 (16°), 4 (48°), and 5 (24°).
When using an IJS elbow stabilizing device, since the axis pin occupies the anatomic origin of the lat- eral ulnar collateral ligament, the repair should be placed as close as possible to the isometric point in the anterior and distal quadrant of the lateral capitellum to maximize postoperative elbow range of motion.
在放置内侧关节稳定器（IJS）后，修复外侧尺侧副韧带（LUCL）的最佳位置尚未确定。IJS 的放置占据了理想的固有修复部位，即外侧上髁等距点，这就需要对 LUCL 进行非解剖修复。这可能导致丧失屈曲、伸展或两者兼失。我们提出了一项尸体研究，旨在确定最大程度地提高术后活动范围的理想非解剖修复位置。
在外侧尺侧副韧带复合体完整的情况下，测试了 10 个尸体肘部的活动范围。然后从肱骨小头抬起韧带，并植入 IJS 装置。使用象限将 5 个外侧侧副韧带修复位置进行分类测试。使用通过在外侧肱骨小头钻的孔中的 Krakow 缝线将韧带修复，然后将其固定在后部皮质上。在每个标本的 10 个尸体中，在所有修复位置下记录了肘部的屈曲和伸展范围。使用方差分析（ANOVA）和 Tukey-Kramer 事后分析进行统计分析，以确定统计学意义。
除了位于 IJS 轴钉中心前侧和远侧的位置 3（丧失 8°的屈曲和 6°的伸展）外，在每个修复位置下，肘部活动范围与原始肘部相比均存在统计学显著差异。只有位置 2（丧失 15°）的屈曲存在显著差异，而位置 1（丧失 51°）和位置 4（丧失 42°）的伸展存在差异。位置 1（丧失 57°）、2（丧失 16°）、4（丧失 48°）和 5（丧失 24°）的总运动损失显著。
当使用 IJS 肘部稳定装置时，由于轴钉占据了外侧尺侧副韧带的解剖起点，因此修复应尽可能靠近肱骨小头前侧和远侧象限的等距点，以最大程度地提高术后肘部活动范围。
