Kouk Shalen N, Beason David P, Rothermich Marcus A, Dugas Jeffrey R, Cain E Lyle
American Sports Medicine Institute, Birmingham, Alabama, USA.
Andrews Sport Medicine and Orthopaedic Center, Birmingham, Alabama, USA.
Orthop J Sports Med. 2022 Nov 14;10(11):23259671221134829. doi: 10.1177/23259671221134829. eCollection 2022 Nov.
Injury to the ulnar collateral ligament (UCL) of the medial elbow has been treated successfully with ligament repair augmented with internal brace. Previous work has shown that this procedure does not overconstrain the ulnohumeral joint; however, the procedures were conducted by a single surgeon, which controlled for anchor placement and graft tensioning.
PURPOSE/HYPOTHESIS: Our purpose was to evaluate the reproducibility of contact mechanics and joint torque after UCL repair with internal brace as performed by different surgeons compared with repair by a single surgeon. It was hypothesized that there would be no significant difference in elbow contact mechanics, valgus torque, or torsional stiffness between the 2 groups.
Controlled laboratory study.
Nine pairs of fresh-frozen cadaveric elbows were tested biomechanically under 3 conditions: UCL-intact (UCL-I), UCL-deficient (UCL-D), and UCL-repaired with internal brace augmentation (UCLR-IB). For each pair, 1 elbow was repaired by a single surgeon, and the contralateral elbow was repaired by 1 of 9 other surgeons. Testing consisted of valgus torsion between 0° and 5° with the elbow positioned at 90° of flexion. Ulnohumeral contact mechanics and overall joint torque and stiffness were measured and compared between surgeon groups.
There were no statistically significant differences between the single-surgeon and multiple-surgeon groups regarding contact area ( = .83), contact force ( = .27), peak pressure ( = .26), or peak force ( = .30); however, contact pressure was significantly affected ( = .02) by surgeon group. Compared with UCL-I, both UCL-D and UCLR-IB conditions had a significant overall effect on contact area ( = .004) and contact force ( = .05); however, contact pressure ( = .56), peak pressure ( = .27), and peak force ( = .24) were not affected by injury condition. Measurements of elbow torque ( = .28) and stiffness ( = .98) were not significantly different between surgeon groups.
UCL repair with internal brace provided consistent results among several surgeons when compared with a single surgeon. The procedure did not lead to joint overconstraint while also returning the ligament to near-intact levels of resisting valgus stress.
UCL repair with internal brace augmentation is a reproducible surgical technique that has good clinical outcomes in the literature.
内侧肘部尺侧副韧带（UCL）损伤通过用内支撑增强韧带修复已成功得到治疗。先前的研究表明，该手术不会过度限制尺肱关节；然而，这些手术是由一位外科医生进行的，其控制了锚钉放置和移植物张紧。
目的/假设：我们的目的是评估与由一位外科医生进行的修复相比，不同外科医生进行的用内支撑修复UCL后接触力学和关节扭矩的可重复性。假设两组之间在肘部接触力学、外翻扭矩或扭转刚度方面无显著差异。
对照实验室研究。
9对新鲜冷冻尸体肘部在3种情况下进行生物力学测试：UCL完整（UCL-I）、UCL缺损（UCL-D）以及用内支撑增强修复UCL（UCLR-IB）。对于每一对，1个肘部由一位外科医生修复，对侧肘部由其他9位外科医生中的1位修复。测试包括在肘部屈曲90°时0°至5°之间的外翻扭转。测量并比较外科医生组之间的尺肱接触力学、整体关节扭矩和刚度。
在单外科医生组和多外科医生组之间，关于接触面积（P = 0.83）、接触力（P = 0.27）、峰值压力（P = 0.26）或峰值力（P = 0.30）没有统计学上的显著差异；然而，接触压力受到外科医生组的显著影响（P = 0.02）。与UCL-I相比，UCL-D和UCLR-IB情况对接触面积（P = 0.004）和接触力（P = 0.05）均有显著的总体影响；然而，接触压力（P = 0.56）、峰值压力（P = 0.27）和峰值力（P = 0.24）不受损伤情况影响。外科医生组之间的肘部扭矩测量值（P = 0.28）和刚度测量值（P = 0.98）没有显著差异。
与一位外科医生相比，多位外科医生进行的用内支撑修复UCL能提供一致的结果。该手术不会导致关节过度限制，同时还能使韧带恢复到接近完整的抵抗外翻应力水平。
用内支撑增强修复UCL是一种可重复的手术技术，在文献中有良好的临床结果。
