Arthrex Department of Research and Development, Munich, Germany.
Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2023 Apr;51(5):1303-1311. doi: 10.1177/03635465231157735. Epub 2023 Mar 6.
Augmented (internal braced) lateral ulnar collateral ligament (LUCL) repair has been biomechanically compared with reconstruction techniques in the elbow. However, LUCL repair alone has not yet been compared with augmented repair and reconstruction techniques.
Internal bracing of LUCL repair would improve time-zero stabilization regarding gap formation, stiffness, and residual torque as compared with repair alone and reconstruction techniques to restore native elbow stability.
Controlled laboratory study.
Overall, 24 cadaveric elbows were used for either internal braced LUCL repair (Repair-IB) or single- and double-strand ligament reconstruction with triceps (Recon-TR) and palmaris longus tendon graft (Recon-PL), respectively. Laxity testing in external rotation was consecutively performed at 90° of elbow flexion on the intact, dissected, and repaired conditions and with the previously assigned techniques. First, intact elbows were loaded to 7.0-N·m external torque to evaluate time-zero ligament rotations at 2.5, 4.0, 5.5, and 7.0 N·m. Rotation-controlled cycling was performed (total of 1000 cycles) for each surgical condition. Gapping, stiffness, and residual torque were analyzed. Finally, these and 8 additional intact elbows underwent torque-to-failure testing (30 deg/min).
The dissected state showed the highest gap formation and lowest peak torques ( < .001). While gap formation of Repair-IB ( < .021) was significantly lower than that of repair without internal bracing at all rotation levels, gaps of Recon-PL were similar to and Recon-TR were significantly higher than those of Repair-IB except for the highest torsion level. Residual peak torques at specific rotation angles between native state and Recon-TR (α), Recon-PL (α), and Repair-IB (α) were similar; all other comparisons were significantly different ( < .027). Torsional stiffness of Repair-IB was significantly higher at all rotation angles measured. Analysis of covariance showed significantly less gap formation over residual peak torques for Repair-IB ( < .001) as compared with all other groups. The native state failure load was significantly higher than Recon-PL and Recon-TR failure loads, with similar stiffness to all other groups.
Repair-IB and Recon-PL of the LUCL showed increased rotational stiffness relative to the intact elbow for restoring posterolateral stability to the native state in a cadaveric model. Recon-TR demonstrated lower residual peak torques but provided near-native rotational stiffness.
Internal bracing of LUCL repair may reduce suture-tearing effects through tissue and provide sufficient stabilization for healing throughout accelerated and reliable recovery without the need for a tendon graft.
在肘部，增强型（内部支撑）外侧尺侧副韧带（LUCL）修复已在生物力学上与重建技术进行了比较。然而，单独的 LUCL 修复尚未与增强修复和重建技术进行比较。
与单独修复和重建技术相比，LUCL 修复的内部支撑将改善零时间稳定性，减少间隙形成、刚度和残余扭矩，以恢复自然肘部稳定性。
对照实验室研究。
总共使用了 24 个尸体肘部，分别进行内部支撑 LUCL 修复（修复-IB）或单股和双股韧带重建，使用三头肌（重建-TR）和掌长肌腱移植物（重建-PL）。在完整、解剖和修复条件下，连续在外旋 90°的肘部屈伸位进行松弛度测试，并使用之前分配的技术进行测试。首先，将完整的肘部加载到 7.0-N·m 的外部扭矩，以评估在 2.5、4.0、5.5 和 7.0 N·m 时的零时间韧带旋转。为每个手术条件进行旋转控制循环（共 1000 次循环）。分析间隙形成、刚度和残余扭矩。最后，这些和另外 8 个完整的肘部进行了失效扭矩测试（30°/min）。
解剖状态显示出最大的间隙形成和最低的峰值扭矩（<.001）。虽然修复-IB（<.021）的间隙形成明显低于所有旋转水平的无内部支撑修复，但修复-PL 的间隙与修复-IB 相似，而修复-TR 的间隙明显高于修复-IB，除了最高扭转水平。在特定旋转角度下，从自然状态到重建-TR（α）、重建-PL（α）和修复-IB（α）的残余峰值扭矩相似；所有其他比较均有显著差异（<.027）。在所有测量的旋转角度下，修复-IB 的扭转刚度均显著升高。协方差分析显示，与所有其他组相比，修复-IB 的残余峰值扭矩的间隙形成明显减少（<.001）。自然状态的失效负荷明显高于重建-PL 和重建-TR 的失效负荷，与所有其他组的刚度相似。
在尸体模型中，LUCL 的修复-IB 和重建-PL 相对于完整的肘部增加了旋转刚度，从而恢复了后外侧稳定性至自然状态。重建-TR 显示出较低的残余峰值扭矩，但提供了接近自然的旋转刚度。
LUCL 修复的内部支撑可以通过组织减少缝线撕裂效应，并提供足够的稳定性，促进愈合，实现加速和可靠的恢复，而无需肌腱移植物。
