The impact of ulnar collateral ligament tear and reconstruction on contact pressures in the lateral compartment of the elbow

Hypothesis: Complete ulnar collateral ligament (UCL) injury increases articular pressure and reduces contact area compared with the normal intact UCL. UCL reconstruction restores the contact area and contact pressure observed in the native joint. Materials and methods: Six male cadaveric elbows were mounted on a custom jig capable of simulating the 2 critical phases of the throwing motion during pitching. A contact sensor was placed through an anterior arthrotomy into the radiocapitellar joint. Each specimen then underwent valgus loading at 1.75 and 5.25 Nm of torque with the biceps, brachialis, and triceps under axial load in each testing condition. Results: The average valgus laxity in the intact elbow at 90 degrees was 3.7 degrees +/- 0.6 degrees at the 5.25 Nm level of torque, which doubled after transection. The reconstruction group demonstrated less laxity (2.4 degrees +/- 0.4 degrees) and reduced valgus angulation of the ulna at 5.25 Nm of torque. The transected UCL condition showed peak contact pressure 67% higher compared with the native ligament group at 5.25 Nm of torque. The reconstructed group increased peak articular cartilage pressures by 33% from the native ligament. At 5.25 Nm of torque for the 90 degrees flexion phase, the transected UCL condition showed an average contact pressure of 84% greater than that of the native ligament group. Reconstruction of the UCL restored average articular pressures to within 20% of intact values at 90 degrees. Conclusion: UCL injury increases radiocapitellar contact pressures and reduces resistance of the elbow to valgus loading. Contact pressures and valgus laxity can be improved with UCL reconstruction. Discussion: Taken as a whole, the peak pressure data indicate that the reconstruction restores valgus stability and lateral contact pressures to nearly normal levels under the conditions tested. Because the 90 position is the clinically significant position, these laboratory data support the clinical success of the docking procedure. Level of evidence: Basic Science Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.