The contribution of the posterolateral capsule to elbow joint stability: a cadaveric biomechanical investigation

Background: Elbow posterolateral rotatory instability occurs after an injury to the lateral collateral ligament complex (LCLC) in isolation or in association with an osteochondral fracture of the posterolateral margin of the capitellum (Osborne-Cotterill lesion [OCL]). The contribution to elbow stability of the posterolateral capsule, attached to this lesion, is unknown. This study quantified the displacement of the radial head on simulated posterior draw with sectioning of the posterior capsule (a simulated OCL) or LCLC. Methods: Biomechanical testing of the elbow was performed in 8 upper limb cadavers. With the elbow 0 degrees, 30 degrees, 60 degrees, and 90 degrees degrees of flexion, posterior displacement of the radius was measured at increments of a load of 5 N up to 50 N. A simulated OCL and LCLC injury was then performed. Results: A simulated OCL results in significantly more displacement of the radial head compared with the intact elbow at 30 degrees to 60 degrees of elbow flexion. LCLC resection confers significantly more displacement. An OCL after LCLC resection does not create further displacement. Conclusions: The degree of radial head displacement is greater after a simulated OCL at 30 degrees to 60 degrees of flexion compared with the intact elbow with the same load but not as great as seen with sectioning of the LCLC. This study suggests that the posterior capsule attaching to the back of the capitellum is important to elbow stability and should be identified as the Osborne-Cotterill ligament. Clinical studies are required to determine the importance of these biomechanical findings. (c) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.