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Biomechanical Evaluation of 2 Techniques for Ulnar Collateral Ligament Reconstruction of the Elbow

George A. Paletta, Jr, MD^*, Steven J. Klepps, MD, Gregory S. Difelice, MD, Tracy Allen, MD, Michael D. Brodt, MS^¶, Meghan E. Burns^¶, Matthew J. Silva, PhD^¶ and Rick W. Wright, MD^||,¶

From the ^* Center for the Athlete’s Shoulder and Elbow at the Orthopaedic Center of St Louis, Chesterfield, Missouri, Montana Orthopedics, Billings, Montana, Ranawat Orthopaedic Center, New York, New York, University of Kentucky, Lexington, Kentucky, and ^¶ Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri

^|| Address correspondence to Rick W. Wright, MD, Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital, Suite 11300 West Pavilion, St Louis, MO 63110 (e-mail: rwwright1{at}aol.com).

Background: Elbow medial ulnar collateral ligament tears often result in pain and instability that may be career threatening in overhead-throwing athletes. Surgical reconstruction is frequently chosen to treat this injury. Ulnar collateral ligament reconstruction as described by Jobe is the most commonly used technique. Testing of this construct has not demonstrated that the biomechanical parameters of the native ligament are restored. A more recent construct, the docking technique, may more reliably reproduce these factors.

Hypothesis: Increasing the number of strands of palmaris longus tendon graft used in ulnar collateral ligament reconstruction and tensioning them using the docking technique result in a construct with improved biomechanical parameters as compared with the Jobe technique.

Study Design: Controlled laboratory study.

Methods: Thirty-three fresh-frozen human cadaveric elbows were randomized into 3 subgroups: Jobe (11), docking (12), and native (10). The Jobe and docking groups underwent reconstruction using their described palmaris tendon graft constructs. The ulnar collateral ligament was left intact in the native group. Elbows were potted and tested using a servohydraulic materials testing machine to apply a valgus moment at 30° of elbow flexion. Maximal moments to failure, stiffness, and strain at maximal moment and with a 3 N·m force applied were determined using a 2-camera motion analysis system to track reflective markers spanning the site.

Results: The docking (14.3 N·m) and native (18.8 N·m) subgroups resulted in higher maximal moment to failure than did the Jobe (8.9 N·m) subgroup (P < .001). There was no significant difference between native and docking groups (P > .05). Native ligaments were stiffer (301.4 N·m) than were Jobe (74.3 N·m) or docking (80.8 N·m; P < .001). Native ligaments demonstrated lower strain at maximal force (0.087 mm/mm) and 3 N·m forces (0.030 mm/mm) than did the Jobe (0.198/0.057 mm/mm) or docking (0.287/0.042 mm/mm) subgroups. There was no difference in stiffness or strain between the Jobe and docking subgroups (P > .05).

Conclusion: Neither technique reproduced the biomechanical profile of the native ulnar collateral ligament; the findings of this study suggest that the docking construct may offer initial biomechanical advantage over the Jobe construct.

Key Words: elbow • ulnar collateral ligament (UCL) • overhead throwing

This article has been cited by other articles:

				R. T. Ruland, C. J. Hogan, C. J. Randall, A. Richards, and S. M. Belkoff Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques Am. J. Sports Med., August 1, 2008; 36(8): 1565 - 1570. [Abstract] [Full Text] [PDF]

				J. Prud'homme, J. E. Budoff, L. Nguyen, and J. A. Hipp Biomechanical Analysis of Medial Collateral Ligament Reconstruction Grafts of the Elbow Am. J. Sports Med., April 1, 2008; 36(4): 728 - 732. [Abstract] [Full Text] [PDF]