Biomechanical assessment of lateral ulnar collateral ligament repair and reconstruction with or without internal brace augmentation

Utilization of Internal Bracing in Elbow Medial UCL Stabilization: From Biomechanics to Clinical Application and Patient Outcomes

“…● Group 3: repair with suture tape with one anchor ● Suture tape augmentation of the LUCL repair (used in groups 2 and 3) significantly increased the load to failure torque ● Suture tape augmentation only showed significantly less laxity for varus movement when the elbow was positioned at 30° and 120° of flexion. Jones et al, 2018 23 ● 10 Matched pairs (20 total) human cadaveric elbows ● Mean age of 75 years ● UCL repair augmented with collagen-coated FiberTape (Arthrex inc) ● Modified Jobe UCL reconstruction ● Comparing the groups after the 10th, 100th, and 500th cycles of valgus rotation, repair with internal bracing showed significantly less gap formation ● At failure, the different techniques showed no significant differences when comparing gap formation, torque to failure, or stiffness Leasure et al, 2019 24 ● 10 Matched pairs (20 total) ● Mean age of 41 years ● Modified docking reconstruction ● Hybrid modified docking reconstruction with suture bracing ● Reconstruction with suture bracing (internal bracing) resulted in significantly reduced gap formation ● Stiffness and torque to failure did were not significantly different when comparing the two groups Melbourne et al, 2020 25 ● 12 Paired cadaveric elbows ● Mean age of 55.42 years 4 groups: ● Primary repair of LUCL ● Primary repair of LUCL with suture tape internal brace ● Reconstruction of LUCL ● Reconstruction of LUCL with suture tape internal brace ● With respect to the repair groups, internal brace augmentation was observed to have significantly higher load to failure torques than primary repair alone and maintained stiffness significantly better ● For the reconstruction comparisons, internal brace augmentation was also observed to have significantly higher load to failure torques with lower displacement than reconstruction alone. No significant difference in maintained stiffness while comparing the reconstruction groups Scheiderer et al, 2020 27 ● 16 Cadaveric human elbows ● Mean age of 66.5 years ● LUCL internal bracing ● Reconstruction with triceps tendon ● Both techniques significantly improved the posterolateral rotatory stability (measured as rotational degree) compared to the torn state when the elbow joint was flexed from 30° to 120° Urch et al, 2019 20 ● 8 Matched pairs of cadaveric elbows ● Mean age of 58.5 years ● UCL internal brace repair ● 3 strand docking UCL reconstruction ● The 3 strand docking reconstruction restored valgus laxity to the native intact state when the elbow was tested at 60° of flexion, but over constrained the elbow at 90° and 120° ● Repair with Internal brace restored the laxity t...…”

“…Their findings revealed that internal bracing in both reconstruction and repair significantly increased the load to failure torques, highlighting the biomechanical strength provided by internal bracing. 25 Only three studies reviewed in this paper performed a direct comparison of traditional reconstruction techniques to reconstruction with internal bracing. 13 , 24 , 25 All three studies reported an advantage in the use of internal bracing in elbow UCL reconstruction, either in improving failure strength 13 , 25 or reducing gap formation.…”

“… 25 Only three studies reviewed in this paper performed a direct comparison of traditional reconstruction techniques to reconstruction with internal bracing. 13 , 24 , 25 All three studies reported an advantage in the use of internal bracing in elbow UCL reconstruction, either in improving failure strength 13 , 25 or reducing gap formation. 24 While these cadaveric studies provided a biomechanical argument for internal brace augmentation in the reconstruction of the elbow UCL, comparative clinical studies will be needed to further determine the efficacy of internal bracing in reconstruction.…”

Internal bracing in the treatment of elbow instabilities

“…Melbourne et al also compared LUCL repair with and without internal bracing [24]. The additional augmentation significantly increased resistance to rotational loads due to higher load-to-failure.…”

“…Melbourne et al also investigated the influence of internal bracing on LUCL reconstruction using a long palmar graft [24]. The internal brace significantly increased the maximum load-to-failure.…”