Biomechanical Comparison of UCL Repair Using Suspensory Fixation Versus UCL Reconstruction

Abstract

Background: Medial ulnar collateral ligament (mUCL) repair is growing in popularity as a treatment for younger athletes with mUCL tears. One of the most recent techniques utilizes a collagen-coated suture tape to augment the repair. The most popular repair technique uses a screw for proximal fixation in the humerus. We present an alternative technique that uses suspensory fixation in the proximal humerus. Purpose: To biomechanically compare elbow valgus stability and load to failure of a novel alternative repair technique with suspensory fixation to an mUCL reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL in an intact, deficient—either repaired or reconstructed—state. The repair technique used a suspensory fixation with suture augmentation, and the docking technique was used on all reconstructions. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: Both ulnar collateral ligament reconstruction and repair restored valgus stability to levels that were not statistically different from intact at all angles of flexion. There was no significant difference in the ultimate torque to failure between repaired and reconstructed mUCLs. Conclusion: There was no significant difference in the valgus strength between the mUCL repair with suspensory fixation and the mUCL reconstruction. Clinical Relevance: Suspensory fixation is an alternative method for proximal fixation in the mUCL without compromising the strength of the construct.

Medial Ulnar Collateral Ligament Repair With Augmentation: A Systematic Review and Meta-analysis of Preclinical Studies

“…Six biomechanical studies were identified from the literature. 7 , 9 , 19 , 27 , 31 , 43 In total, there were 106 cadaveric elbows, of which 53 were treated with ulnar collateral ligament (UCL) internal brace (IB) repair and 53 with UCL reconstruction. The mean age of the specimens was 63.7 years (range, 44.7-73.2 years), with 57.8% of the specimens being from men.…”

“…Four studies had similar anchor and fixation placement for the FiberTape Internal Brace (Arthrex). 9 , 19 , 27 , 31 Of the remaining 2 studies, 1 had additional anchors incorporating SutureTape (Arthrex) in the sublime tubercle for posterior band augmentation. 43 The final study incorporated a novel suspensory fixation in the medial epicondyle for suture tape augmentation.…”

“…Although reconstruction was the main comparator, 2 studies used the modified Jobe technique, 19 , 27 2 the simple docking technique, 9 , 31 and 2 modified docking (Supplemental Table S2). 7 , 43 …”

“…Where described, specimen preparation was generally consistent among all studies, with either flexor-pronator mass splitting 9 , 31 or an elevation approach used for MUCL exposure. 19 , 27 Acute tears were either proximal or distal and were different among studies.…”

Biomechanical Properties of Knee Medial Collateral Ligament Compared to Palmaris Longus for Ulnar Collateral Ligament Reconstruction

“…Dr. Frank Jobe first described the successful reconstruction of the UCL in 1986, allowing athletes to return to their pre-injury level of the sport [19,20]. Since then, a variety of ulnar collateral ligament reconstruction (UCLR) techniques have been described, including methods that use both allograft and autograft tendons [12,22,23].…”