Sonographic Assessment of the Medial Ulnar Collateral Ligament Distal Ulnar Attachment

Farrow, Lutul D.; Mahoney, Andrew P.; Sheppard, Joseph E.; Schickendantz, Mark S.; Taljanovic, Mihra S.

doi:10.7863/ultra.33.8.1485

Cited by 18 publications

(7 citation statements)

References 22 publications

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“…In this study, length of the ulnar footprint measured an average of 29.2 mm. Others have found similar lengths when appreciating a tapered insertion with means of 30.2 mm and 29.2 mm[ 21 , 22 ]. Further study by Camp et al[ 18 ] identified a tapered insertion with a mean surface area of 187.6 mm 2 and an ulnar footprint length averaging 29.7 mm.…”

Section: Anatomymentioning

confidence: 81%

“…These lengths were measured from the center of the origin to center of sublime tubercle, based on a direct insertion onto the sublime tubercle without a distal extension. In contrast, more recent reports measured from the center of the humeral origin to the most distal point of tapered insertion reported mean lengths of 53.9 mm[ 21 ] and 51.7 mm[ 22 ]. The difference in length measured between a non-tapered sublime insertion and a tapered insertion calls for further study to evaluate native AB anatomy and the clinical relevance of different measurements.…”

Section: Anatomymentioning

confidence: 99%

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Understanding the medial ulnar collateral ligament of the elbow: Review of native ligament anatomy and function

Labott

Aibinder

Dines

et al. 2018

WJO

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The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament (MUCL)], posterior (PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands (anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail comprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL (AB), PB, and transverse ligament.

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Section: Anatomymentioning

confidence: 81%

Section: Anatomymentioning

confidence: 99%

Understanding the medial ulnar collateral ligament of the elbow: Review of native ligament anatomy and function

Labott

Aibinder

Dines

et al. 2018

WJO

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“…First, anatomic and biomechanical studies suggest that higher elbow flexion angles may tension the portion of the UCL imaged during this investigation [37‐40]. The anterior bundle of the UCL originates from the flat, anteroinferior surface of the medial epicondyle and inserts broadly over the sublime tubercle and proximal ulna [2,22,37‐42]. Sonographically, the most distinct region of the UCL has been shown to be the anterior band of the anterior bundle, which is most taut from 60° to 90° of flexion [9,10,16].…”

Section: Discussionmentioning

confidence: 94%

“…When measuring CSA, the distal perimeter of the UCL was considered to be the sublime tubercle. Although the long ulnar attachment of the UCL was visualized in all cases, as recently described, this portion of the UCL was excluded from CSA measurements because of its long, thin structure and unclear clinical significance [2,22].…”

Section: Methodsmentioning

confidence: 93%

Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

Lueders

Pourcho

Sellon

et al. 2015

PM&R

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“…In previous studies ( Table 3 ), § morphological features of the AB and PB were not consistent. This is because limb positions at the time of measurement have included the elbow joint in extension with the forearm in supination, 3 , 19 elbow flexion at 25°, 15 elbow flexion at 90°, 9 maximum tension position, 28 maximum tension position in neutral position of the forearm, 1 neutral position of the forearm, 10 and even undescribed positions 2 , 16 - 18 , 22 , 30 , 32 , 33 , 35 that presumably varied widely among studies. In addition, the AB is generally measured as a single bundle originating from the anteroinferior aspect of the medial epicondyle of the humerus and inserting at the sublime tubercle of the ulna.…”

Section: Discussionmentioning

confidence: 99%

Morphological Features of the Ulnar Collateral Ligament of the Elbow and Common Tendon of Flexor-Pronator Muscles

Ikezu

Edama

Matsuzawa

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The anterior bundle (AB) of the ulnar collateral ligament is the most important structure for valgus stabilization of the elbow. However, anatomic relationships among the AB, posterior bundle (PB) of the ulnar collateral ligament, and common tendon (CT) of the flexor-pronator muscles have not been fully clarified. Purpose: To classify the AB, PB, and CT and to clarify their morphological features. Study Design: Descriptive laboratory study. Methods: This investigation examined 56 arms from 31 embalmed Japanese cadavers. The CT investigation examined 34 arms from 23 embalmed Japanese cadavers with CTs remaining. Type classification was performed by focusing on positional relationships with surrounding structures. Morphological features measured were length, width, thickness, and footprint for the AB and PB and attachment length, thickness, and footprint for the CT. Results: The AB was classified as type I (44 elbows; 78.6%), can be separated as a single bundle, or type II (12 elbows; 21.4%), cannot be separated from the PB and joint capsule. The PB was classified as type I (28 elbows; 50.0%), can be separated as a single bundle; type IIa (6 elbows; 10.7%), posterior edge cannot be separated; type IIb (7 elbows; 12.5%), anterior edge cannot be separated; or type III (15 elbows; 26.8%), cannot be separated from the joint capsule. The CT was classified as type I (18 elbows; 52.9%), can be separated from the AB, or type II (16 elbows; 47.1%), cannot be separated from the AB. Significant differences in frequencies of AB, PB, and CT types were identified between men and women. Morphological features were measured only for type I of each structure, and reliability was almost perfect. Conclusion: These results suggest that the AB, PB, and CT each can be classified into an independent form and an unclear form. Presence of the unclear form was suggested as one factor contributing to morphological variation. Clinical Relevance: This study may provide basic information for clarifying functional roles of the AB, PB, and CT.

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Sonographic Assessment of the Medial Ulnar Collateral Ligament Distal Ulnar Attachment

Abstract: We have successfully shown that the distal ulnar attachment of the MUCL can be visualized on high-resolution sonography. This preliminary work provides a framework for developing protocols for diagnosis of injuries to the distal ulnar collateral ligament.

Cited by 18 publications

References 22 publications

Understanding the medial ulnar collateral ligament of the elbow: Review of native ligament anatomy and function

Understanding the medial ulnar collateral ligament of the elbow: Review of native ligament anatomy and function

Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

Morphological Features of the Ulnar Collateral Ligament of the Elbow and Common Tendon of Flexor-Pronator Muscles

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