Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study
Background: The ulnar collateral ligament (UCL) complex of the elbow plays a primary role in valgus and posteromedial stability of the elbow. The anterior oblique ligament (AOL) of the UCL is believed to provide the majority of resistance to external forces on the medial elbow. The transverse ligame...
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doaj-f6079b90a0394fbbb0562dfa64a889f72021-05-30T04:44:57ZengElsevierJSES International2666-63832021-05-0153549553Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical studyGiovanni F. Solitro, PhD0Roberto Fattori, MD1Kevin Smidt, MD2Christian Nguyen, BS3Massimo Max Morandi, MD4R. Shane Barton, MD5Department of Orthopedic Surgery, Louisiana State University Health – Shreveport, Shreveport, LA, USAClincal Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, ItalyDepartment of Orthopedic Surgery, Louisiana State University Health – Shreveport, Shreveport, LA, USASchool of Medicine, Louisiana State University Health – Shreveport, Shreveport, LA, USADepartment of Orthopedic Surgery, Louisiana State University Health – Shreveport, Shreveport, LA, USADepartment of Orthopedic Surgery, Louisiana State University Health – Shreveport, Shreveport, LA, USA; Corresponding author: R. Shane Barton, MD, Department of Orthopaedic Surgery, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71103, USA.Background: The ulnar collateral ligament (UCL) complex of the elbow plays a primary role in valgus and posteromedial stability of the elbow. The anterior oblique ligament (AOL) of the UCL is believed to provide the majority of resistance to external forces on the medial elbow. The transverse ligament (TL) of the UCL is generally thought to have minimal contribution to the elbow’s overall stability. However, recent studies have suggested a more significant role for the TL. The primary aim of this study was to identify the TL’s contribution to the stability of the elbow joint in determining the joint stiffness and neutral zone variation in internal rotation. Methods: Twelve cadaveric elbows, set at a 90° flexion angle, were tested by applying an internal rotational force on the humerus to generate a medial opening torque at the level of the elbow. The specimens were preconditioned with 10 cycles of humeral internal rotation with sinusoidal torque ranging from 0 to 5 Nm. Elbow stiffness measures and joint neutral zone were first evaluated in its integrity during a final ramp loading. The test was subsequently repeated after cutting the TL at 33%, 66%, and 100% followed by the AOL in the same fashion. Results: The native UCL complex joint stiffness to internal rotation measured 1.52 ± 0.51 Nm/°. The first observable change occurred with 33% sectioning of the AOL, with further sectioning of the AOL minimizing the joint stiffness to 1.26 ± 0.32 Nm/° (P = .004). A 33% resection of the TL found an initial neutral zone variation of 0.376 ± 0.23° that increased to 0.771 ± 0.41° (P < .01) at full resection. These values were marginal when compared with the full resection of the AOL for which we have found 3.69 ± 1.65° (P < .01). Conclusion: The TL had no contribution to internal rotation elbow joint stiffness at a flexion angle of 90°. However, sequential sectioning of the TL was found to significantly increase the joint neutral zone when compared with the native cadaveric elbow at a flexion angle of 90°. This provides evidence toward the TL having some form of contribution to the elbow’s overall stability.http://www.sciencedirect.com/science/article/pii/S2666638321000712Ulnar collateral ligamentTransverse ligamentAnterior oblique ligamentCadaverBiomechanics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Giovanni F. Solitro, PhD Roberto Fattori, MD Kevin Smidt, MD Christian Nguyen, BS Massimo Max Morandi, MD R. Shane Barton, MD |
spellingShingle |
Giovanni F. Solitro, PhD Roberto Fattori, MD Kevin Smidt, MD Christian Nguyen, BS Massimo Max Morandi, MD R. Shane Barton, MD Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study JSES International Ulnar collateral ligament Transverse ligament Anterior oblique ligament Cadaver Biomechanics |
author_facet |
Giovanni F. Solitro, PhD Roberto Fattori, MD Kevin Smidt, MD Christian Nguyen, BS Massimo Max Morandi, MD R. Shane Barton, MD |
author_sort |
Giovanni F. Solitro, PhD |
title |
Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
title_short |
Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
title_full |
Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
title_fullStr |
Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
title_full_unstemmed |
Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
title_sort |
role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study |
publisher |
Elsevier |
series |
JSES International |
issn |
2666-6383 |
publishDate |
2021-05-01 |
description |
Background: The ulnar collateral ligament (UCL) complex of the elbow plays a primary role in valgus and posteromedial stability of the elbow. The anterior oblique ligament (AOL) of the UCL is believed to provide the majority of resistance to external forces on the medial elbow. The transverse ligament (TL) of the UCL is generally thought to have minimal contribution to the elbow’s overall stability. However, recent studies have suggested a more significant role for the TL. The primary aim of this study was to identify the TL’s contribution to the stability of the elbow joint in determining the joint stiffness and neutral zone variation in internal rotation. Methods: Twelve cadaveric elbows, set at a 90° flexion angle, were tested by applying an internal rotational force on the humerus to generate a medial opening torque at the level of the elbow. The specimens were preconditioned with 10 cycles of humeral internal rotation with sinusoidal torque ranging from 0 to 5 Nm. Elbow stiffness measures and joint neutral zone were first evaluated in its integrity during a final ramp loading. The test was subsequently repeated after cutting the TL at 33%, 66%, and 100% followed by the AOL in the same fashion. Results: The native UCL complex joint stiffness to internal rotation measured 1.52 ± 0.51 Nm/°. The first observable change occurred with 33% sectioning of the AOL, with further sectioning of the AOL minimizing the joint stiffness to 1.26 ± 0.32 Nm/° (P = .004). A 33% resection of the TL found an initial neutral zone variation of 0.376 ± 0.23° that increased to 0.771 ± 0.41° (P < .01) at full resection. These values were marginal when compared with the full resection of the AOL for which we have found 3.69 ± 1.65° (P < .01). Conclusion: The TL had no contribution to internal rotation elbow joint stiffness at a flexion angle of 90°. However, sequential sectioning of the TL was found to significantly increase the joint neutral zone when compared with the native cadaveric elbow at a flexion angle of 90°. This provides evidence toward the TL having some form of contribution to the elbow’s overall stability. |
topic |
Ulnar collateral ligament Transverse ligament Anterior oblique ligament Cadaver Biomechanics |
url |
http://www.sciencedirect.com/science/article/pii/S2666638321000712 |
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