Abstract

Purpose

Simple elbow dislocations are accompanied with lateral ulnar collateral ligament ruptures. For persisting instability, surgery is indicated to prevent chronic posterolateral rotatory instability. After lateral collateral ligament (LCL) complex repair the repair is protected by temporary immobilization, limited range of motion and hinged bracing. Internal bracing is an operative alternative augmenting the LCL repair using non-absorbable suture tapes. However, the stability of LCL repair with and without additional augmentation remains unclear. The hypothesis was that LCL repair with additional suture tape augmentation would improve load to failure. Secondary goal of this study was to evaluate different humeral fixation techniques. A humeral fixation using separate anchors for the LCL repair and the augmentation was not expected to provide superior stability compared to using only one single anchor.

Methods

Twenty-one elbows were tested. A cyclic varus rotational torque of 0.5–3.5 Nm was applied in 90°, 60°, 30°, and 120° elbow flexion to the intact, torn, and repaired LCLs. The specimens were randomized into three groups: repair alone (group I), repair with additional internal bracing using two anchors (group II), repair using one humeral anchor (group III). A load-to-failure protocol was conducted.

Results

Load to failure was significantly higher in groups II (26.6 Nm; P = 0.017) and III (23.18 Nm; P = 0.038) than in group I (12.13 Nm). No significant difference was observed between group II and III. All specimens lost reduction after LCL dissection by a mean of 4.48° ± 4.99° (range 0.66–15.82). The mean reduction gain after repair was 7.21° ± 4.97° (2.70–21.23; mean over reduction, 2.73°). The laxity was comparable between the intact and repaired LCLs (n.s.), except for varus movements at 30° in group II (P = 0.035) and 30° (P = 0.001) and 120° in group III (P = 0.008) with significantly less laxity. Inserting the ulnar suture anchor showed failure in the thread in 10 cases.

Conclusion

LCL repair with additional internal bracing yielded higher load to failure than repair alone. Repair with additional internal bracing for the humeral side using one anchor was sufficient. A higher primary stability would facilitate postoperative management and allow immediate functional treatment. Reducing the number of humeral anchors would save costs.

中文翻译：

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尺侧副韧带缝合带的增加增加了模拟后外侧旋转不稳中的失败负荷

摘要

目的

简单的肘关节脱位伴有尺侧外侧副韧带断裂。对于持续的不稳定性，需要手术预防慢性后外侧旋转不稳定性。外侧副韧带（LCL）复合体修复后，通过临时固定，活动范围有限和铰接支撑来保护修复。内部支撑是使用不可吸收的缝合带增加LCL修复的有效替代方法。然而，有或没有其他增强的LCL修复的稳定性仍不清楚。假说是，通过增加缝线带的修补来修复LCL可以提高失败的负荷。这项研究的次要目标是评估不同的肱骨固定技术。

方法

测试二十一个肘。在完整，撕裂和修复的LCL的90°，60°，30°和120°肘部弯曲中施加0.5-3.5 Nm的循环内翻旋转扭矩。将标本随机分为三组：单独修复（I组），使用两个锚固件进行额外的内部支撑修复（II组），使用肱骨锚固件进行修复（III组）。进行了从加载到失败的协议。

结果

II组（26.6 Nm; P  = 0.017）和III组（23.18 Nm; P  = 0.038）的失效载荷明显高于I组（12.13 Nm）。在第二组和第三组之间没有观察到显着差异。LCL解剖后，所有标本均减少了平均4.48°±4.99°（范围0.66–15.82）的减少。修复后的平均复位增益为7.21°±4.97°（2.70–21.23；平均过复位为2.73°）。松散度在完整的和修复的LCL之间是相当的（ns。），除了II组在30°（P  = 0.035）和 III组在30°（P = 0.001）和120°（P  = 0.008）内翻运动外。轻松度大大降低。插入尺骨缝合锚钉显示10例螺纹断裂。

结论

带有额外内部支撑的LCL维修比单独维修产生更高的失效负载。使用一个锚固器对肱骨侧进行额外的内部支撑即可修复。较高的初级稳定性将有助于术后处理并允许立即进行功能治疗。减少肱骨锚的数量可以节省成本。