Background: 

To improve the clinical results of lateral ulnar collateral ligament (LUCL) reconstruction of the elbow joint, better understanding of the anatomy of the aponeuroses and joint capsule could be relevant. This study considers the previously described anatomy of the LUCL in relation to the related aponeuroses and joint capsule rather than as a discrete ligament. We hypothesized that the deep aponeuroses of the superficial extensor muscles and supinator form a relevant portion of the joint capsule previously defined as the LUCL.

Methods: 

Twenty-four elbows (12 right) from 21 embalmed cadavers (age at the time of death, 54 to 99 years) were included in the study. Twenty elbows were studied macroscopically and 4, histologically. The joint capsule was detached from the bones, and local thickness was quantitatively analyzed using micro-computed tomography (micro-CT).

Results: 

The supinator aponeurosis and joint capsule intermingled to form a thick membrane (mean and standard deviation, 4.8 ± 1.2 mm), which we termed “the capsulo-aponeurotic membrane.” It was thicker than the anterior (1.3 ± 0.4 mm) and posterior (2.5 ± 0.9 mm) parts of the capsule of the humeroradial joint (p < 0.001). The capsulo-aponeurotic membrane had a wide attachment on the distal part of the extensor digitorum communis and extensor digiti minimi (EDC/EDM) origin of the humerus, the lateral part of the coronoid process, and the posterior part of the radial notch of the ulna. The humeral attachment had a fibrocartilaginous structure. The deep aponeuroses of the EDC and extensor carpi ulnaris (ECU) were connected to the capsulo-aponeurotic membrane.

Conclusions: 

The capsulo-aponeurotic membrane was composed of the supinator aponeurosis and joint capsule and was attached to the lateral epicondyle of the humerus, radial side of the coronoid process, and posterior part of the radial notch on the ulna. The entire structure appeared identical to the commonly defined lateral collateral ligament. The most posterior part was connected to the EDC and ECU aponeuroses, which is commonly labeled the LUCL but does not exist as a discrete ligament.

Clinical Relevance: 

Consideration of the accurate anatomy of the extensive attachment of the capsulo-aponeurotic membrane could provide useful clues for improvement in techniques of LUCL reconstruction and lateral epicondylitis pathology.

中文翻译：

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肘关节外侧尺侧副韧带：从与周围纤维结构的连接角度重新考虑解剖学

背景： 

为了改善肘关节外侧尺侧副韧带（LUCL）重建的临床结果，更好地了解腱膜和关节囊的解剖结构可能是相关的。本研究考虑了先前描述的与相关腱膜和关节囊相关的 LUCL 解剖结构，而不是离散韧带。我们假设浅伸肌和旋后肌的深部腱膜形成了先前定义为 LUCL 的关节囊的相关部分。

方法： 

该研究包括来自 21 具防腐处理的尸体（死亡时年龄为 54 至 99 岁）的 24 个肘部（12 个右侧）。20 个肘部进行了宏观研究，4 个肘部进行了组织学研究。将关节​​囊从骨骼中分离出来，并使用微型计算机断层扫描 (micro-CT) 对局部厚度进行定量分析。

结果： 

旋后肌腱膜和关节囊混合形成厚膜（平均值和标准偏差，4.8 ± 1.2 mm），我们将其称为“囊-腱膜”。它比肱桡关节囊的前部 (1.3 ± 0.4 mm) 和后部 (2.5 ± 0.9 mm) 厚 (p < 0.001)。腱膜膜在肱骨的总指伸肌和小指伸肌（EDC/EDM）起点的远端、冠状突的外侧和桡侧切迹的后部有广泛的附着。尺骨。肱骨附件具有纤维软骨结构。EDC 和尺侧腕伸肌 (ECU) 的深腱膜与囊膜腱膜相连。

结论： 

囊-腱膜由旋后肌腱膜和关节囊组成，附着于肱骨外上髁、冠状突桡侧、尺骨桡侧切迹后部。整个结构看起来与通常定义的侧副韧带相同。最后部分连接到 EDC 和 ECU 腱膜，通常标记为 LUCL，但不作为离散韧带存在。

临床相关性： 

考虑囊腱膜广泛附着的准确解剖可以为改进 LUCL 重建和外上髁炎病理学技术提供有用的线索。