Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction

Abstract

Background:

The number of throwing athletes with ulnar collateral ligament (UCL) injuries has increased recently, with a seemingly exponential increase of such injuries in adolescents. In cases of acute proximal or distal UCL insertion injuries or in partial-thickness injuries that do not respond to nonoperative management, UCL repair and augmentation rather than reconstruction may be a viable option.

Purpose/Hypothesis:

The purpose of this study was to biomechanically compare a new technique of augmented UCL repair versus a typical modified Jobe UCL reconstruction technique. The hypotheses were that (1) the repaired specimens would have less gap formation and a higher maximal torque to failure compared with the reconstruction group, and (2) while both groups would show an increase in gap formation after the simulated tear, the repair group would return closer to the native values compared with the reconstruction group.

Study Design:

Controlled laboratory study.

Methods:

Nine matched pairs of cadaveric arms were dissected to expose the UCL. Each elbow was mounted on a test frame at 90° of flexion. A cyclic valgus rotational torque was applied to the humerus with the UCL in its intact state and repeated in its surgically torn state. Finally, each specimen received either an augmented repair or reconstruction and was again put through the cyclic protocol, followed by a torque to failure.

Results:

Gap formation (0.51 ± 0.22 mm) in the torn state for the repair group was significantly higher (P = .04) than in the intact state (0.33 ± 0.12 mm). After the procedures, the repair group (0.35 ± 0.16 mm) showed greater resistance to gapping (P = .03) compared with the reconstruction group (0.53 ± 0.23 mm). No statistical differences were found for the maximum torque at failure, torsional stiffness, or gap formation during the failure test.

Conclusion:

The current study shows that this novel technique of augmented UCL repair replicates the time-zero failure strength of traditional graft reconstruction and appears to be more resistant to gapping at low cyclic loads.

Clinical Relevance:

This study demonstrates that this novel technique has important biomechanical properties, including time-zero strength and ultimate failure load, compared with the gold standard of UCL reconstruction. In some throwing athletes, this technique may supplant standard UCL reconstruction as the procedure of choice.