Restoring Isometry in Lateral Ulnar Collateral Ligament Reconstruction

Purpose To ascertain whether placing the humeral attachment of the lateral ulnar collateral ligament (LUCL) at the humeral center of rotation (hCOR) on the humerus would provide the most isometric reconstruction. Methods We analyzed 13 cadaver limbs from mid-humerus to the hand. The morphology of the ligament complex was assessed. The hCOR was then found using radiographic parameters. We chose 7 points on the humerus located at and around the hCOR and 3 points paralleling the supinator crest of the ulna and then calculated distances from these points using a digital caliper at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 130 degrees flexion. Differences in potential ligamentous lengths (termed graft elongation) were then calculated and statistical analysis was performed. Results There was no perfectly isometric point along the humerus or ulna. However, in all specimens the hCOR was the most isometric point for the humeral reconstruction site, with an average graft elongation of 1.1 mm. Differences in humeral tunnel position dramatically affected graft elongation at all 3 ulnar insertions. Overall, ulnar position had a minimal effect on graft elongation. Conclusions Although no perfectly isometric points were found, the humeral center of rotation consistently reproduced the most isometry when assessing graft elongation over range of motion. These data may assist surgeons in proper tunnel placement in LUCL reconstruction. Clinical relevance In LUCL reconstruction, the humeral tunnel should be placed as close as possible to the center of rotation, whereas placement on the ulna is less critical. Copyright (C) 2015 by the American Society for Surgery of the Hand. All rights reserved