Medial collateral ligament strain with partial posteromedial olecranon resection

A biomechanical study

Srinath Kamineni, Neal S. Elattrache, Shawn W. O'Driscoll, Christopher S. Ahmad, Hirotsune Hirohara, Patricia G. Neale, Kai N. An, Bernard F. Morrey

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Partial resection of the posteromedial aspect of the olecranon in the treatment of valgus extension impingement osteophytosis is a well-described technique. It has been hypothesized that removal of the normal olecranon process, beyond the osteophytic margin, increases the strain in the anterior bundle of the medial collateral ligament. Methods: We used an electromagnetic tracking device to investigate the strain in the anterior bundle of the medial collateral ligament as a function of increasing applied torque and posteromedial resections of the olecranon in seven cadaveric elbows. Applied torques under valgus stress consisted of hand weight, hand weight plus 1.75 Nm, and hand weight plus 3.5 Nm. Resections were conducted in sequential 3-mm increments, from 0 to 9 mm. We measured changes in the length of the anterior and posterior bands of the anterior bundle of the medial collateral ligament with strain gauges. The strains of the two bands were averaged, and the average was reported. Results: The strain in the anterior bundle of the medial collateral ligament was found to increase with increasing flexion angle, valgus torque, and olecranon resection beyond 3 mm. In two elbows, the anterior bundle of the medial collateral ligament ruptured during testing following the 9-mm resection. There was a significant difference between the strain following the 6-mm resection and that following the 3-mm resection at 110° of flexion with 3.5 Nm of added torque (p = 0.004). Conclusions: In this in vitro cadaver study, an increase in flexion angle, an increase in valgus torque, and resection of ≥6 mm led to an increase in strain in the anterior bundle of the medial collateral ligament. The non-uniform change in strain related to 3 mm of resection suggests that resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle. Clinical Relevance: Resection of the olecranon beyond the posteromedial osteophytic margin increases the strain in the anterior bundle of the medial collateral ligament, with the potential for a consequent ligament rupture. We advise resection of the osteophytes only.

Original languageEnglish (US)
Pages (from-to)2424-2430
Number of pages7
JournalJournal of Bone and Joint Surgery - Series A
Volume86
Issue number11
StatePublished - Nov 2004

Fingerprint

Olecranon Process
Collateral Ligaments
Torque
Hand
Elbow
Weights and Measures
Osteophyte
Electromagnetic Phenomena
Cadaver
Ligaments
Rupture
Equipment and Supplies

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Kamineni, S., Elattrache, N. S., O'Driscoll, S. W., Ahmad, C. S., Hirohara, H., Neale, P. G., ... Morrey, B. F. (2004). Medial collateral ligament strain with partial posteromedial olecranon resection: A biomechanical study. Journal of Bone and Joint Surgery - Series A, 86(11), 2424-2430.

Medial collateral ligament strain with partial posteromedial olecranon resection : A biomechanical study. / Kamineni, Srinath; Elattrache, Neal S.; O'Driscoll, Shawn W.; Ahmad, Christopher S.; Hirohara, Hirotsune; Neale, Patricia G.; An, Kai N.; Morrey, Bernard F.

In: Journal of Bone and Joint Surgery - Series A, Vol. 86, No. 11, 11.2004, p. 2424-2430.

Research output: Contribution to journalArticle

Kamineni, S, Elattrache, NS, O'Driscoll, SW, Ahmad, CS, Hirohara, H, Neale, PG, An, KN & Morrey, BF 2004, 'Medial collateral ligament strain with partial posteromedial olecranon resection: A biomechanical study', Journal of Bone and Joint Surgery - Series A, vol. 86, no. 11, pp. 2424-2430.
Kamineni S, Elattrache NS, O'Driscoll SW, Ahmad CS, Hirohara H, Neale PG et al. Medial collateral ligament strain with partial posteromedial olecranon resection: A biomechanical study. Journal of Bone and Joint Surgery - Series A. 2004 Nov;86(11):2424-2430.
Kamineni, Srinath ; Elattrache, Neal S. ; O'Driscoll, Shawn W. ; Ahmad, Christopher S. ; Hirohara, Hirotsune ; Neale, Patricia G. ; An, Kai N. ; Morrey, Bernard F. / Medial collateral ligament strain with partial posteromedial olecranon resection : A biomechanical study. In: Journal of Bone and Joint Surgery - Series A. 2004 ; Vol. 86, No. 11. pp. 2424-2430.
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T1 - Medial collateral ligament strain with partial posteromedial olecranon resection

T2 - A biomechanical study

AU - Kamineni, Srinath

AU - Elattrache, Neal S.

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AU - Ahmad, Christopher S.

AU - Hirohara, Hirotsune

AU - Neale, Patricia G.

AU - An, Kai N.

AU - Morrey, Bernard F.

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N2 - Background: Partial resection of the posteromedial aspect of the olecranon in the treatment of valgus extension impingement osteophytosis is a well-described technique. It has been hypothesized that removal of the normal olecranon process, beyond the osteophytic margin, increases the strain in the anterior bundle of the medial collateral ligament. Methods: We used an electromagnetic tracking device to investigate the strain in the anterior bundle of the medial collateral ligament as a function of increasing applied torque and posteromedial resections of the olecranon in seven cadaveric elbows. Applied torques under valgus stress consisted of hand weight, hand weight plus 1.75 Nm, and hand weight plus 3.5 Nm. Resections were conducted in sequential 3-mm increments, from 0 to 9 mm. We measured changes in the length of the anterior and posterior bands of the anterior bundle of the medial collateral ligament with strain gauges. The strains of the two bands were averaged, and the average was reported. Results: The strain in the anterior bundle of the medial collateral ligament was found to increase with increasing flexion angle, valgus torque, and olecranon resection beyond 3 mm. In two elbows, the anterior bundle of the medial collateral ligament ruptured during testing following the 9-mm resection. There was a significant difference between the strain following the 6-mm resection and that following the 3-mm resection at 110° of flexion with 3.5 Nm of added torque (p = 0.004). Conclusions: In this in vitro cadaver study, an increase in flexion angle, an increase in valgus torque, and resection of ≥6 mm led to an increase in strain in the anterior bundle of the medial collateral ligament. The non-uniform change in strain related to 3 mm of resection suggests that resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle. Clinical Relevance: Resection of the olecranon beyond the posteromedial osteophytic margin increases the strain in the anterior bundle of the medial collateral ligament, with the potential for a consequent ligament rupture. We advise resection of the osteophytes only.

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