The Journal of Bone and Joint Surgery (American). 2007;89:2011-2017.
doi:10.2106/JBJS.F.00868
© 2007 The Journal of Bone and Joint Surgery, Inc.
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The in Vivo Isometric Point of the Lateral Ligament of the Elbow

Hisao Moritomo, MD, PhD1, Tsuyoshi Murase, MD, PhD1, Sayuri Arimitsu, MD1, Kunihiro Oka, MD1, Hideki Yoshikawa, MD, PhD1 and Kazuomi Sugamoto, MD, PhD1

1 Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan

Investigation performed at the Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Grants-in-Aid for Scientific Research, the Ministry of Education, Science and Culture of Japan. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Many reports have discussed reconstruction of the lateral ulnar collateral ligament for the treatment of posterolateral rotatory instability of the elbow, but information regarding the isometric point of the lateral ligament of the elbow is limited. The purposes of the present study were to investigate the in vivo and three-dimensional length changes of the lateral ulnar collateral ligament and the radial collateral ligament during elbow flexion in order to clarify the role of these ligaments as well as to identify the isometric point for the reconstructed lateral ulnar collateral ligament on the humerus where the grafted tendon should be anchored.

Methods: We studied in vivo and three-dimensional kinematics of the normal elbow joint with use of a markerless bone-registration technique. Magnetic resonance images of the right elbows of seven healthy volunteers were acquired in six positions between 0° and 135° of flexion. We created three-dimensional models of the elbow bones, the lateral ulnar collateral ligament, and the radial collateral ligament. The ligament models were based on the shortest calculated paths between each origin and insertion in three-dimensional space with the bone as obstacles. We calculated two types of three-dimensional distances for the ligament paths with each flexion position: (1) between the center of the capitellum and the distal insertions of the ligaments (to investigate the physiological change in ligament length) and (2) between eight different humeral origins and the one typical insertion of the lateral ulnar collateral ligament (to identify the isometric point of the reconstructed lateral ulnar collateral ligament).

Results: The three-dimensional distancefor the lateral ulnar collateral ligament was found to increase during elbow flexion, whereas that for the radial collateral ligament changed little. The path of the lateral ulnar collateral ligament gradually developed a detour because of the osseous protrusion of the lateral condyle with flexion. The most isometric point for the reconstructed lateral ulnar collateral ligament was calculated to be at a point 2 mm proximal to the center of the capitellum.

Conclusions: The radial collateral ligament is essentially isometric, but the lateral ulnar collateral ligament is not. The lateral ulnar collateral ligament is loose in elbow extension and becomes tight with elbow flexion.

Clinical Relevance: The present study suggests that the isometric point for the lateral ulnar collateral ligament graft origin is approximately 2 mm proximal to the center of the capitellum.


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