Review of Anatomy of the Medial Ulnar Collateral Ligament Complex of the Elbow-Reference-Cited by-同舟云学术

Review of Anatomy of the Medial Ulnar Collateral Ligament Complex of the Elbow

Published:2020-01-27 Issue:1 Volume:13 Page:96-102
ISSN:1935-9748
Container-title:Current Reviews in Musculoskeletal Medicine
language:en
Short-container-title:Curr Rev Musculoskelet Med

Author:

Cinque Mark E.,Schickendantz Mark,Frangiamore Salvatore

Publisher

Springer Science and Business Media LLC

Subject

Orthopedics and Sports Medicine

Link

http://link.springer.com/content/pdf/10.1007/s12178-020-09609-z.pdf

Reference26 articles.

1. •• Camp CL, Tubbs TG, Fleisig GS, Dines JS, Dines DM, Altchek DW, et al. The relationship of throwing arm mechanics and elbow varus torque: Within-Subject Variation for Professional Baseball Pitchers Across 82,000 Throws. Am J Sports Med. 2017;45:3030–5 Purpose: To describe the within-subject relationship between elbow varus torque and arm slot and arm rotation in professional baseball pitchers. Methods: A total of 81 professional pitchers performed 82,000 throws while wearing a motusBASEBALL sensor and sleeve. These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot (angle of the forearm relative to the ground at ball release), arm speed (maximal rotational velocity of the forearm), arm rotation (maximal external rotation of the throwing arm relative to the ground), and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were used to estimate the relationship between elbow varus torque and arm slot, arm speed, and arm rotation within individual pitchers. Results: All 3 metrics—arm slot (χ2= 428,P< .001), arm speed (χ2= 57,683,P< .001), and arm rotation (χ2= 1392,P< .001)—were found to have a significant relationship with elbow varus torque. Within individual athletes, a 1-N m increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116°/s increase in arm speed, and an 8° increase in arm rotation. Conclusion: Elbow varus torque increased significantly as pitchers increased their arm rotation during the arm cocking phase, increased the rotational velocity of their arm during the arm acceleration phase of throwing, and decreased arm slot at ball release. Thus, shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are interrelated and should be considered collectively when treating pitchers.

2. Dodson CC, Altchek DW. Ulnar collateral ligament reconstruction revisited: the procedure I use and why. Sports Health. 2012;4:433–7.

3. Udall JH, Fitzpatrick MJ, McGarry MH, Leba TB, Lee TQ. Effects of flexor-pronator muscle loading on valgus stability of the elbow with an intact, stretched, and resected medial ulnar collateral ligament. J Shoulder Elb Surg. 2009;18:773–8.

4. Alcid JG, Ahmad CS, Lee TQ. Elbow anatomy and structural biomechanics. Clin Sports Med. 2004;23(503–517):vii.

5. •• Frangiamore SJ, Moatshe G, Kruckeberg BM, Civitarese DM, Muckenhirn KJ, Chahla J, et al. Qualitative and quantitative analyses of the dynamic and static stabilizers of the medial elbow: an anatomic study. The American Journal of Sports Medicine. 2018;46:687–94 Purpose: To perform qualitative and quantitative anatomic evaluations of the medial elbow-UCL complex with specific attention to pertinent osseous and soft tissue landmarks. Methods: Ten nonpaired, fresh-frozen human cadaveric elbows (mean age, 54.1 years [range, 42–64 years]; all male) were utilized for this study. Quantitative analysis was performed with a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks and tendon and ligament footprints on the humerus, ulna, and radius. Results: The anterior bundle of the UCL attached 8.5 mm (95% CI, 6.9–10.0) distal and 7.8 mm (95% CI, 6.6–9.1) lateral to the medial epicondyle, 1.5 mm (95% CI, 0.5–2.5) distal to the sublime tubercle, and 7.3 mm (95% CI, 6.1–8.5) distal to the joint line on the ulna along the ulnar ridge. The flexor digitorum superficialis (FDS) ulnar tendinous insertion was closely related and interposed within the anterior bundle of the UCL, overlapping with 45.6% (95% CI, 38.1–53.6) of the length of the anterior bundle of the UCL. The flexor carpi ulnaris (FCU) attached 1.9 mm (95% CI, 0.8–2.9) posterior and 1.3 mm (95% CI, 0.6–3.2) proximal to the sublime tubercle and overlapped with 20.9% (95% CI, 7.2–34.5) of the area of the distal footprint of the anterior bundle of the UCL. Conclusion: The anterior bundle of the UCL had consistent attachment points relative to the medial epicondyle and sublime tubercle. The ulnar limb of the FDS and FCU tendons demonstrated consistent insertions onto the ulnar attachment of the anterior bundle of the UCL. These anatomic relationships are important to consider when evaluating distal UCL tears both operatively and nonoperatively. Excessive stripping of the sublime tubercle should be avoided during UCL reconstruction to prevent violation of these tendinous attachments.

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