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Noriego D, Carrera A, Tubbs RS, Guibernau J, San Millán M, Iwanaga J, Cateura A, Sañudo J, Reina F. The lateral ulnar collateral ligament: Anatomical and structural study for clinical application in the diagnosis and treatment of elbow lateral ligament injuries. Clin Anat 2023; 36:866-874. [PMID: 36509693 DOI: 10.1002/ca.23991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
The lateral ulnar collateral ligament (LUCL) is considered one of the main stabilizers of the elbow. However, its anatomical description is not well established. Imaging techniques do not always have agreed upon parameters for the study of this ligament. Therefore, herein, we studied the macro and microanatomy of the LUCL to establish its morphological and morphometric characteristics more precisely. Fifty-five fresh-frozen human elbows underwent dissection of the lateral collateral ligament. Morphological characteristics were studied in detail. Ultrasound (US) and magnetic resonance (MR) were done before dissection. Two specimens were selected for PGP 9.5 S immunohistochemistry. Ten additional elbows were analyzed by E12 sheet plastination. LUCL was identified in all specimens and clearly defined by E12 semi-thin sections. It fused with the common extensor tendon and the radial ligament. The total length of the LUCL was 48.50 mm at 90°, 46.76 mm at maximum flexion and 44.10 mm at complete extension. Three morphological insertion variants were identified. Both US and MR identified the LUCL in all cases. It was hypoechoic in the middle and distal third in 85%. The LUCL was hypointense on MR in 95%. Free nerve endings were present on histology. The LUCL is closely related to the anular ligament. It is stretched during flexion and supination. US and MR can reliably identify its fibers. Anatomical data are relevant to the surgeon who repairs the ligaments of the elbow. Also, to the radiologist and pain physician who interpret imaging and treat patients with pain syndromes of the elbow.
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Affiliation(s)
- Diana Noriego
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
- Department of Orthopedic Surgery, University Hospital Dr. Trueta, Girona, Spain
| | - Anna Carrera
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Jorge Guibernau
- IDIBGI Girona Biomedical Research Center, Girona, Spain
- Department of Radiology, Salut Empordà Hospital Foundation, Figueres, Spain
| | - Marta San Millán
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aïda Cateura
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Jose Sañudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Reina
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
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Xu G, Chen W, Yang Z, Yang J, Liang Z, Li W. Finite Element Analysis of Elbow Joint Stability by Different Flexion Angles of the Annular Ligament. Orthop Surg 2022; 14:2837-2844. [PMID: 36106628 PMCID: PMC9627061 DOI: 10.1111/os.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The injury of the annular ligament can change the stress distribution and affect the stability of the elbow joint, but its biomechanical mechanism is unclear. The present study investigated the biomechanical effects of different flexion angles of the annular ligament on elbow joint stability. Methods A cartilage and ligament model was constructed using SolidWorks software according to the magnetic resonance imaging results to simulate the annular ligament during normal, loosened, and ruptured conditions at different buckling angles (0°, 30°, 60°, 90°, and 120°). The fixed muscle strengths were 40 N (F1), 20 N (F2), 20 N (F3), 20 N (F4), and 20 N (F5) for the triceps, biceps, and brachial tendons and the base of the medial collateral ligament and lateral collateral ligament. The different elbow three‐dimensional (3D) finite element models were imported into ABAQUS software to calculate and analyze the load, contact area, contact stress, and stress of the medial collateral ligament of the olecranon cartilage. Results The results showed that the stress value of olecranon cartilage increased under different conditions (normal, loosened, and ruptured annular ligament) with elbow extension, and the maximum stress value of olecranon cartilage was 2.91 ± 0.24 MPa when the annular ligament was ruptured. The maximum contact area of olecranon cartilage was 254 mm2 with normal annular ligament when the elbow joint was flexed to 30°, while the maximum contact area of loosened and ruptured annular ligament was 283 and 312 mm2 at 60° of elbow flexion, and then decreased gradually. The maximum stress of the medial collateral ligament was 6.52 ± 0.23, 11.51 ± 0.78, and 18.74 ± 0.94 MPa under the different conditions, respectively. Conclusion When the annular ligament ruptures, it should be reconstructed as much as possible to avoid the elevation of stress on the surface of the medial collateral ligament of the elbow and the annular cartilage, which may cause clinical symptoms.
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Affiliation(s)
- Guangming Xu
- Department of Orthopaedics Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine Shenzhen China
| | - Wenzhao Chen
- Department of Orthopaedics Foshan Jianxiang Orthopedic Hospital Foshan China
| | - Zhengzhong Yang
- Department of Orthopaedics Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital Shenzhen China
| | - Jiyong Yang
- Department of Orthopaedics Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital Shenzhen China
| | - Ziyang Liang
- Department of Orthopaedics The Second Xiangya Hospital of Central South University Changsha China
| | - Wei Li
- Department of Orthopaedics Shenzhen Pingle Orthopedic Hospital & Shenzhen Pingshan Traditional Chinese Medicine Hospital Shenzhen China
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