Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study

Giovanni F Solitro; Roberto Fattori; Kevin Smidt; Christian Nguyen; Massimo Max Morandi; R Shane Barton

doi:10.1016/j.jseint.2021.01.009

Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study

JSES Int. 2021 Mar 23;5(3):549-553. doi: 10.1016/j.jseint.2021.01.009. eCollection 2021 May.

Authors

Giovanni F Solitro¹, Roberto Fattori², Kevin Smidt¹, Christian Nguyen³, Massimo Max Morandi¹, R Shane Barton¹

Affiliations

¹ Department of Orthopedic Surgery, Louisiana State University Health - Shreveport, Shreveport, LA, USA.
² Clincal Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
³ School of Medicine, Louisiana State University Health - Shreveport, Shreveport, LA, USA.

Abstract

Background: The ulnar collateral ligament (UCL) complex of the elbow plays a primary role in valgus and posteromedial stability of the elbow. The anterior oblique ligament (AOL) of the UCL is believed to provide the majority of resistance to external forces on the medial elbow. The transverse ligament (TL) of the UCL is generally thought to have minimal contribution to the elbow's overall stability. However, recent studies have suggested a more significant role for the TL. The primary aim of this study was to identify the TL's contribution to the stability of the elbow joint in determining the joint stiffness and neutral zone variation in internal rotation.

Methods: Twelve cadaveric elbows, set at a 90° flexion angle, were tested by applying an internal rotational force on the humerus to generate a medial opening torque at the level of the elbow. The specimens were preconditioned with 10 cycles of humeral internal rotation with sinusoidal torque ranging from 0 to 5 Nm. Elbow stiffness measures and joint neutral zone were first evaluated in its integrity during a final ramp loading. The test was subsequently repeated after cutting the TL at 33%, 66%, and 100% followed by the AOL in the same fashion.

Results: The native UCL complex joint stiffness to internal rotation measured 1.52 ± 0.51 Nm/°. The first observable change occurred with 33% sectioning of the AOL, with further sectioning of the AOL minimizing the joint stiffness to 1.26 ± 0.32 Nm/° (P = .004). A 33% resection of the TL found an initial neutral zone variation of 0.376 ± 0.23° that increased to 0.771 ± 0.41° (P < .01) at full resection. These values were marginal when compared with the full resection of the AOL for which we have found 3.69 ± 1.65° (P < .01).

Conclusion: The TL had no contribution to internal rotation elbow joint stiffness at a flexion angle of 90°. However, sequential sectioning of the TL was found to significantly increase the joint neutral zone when compared with the native cadaveric elbow at a flexion angle of 90°. This provides evidence toward the TL having some form of contribution to the elbow's overall stability.

Keywords: Anterior oblique ligament; Biomechanics; Cadaver; Transverse ligament; Ulnar collateral ligament.