The moving valgus stress test produces more ulnar collateral ligament change in length during extension than during flexion: a biomechanical study

Abstract

Hypothesis and background: Injuries to the elbow medial ulnar collateral ligament (mUCL) pose a diagnostic challenge, with the moving valgus stress test (MVST) currently accepted as the gold-standard clinical test. This study sought to biomechanically evaluate the change in length of the ulnar collateral ligament (UCL) during flexion-extension using a null hypothesis that the mUCL will not experience a greater change in length with movement than with static loading.

Methods: Seven fresh-frozen human cadaveric elbows were tested with static and dynamic valgus stress. We measured (1) ligament length with a multi-camera optical system, (2) elbow flexion with an incremental encoder, and (3) valgus deviation with an electronic inclinometer. With a force applied to the wrist to simulate a clinical stress examination, the elbow was flexed and extended in a physiological elbow simulator to mimic the flexion and extension of the MVST.

Results: The simulated MVST produced more elongation of the UCL compared with static stress testing (P < .001). Ninety degrees of flexion produced the highest mean change, and the anterior and posterior bands demonstrated different length change characteristics. Comparison of dynamic flexion and extension showed a statistically significant difference in change in length: The mUCL reached the greatest change during extension, with the greatest changes during extension near 90° of flexion.

Discussion and conclusion: The MVST produces significantly more elongation of the mUCL than either a static test or a moving test in flexion. This study provides biomechanical evidence of the validity of the MVST as a superior examination technique for injuries to the UCL.

Keywords: MVST; biomechanics; clinical examination; elbow; medial ulnar collateral ligament; stress test; valgus loading.