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Medial Collateral Ligament Strain with Partial Posteromedial Olecranon ResectionA Biomechanical Study
Srinath Kamineni, MD, FRCS(Tr+Orth)1; Neal S. ElAttrache, MD2; Shawn W. O'Driscoll, MD, PhD3; Christopher S. Ahmad, MD4; Hirotsune Hirohara, MD3; Patricia G. Neale, MS3; Kai-Nan An, PhD3; Bernard F. Morrey, MD3
1 Department of Orthopaedics and Biomechanics, Imperial College London and Hillingdon Hospital NHS Trust, South Kensington Campus, London SW7 2AZ, United Kingdom
2 Kerlan-Jobe Sports Clinic, 6801 Park Terrace Drive, Los Angeles, CA 90045-1539
3 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
4 Department of Orthopaedic Surgery, New York-Presbyterian Hospital, 622 West 168th Street, PH 11th Floor, New York, NY 10024-2838
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedic Biomechanics, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Nov 01;86(11):2424-2430
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Background: Partial resection of the posteromedial aspect of the olecranon in the treatment of valgus extension impingement osteophytosis is a well-described technique. It has been hypothesized that removal of the normal olecranon process, beyond the osteophytic margin, increases the strain in the anterior bundle of the medial collateral ligament.

Methods: We used an electromagnetic tracking device to investigate the strain in the anterior bundle of the medial collateral ligament as a function of increasing applied torque and posteromedial resections of the olecranon in seven cadaveric elbows. Applied torques under valgus stress consisted of hand weight, hand weight plus 1.75 Nm, and hand weight plus 3.5 Nm. Resections were conducted in sequential 3-mm increments, from 0 to 9 mm. We measured changes in the length of the anterior and posterior bands of the anterior bundle of the medial collateral ligament with strain gauges. The strains of the two bands were averaged, and the average was reported.

Results: The strain in the anterior bundle of the medial collateral ligament was found to increase with increasing flexion angle, valgus torque, and olecranon resection beyond 3 mm. In two elbows, the anterior bundle of the medial collateral ligament ruptured during testing following the 9-mm resection. There was a significant difference between the strain following the 6-mm resection and that following the 3-mm resection at 110° of flexion with 3.5 Nm of added torque (p = 0.004).

Conclusions: In this in vitro cadaver study, an increase in flexion angle, an increase in valgus torque, and resection of =6 mm led to an increase in strain in the anterior bundle of the medial collateral ligament. The non-uniform change in strain related to 3 mm of resection suggests that resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle.

Clinical Relevance: Resection of the olecranon beyond the posteromedial osteophytic margin increases the strain in the anterior bundle of the medial collateral ligament, with the potential for a consequent ligament rupture. We advise resection of the osteophytes only.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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