Annular Ligament Reconstruction Using the Distal Tendon of the Superficial Head of the Brachialis Muscle: An Anatomical Feasibility Study

Abstract

To evaluate the potential use of the longer tendinous insertion of the superficial head of the brachialis as a local graft source for elbow annular ligament reconstruction. The tendon of the superficial head of the brachialis muscle was harvested as a distally based graft in 24 unmatched, fresh-frozen cadaveric specimens. The tendon insertion on the proximal ulna was preserved, and the graft was passed around the proximal radius to recreate the annular ligament. We measured the total length of the graft, the length of graft required to approximate the posterior insertion of the annular ligament reconstruction, and the length of excess graft. The average length of the superficial head of the brachialis muscle tendon available for use in reconstruction was 81 mm. The average length of tendon required to approximate the posterior anatomical insertion of the annular ligament was 69 mm. The average length of excess tendon was 12 mm. The tendon graft of the superficial head permitted potential annular ligament reconstruction in all specimens. A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. Future studies should consider the biomechanical stability of this ligament reconstruction, choices of optimal posterior graft fixation, and clinical outcomes. Incompetence of the annular ligament may cause persisting instability of the proximal radius requiring ligament reconstruction. The anatomic feasibility of using the distal tendon of the superficial head of the brachialis muscle as a distally based graft source is evaluated for annular ligament reconstruction.