Biomechanical Analysis of Medial Collateral Ligament Reconstruction Grafts of the Elbow

Abstract

Background There are no biomechanical studies evaluating different tendon grafts for elbow medial collateral ligament reconstruction. Hypothesis Using a larger tendon for the graft will yield greater resistance to valgus load for medial collateral ligament docking technique reconstructions. The type of graft used for a medial collateral ligament docking technique reconstruction will have a significant effect on the resistance to valgus loads. Study Design Controlled laboratory study. Methods Cadaveric elbows from male donors were cyclically loaded to 3 and 5 mm elongation, both intact and after a docking technique medial collateral ligament reconstruction using palmaris longus, gracilis, semitendinosus, and patellar tendon grafts. Results There was no significant difference in load to 3 or 5 mm elongation, number of cycles to failure, or stiffness between any tendon graft studied. Every tendon graft reconstruction tested was significantly weaker and less stiff than was the native medial collateral ligament. Conclusion There appears to be no biomechanical advantage to be gained by using a larger tendon graft instead of a palmaris longus graft. Clinical Relevance The most readily available graft source with the lowest morbidity (often the palmaris longus tendon) should be used for medial collateral ligament reconstruction.