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Abstract
Computational elbow joint models, capable of simulating medial collateral ligament deficiency, can be extremely valuable tools for surgical planning and refinement of therapeutic strategies. The objective of this study was to investigate the effects of varying levels of medial collateral ligament deficiency on elbow joint stability using subject-specific computational models. Two elbow joint models were placed at the pronated forearm position and passively flexed by applying a vertical downward motion on humeral head. The models included three-dimensional bone geometries, multiple ligament bundles wrapped around the joint, and the discretized cartilage representation. Four different ligament conditions were simulated: All intact ligaments, isolated medial collateral ligament (MCL) anterior bundle deficiency, isolated MCL posterior bundle deficiency, and complete MCL deficiency. Minimal kinematic differences were observed for isolated anterior and posterior bundle deficient elbows. However, sectioning the entire MCL resulted in significant kinematic differences and induced substantial elbow instability. Joint contact areas were nearly similar for the intact and isolated posterior bundle deficiency. Minor differences were observed for the isolated anterior bundle deficiency, and major differences were observed for the entire MCL deficiency. Complete elbow dislocations were not observed for any ligament deficiency level. As expected, during isolated anterior bundle deficiency, the remaining posterior bundle experiences higher load and vice versa. Overall, the results indicate that either MCL anterior or posterior bundle can provide anterior elbow stability, but the anterior bundle has a somewhat bigger influence on joint kinematics and contact characteristics than posterior one. A study with a larger sample size could help to strengthen the conclusion and statistical significant.
Highlights
Elbow dislocations are very common in adults and children and represent 11–28% of all elbow injuries at an average annual rate of 6 to 13 cases per 100,000 population [1,2]
Dislocations of the elbow can be simple, where the dislocation occurs with the medial collateral ligament (MCL) and/or lateral collateral ligament injury or can be complex, where the dislocation causes both ligament injury and fracture of the articular surface [2]
This study investigated the elbow joint behavior during passive flexion in the presence of medial collateral ligament deficiency in a computational model
Summary
Elbow dislocations are very common in adults and children and represent 11–28% of all elbow injuries at an average annual rate of 6 to 13 cases per 100,000 population [1,2]. Dislocations of the elbow can be simple, where the dislocation occurs with the medial collateral ligament (MCL) and/or lateral collateral ligament injury or can be complex, where the dislocation causes both ligament injury and fracture of the articular surface [2]. The MCL provides resistance to valgus motion of the elbow joint. While the bony articulation contributes to stability, the MCL complex provides the primary medial elbow stabilization. MCL injury has been reported as high as 100% [3]. MCL injury can produce chronic pain in the medial aspect of the elbow and can result in problems in other surrounding areas such as the ulnar nerve, the flexorpronator musculotendinous unit, the radiocapitellar joint, and the posterior compartment of the elbow [5].2018, MCL can cause significant joint morbidity and may end the career for overhead Bioengineering
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