Abstract：
There has been a renewed interest and, recently, wider implementation of ulnar collateral ligament (UCL) repair in throwing athletes because of improvement in ligament repair technology and corresponding outcome data.
To compare the biomechanical parameters and failure mode between 2 brace-tightening techniques for UCL repair.
Controlled laboratory study.
Eleven matched pairs of cadaveric arms were procured. One limb from each pair underwent UCL repair with suture tape augmentation with either (1) attempted restoration of physiologic ligament tension or (2) maximal tension. Each specimen was subjected to 10 cycles of subfailure valgus torque at 90º of flexion in the intact state after UCL avulsion and then after UCL repair. Specimens were then torqued to failure. Articular contact mechanics, linear gap distance, angular displacement, failure torque, failure stiffness, and suture tape pull-through length were recorded. Two-way analysis of variance and paired t tests were used to test for statistical differences.
There was a significant effect (P = .01) of tightening on joint contact area. There was a significant decrease in gap distance (P = .03) and angular displacement (P = .004) from the torn condition to the repaired condition for the maximum tension group, without a significant difference in gap distance from the intact condition. Failure torque and stiffness were not significantly different between groups, although there was a significant difference (P = .001) in the overall suture tape pull-through length.
Although there are potential physiologic changes at time zero-including significant decreases in contact area, normalized gap distance, and normalized angular displacement with maximal tension repair-examination of failure biomechanics suggests that these effects may be mitigated over time within the construct by suture tape pull-through at the tape-anchor interface. Neither method of UCL repair with suture tape augmentation resulted in overconstraint of the elbow joint compared with the native ligament biomechanics.
As more long-term outcome data from UCL repair with suture tape augmentation emerge, there will be wider implementation with various techniques to tension the suture tape. Examining the potential biomechanical sequelae of the UCL repair construct applied under maximal tension will help further refine recommendations for surgeons who utilize this technique for UCL repair.
To compare the biomechanical parameters and failure mode between 2 brace-tightening techniques for UCL repair.
Controlled laboratory study.
Eleven matched pairs of cadaveric arms were procured. One limb from each pair underwent UCL repair with suture tape augmentation with either (1) attempted restoration of physiologic ligament tension or (2) maximal tension. Each specimen was subjected to 10 cycles of subfailure valgus torque at 90º of flexion in the intact state after UCL avulsion and then after UCL repair. Specimens were then torqued to failure. Articular contact mechanics, linear gap distance, angular displacement, failure torque, failure stiffness, and suture tape pull-through length were recorded. Two-way analysis of variance and paired t tests were used to test for statistical differences.
There was a significant effect (P = .01) of tightening on joint contact area. There was a significant decrease in gap distance (P = .03) and angular displacement (P = .004) from the torn condition to the repaired condition for the maximum tension group, without a significant difference in gap distance from the intact condition. Failure torque and stiffness were not significantly different between groups, although there was a significant difference (P = .001) in the overall suture tape pull-through length.
Although there are potential physiologic changes at time zero-including significant decreases in contact area, normalized gap distance, and normalized angular displacement with maximal tension repair-examination of failure biomechanics suggests that these effects may be mitigated over time within the construct by suture tape pull-through at the tape-anchor interface. Neither method of UCL repair with suture tape augmentation resulted in overconstraint of the elbow joint compared with the native ligament biomechanics.
As more long-term outcome data from UCL repair with suture tape augmentation emerge, there will be wider implementation with various techniques to tension the suture tape. Examining the potential biomechanical sequelae of the UCL repair construct applied under maximal tension will help further refine recommendations for surgeons who utilize this technique for UCL repair.
摘要：
■有了新的兴趣，最近,由于韧带修复技术和相应结果数据的改进，在投掷运动员中更广泛地实施尺侧副韧带（UCL）修复。
■比较用于UCL修复的2种支具-收紧技术之间的生物力学参数和失效模式。
■对照实验室研究。
■采购了11对匹配的尸体臂。每对中的一条肢体都进行了UCL修复，并通过（1）尝试恢复生理韧带张力或（2）最大张力来增强缝合胶带。在UCL撕脱后，然后在UCL修复后，在完整状态下，每个标本在屈曲90º下经受10个周期的亚失效外翻扭矩。然后将标本扭转为失败。关节接触力学，线性间隙距离,角位移,失效扭矩,破坏刚度,并记录缝合胶带拉穿长度。采用双向方差分析和配对t检验进行统计学差异检验。
■拧紧对关节接触面积有显着影响（P=.01）。最大张力组从撕裂状态到修复状态的间隙距离（P=.03）和角位移（P=.004）显着减少，与完整状态的间隙距离没有显着差异。两组之间的失效扭矩和刚度没有显着差异，尽管在整体缝合带拉通长度上存在显著差异(P=.001)。
■尽管在时间零点存在潜在的生理变化-包括接触面积的显着减少，归一化间隙距离，以及具有最大张力修复的标准化角位移-对失效生物力学的检查表明，随着时间的推移，这些影响可以通过在胶带-锚接口处的缝线胶带拉拔来减轻。与天然韧带生物力学相比，采用缝合胶带增强的UCL修复方法均未导致肘关节过度受约束。
■随着更多来自UCL修复和缝合带增强的长期结果数据的出现，将有更广泛的实施与各种技术来张紧缝合带。检查在最大张力下应用的UCL修复构造的潜在生物力学后遗症将有助于进一步完善对利用该技术进行UCL修复的外科医生的建议。
■比较用于UCL修复的2种支具-收紧技术之间的生物力学参数和失效模式。
■对照实验室研究。
■采购了11对匹配的尸体臂。每对中的一条肢体都进行了UCL修复，并通过（1）尝试恢复生理韧带张力或（2）最大张力来增强缝合胶带。在UCL撕脱后，然后在UCL修复后，在完整状态下，每个标本在屈曲90º下经受10个周期的亚失效外翻扭矩。然后将标本扭转为失败。关节接触力学，线性间隙距离,角位移,失效扭矩,破坏刚度,并记录缝合胶带拉穿长度。采用双向方差分析和配对t检验进行统计学差异检验。
■拧紧对关节接触面积有显着影响（P=.01）。最大张力组从撕裂状态到修复状态的间隙距离（P=.03）和角位移（P=.004）显着减少，与完整状态的间隙距离没有显着差异。两组之间的失效扭矩和刚度没有显着差异，尽管在整体缝合带拉通长度上存在显著差异(P=.001)。
■尽管在时间零点存在潜在的生理变化-包括接触面积的显着减少，归一化间隙距离，以及具有最大张力修复的标准化角位移-对失效生物力学的检查表明，随着时间的推移，这些影响可以通过在胶带-锚接口处的缝线胶带拉拔来减轻。与天然韧带生物力学相比，采用缝合胶带增强的UCL修复方法均未导致肘关节过度受约束。
■随着更多来自UCL修复和缝合带增强的长期结果数据的出现，将有更广泛的实施与各种技术来张紧缝合带。检查在最大张力下应用的UCL修复构造的潜在生物力学后遗症将有助于进一步完善对利用该技术进行UCL修复的外科医生的建议。
