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Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow

BACKGROUND: Lateral collateral ligament (LCL) tears are frequently observed in fractures and dislocations of the elbow. Recent biomechanical evidence suggests that additional ligament augmentation may improve repair stability. The aim of this biomechanical in-vitro study was to compare the resistanc...

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Autores principales: Ott, Nadine, Harland, Arne, Lanzerath, Fabian, Leschinger, Tim, Hackl, Michael, Wegmann, Kilian, Müller, Lars Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9925465/
https://www.ncbi.nlm.nih.gov/pubmed/35064826
http://dx.doi.org/10.1007/s00402-022-04337-0
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author Ott, Nadine
Harland, Arne
Lanzerath, Fabian
Leschinger, Tim
Hackl, Michael
Wegmann, Kilian
Müller, Lars Peter
author_facet Ott, Nadine
Harland, Arne
Lanzerath, Fabian
Leschinger, Tim
Hackl, Michael
Wegmann, Kilian
Müller, Lars Peter
author_sort Ott, Nadine
collection PubMed
description BACKGROUND: Lateral collateral ligament (LCL) tears are frequently observed in fractures and dislocations of the elbow. Recent biomechanical evidence suggests that additional ligament augmentation may improve repair stability. The aim of this biomechanical in-vitro study was to compare the resistance of a locking suture repair of the LCL with a ligament augmentation technique. MATERIAL AND METHODS: Eight fresh frozen cadaveric elbows were evaluated for stability against varus/posterolateral rotatory forces (3 Nm). A strain gauge (µm/m; negative values) was placed at the origin and insertion of the lateral ulnar collateral ligament (LUCL) and cyclic loading was performed for 1000 cycles. We analyzed three distinct scenarios: (A) native LCL, (B) locking transosseou suture repair of the LCL, (C) simple LCL repair with additional ligament augmentation of the LUCL. RESULTS: The mean measured strain was − 416.1 µm/m (A), − 618 µm/m (B) and − 288.5 µm/m (C) with the elbow flexion at 90°; the strain was significantly higher in scenario B compared to C (p = .01). During the cyclic load (1000) the mean measured strain was − 523.1 µm/m (B) and − 226.3 µm/m (C) with the elbow flexion at 60°; the strain was significantly higher in scenario B compared to C (p = .01). No significant difference between the first and the last cycles was observed (p = .09; p = .07). One failure of the LCL repair was observed after 1000 cycles; none of the ligament augmentations failed. CONCLUSION: Ligament augmentation (C) provides higher resistance compared to the native LCL (A) and to the locking suture repair technique (B). Both techniques, however, hold up during 1000 cycles. While ligament augmentation might enhance the primary stability of the repair, future clinical studies have to show whether this increase in resistance leads to negative effects like higher rates of posttraumatic elbow stiffness. LEVEL OF EVIDENCE: Basic science study, biomechanics.
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spelling pubmed-99254652023-02-15 Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow Ott, Nadine Harland, Arne Lanzerath, Fabian Leschinger, Tim Hackl, Michael Wegmann, Kilian Müller, Lars Peter Arch Orthop Trauma Surg Trauma Surgery BACKGROUND: Lateral collateral ligament (LCL) tears are frequently observed in fractures and dislocations of the elbow. Recent biomechanical evidence suggests that additional ligament augmentation may improve repair stability. The aim of this biomechanical in-vitro study was to compare the resistance of a locking suture repair of the LCL with a ligament augmentation technique. MATERIAL AND METHODS: Eight fresh frozen cadaveric elbows were evaluated for stability against varus/posterolateral rotatory forces (3 Nm). A strain gauge (µm/m; negative values) was placed at the origin and insertion of the lateral ulnar collateral ligament (LUCL) and cyclic loading was performed for 1000 cycles. We analyzed three distinct scenarios: (A) native LCL, (B) locking transosseou suture repair of the LCL, (C) simple LCL repair with additional ligament augmentation of the LUCL. RESULTS: The mean measured strain was − 416.1 µm/m (A), − 618 µm/m (B) and − 288.5 µm/m (C) with the elbow flexion at 90°; the strain was significantly higher in scenario B compared to C (p = .01). During the cyclic load (1000) the mean measured strain was − 523.1 µm/m (B) and − 226.3 µm/m (C) with the elbow flexion at 60°; the strain was significantly higher in scenario B compared to C (p = .01). No significant difference between the first and the last cycles was observed (p = .09; p = .07). One failure of the LCL repair was observed after 1000 cycles; none of the ligament augmentations failed. CONCLUSION: Ligament augmentation (C) provides higher resistance compared to the native LCL (A) and to the locking suture repair technique (B). Both techniques, however, hold up during 1000 cycles. While ligament augmentation might enhance the primary stability of the repair, future clinical studies have to show whether this increase in resistance leads to negative effects like higher rates of posttraumatic elbow stiffness. LEVEL OF EVIDENCE: Basic science study, biomechanics. Springer Berlin Heidelberg 2022-01-22 2023 /pmc/articles/PMC9925465/ /pubmed/35064826 http://dx.doi.org/10.1007/s00402-022-04337-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Trauma Surgery
Ott, Nadine
Harland, Arne
Lanzerath, Fabian
Leschinger, Tim
Hackl, Michael
Wegmann, Kilian
Müller, Lars Peter
Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title_full Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title_fullStr Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title_full_unstemmed Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title_short Locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
title_sort locking suture repair versus ligament augmentation—a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow
topic Trauma Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9925465/
https://www.ncbi.nlm.nih.gov/pubmed/35064826
http://dx.doi.org/10.1007/s00402-022-04337-0
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