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Early extension is safe after UCL reconstruction
Research showed that limited motion from full extension to 50° was safe in early rehabilitation.
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Extreme flexion strains the ulnar collateral ligament’s posterior band after reconstruction, however, early motion to 100º is safe for rehabilitation, researchers said.
“We determined that elbow extension is safe after ulnar collateral ligament (UCL) reconstruction for both bands of the anterior bundle. Flexion beyond 50° in the posterior band causes high strain. UCL strain was not affected by forearm rotation,” Geoffrey A. Bernas, MD, said.
Cadaver elbows
The research team designed the cadaver study to assess how current rehabilitation techniques used in overhead athletes following elbow UCL reconstruction affect gracilis tendon grafts.
Exercises incorporating valgus torque significantly increased graft strain, Bernas explained at the 2008 American Orthopaedic Society for Sports Medicine (AOSSM) meeting, where the team was presented with the AOSSM Excellence in Research Award.
“Our goal was to define safe range of motion (ROM) after UCL reconstruction,” Bernas said.
Docking procedure
Researchers used a UCL docking reconstruction technique with gracilis tendon grafts and measured the strain on the UCL bands in cadaveric models.
“Our primary assumption was graft strain greater than 3% may be detrimental to proper graft healing,” Bernas said, citing research supporting this concept and showing collagen microfiber failure beyond 3% strain.
“Our results show low strain in extension. Anterior and posterior bands behave differently, with the anterior band not exceeding 3% strain,” Bernas said. Anterior band strain only increased in the presence of higher flexion angles.
In the posterior band, load strains started early and passed the safe point at 50° to 60°.
Strain in the posterior band at 90° is 7% and may mean commonly performed isometric exercises may not be safe in this position, Bernas told Orthopedics Today.
For more information:
- Geoffrey A. Bernas, MD, can be reached at University Orthopaedic Center – Southtowns, Mercy Ambulatory Care Center, Suite 207, 3671 Southwestern Blvd., Orchard Park, NY 14127; 716-821-4400; e-mail: gabernas@buffalo.edu. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- Bernas GA, Ruberte Thiele RA, Kinnaman KA, et al. Defining safe rehabilitation for ulnar collateral ligament reconstruction of the elbow: A biomechanical study. Presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting. July 10-13, 2008. Orlando, Fla.