Single-strand ligament reconstruction of the medial collateral ligament restores valgus elbow stability

The purpose of this study was to determine the contribution of the central portion of the anterior bundle of the medial collateral ligament (MCL) to elbow stability and to evaluate the effectiveness of a single-strand MCL reconstruction in restoring elbow stability. Testing of 11 fresh-frozen upper extremities was first performed on the intact elbow and then with the capsule, flexor-pronator muscle group, posterior bundle, anterior or posterior band, and central band cut sequentially. Next, a single-strand reconstruction of the MCL was performed. The elbow was moved passively through a full arc of flexion in both varus and valgus gravity-loaded positions. Ulnar movement with respect to the humerus was analyzed by means of an electromagnetic tracking system. Maximum varus-valgus laxity throughout the arc of supinated flexion and pronated flexion was 6.6° ± 2.4° and 7.4° ± 2.0°, respectively, for the intact specimen, 34.2° ± 5.6° and 37.7° ± 11.8° for the specimen with all of the medial valgus elbow stabilizers cut, and 9.0° ± 2.5° and 10.5° ± 2.7° for the reconstructed specimen. Maximum varus-valgus laxity was not significantly different among any of the sectioning sequences until the central band was cut (P <.0001). There was no significant difference in maximum varus-valgus laxity between the intact and reconstructed elbows (P <.05). Our results demonstrate that the central band is an important valgus stabilizer of the elbow and that a simplified single-strand reconstruction is able to restore stability to the MCL-deficient elbow. (J Shoulder Elbow Surg 2002;11:65-71.)