Ulnar collateral ligament dysfunction increases stress on the humeral capitellum: a finite element analysis

Background

Repetitive mechanical stress on the elbow joint during throwing is a cause of ulnar collateral ligament dysfunction that may increase the compressive force on the humeral capitellum. This study aimed to examine the effects of ulnar collateral ligament material properties on the humeral capitellum under valgus stress using the finite element method.

Methods

Computed tomography data of the dominant elbow of five healthy adults were used to create finite element models. The elbows were kept at 90° of flexion with the forearm in the neutral position, and the ulnar collateral ligament was reproduced using truss elements. The proximal humeral shaft was restrained, and valgus torque of 40 N·m was applied to the forearm. The ulnar collateral ligament condition was changed to simulate ulnar collateral ligament dysfunction. Ulnar collateral ligament stiffness values were changed to 72.3 N/mm, 63.3 N/mm, 54.2 N/mm, 45.2 N/mm, and 36.1 N/mm to simulate ulnar collateral ligament laxity. The ulnar collateral ligament toe region width was changed in increments of 0.5 mm from 0.0 to 2.5 mm to simulate ulnar collateral ligament loosening. We assessed the maximum equivalent stress and stress distribution on the humeral capitellum under these conditions.

Results

As ulnar collateral ligament stiffness decreased, the maximum equivalent stress on the humeral capitellum gradually increased under elbow valgus stress (P < .001). Regarding the change in the ulnar collateral ligament toe region width, as the toe region elongated, the maximum equivalent stress of the humeral capitellum increased significantly under elbow valgus stress (P < .001). On the capitellum, the equivalent stress on the most lateral part was significantly higher than that on other parts (P < .01 for all).

Conclusion

Under elbow valgus stress with elbow flexion of 90° and the forearm in the neutral position, ulnar collateral ligament dysfunction increased equivalent stress on the humeral capitellum during the finite element analysis. The highest equivalent stress was noted on the lateral part of the capitellum.