Arch Hand Microsurg.  2021 Sep;26(3):152-160. 10.12790/ahm.21.0113.

Topographic and Histologic Analysis of the Collateral Ligament Complex around the Elbow

• Kim JP
• Park JK
• Yoo JY
• Shin WJ
• Kim JS
• Kim YI

• KMID: 2519467
• DOI: http://doi.org/10.12790/ahm.21.0113

Abstract

Purpose
The purpose of this study was to evaluate topographic anatomy of the footprints of key ligaments of the elbow and assess their relationships with bony parameters using micro-computed tomography (micro-CT). Additionally, the ratios of type I/III collagen at the medial collateral ligament (MCL) and lateral collateral ligament (LCL) of elbow were investigated.
Methods
Eleven cadaveric elbows attached by both the MCL and LCL were scanned using micro-CT and reconstructed three-dimensionally. Additionally, the ligaments were examined under polarized light microscopy to determine the histological characteristics of collagen patterns.
Results
Areas of footprints of the MCL and LCL attaching onto the humerus were 133.2±25.8 mm² and 128.3±23.2 mm², respectively. Footprint sizes of anterior and posterior bundles of the MCL in the proximal ulna and lateral ulnar collateral ligament (LUCL) attaching to the proximal ulna averaged to 109.9 mm², 89.2 mm², and 89.7 mm², respectively. There were a positive correlation between footprint size of the MCL and LUCL at the humeral side and a negative correlation between the footprint size of the MCL at humeral side and maximal diameter of the radial head. The collagen I/III ratio of the humeral attachment of the MCL was higher than distal attachment of the MCL.
Conclusion
This study provides a better understanding of the pathologies of the MCL and LCL complex of the elbow and their relationships with osseous anatomy and may assist the clinician with an anatomic reconstruction of the ligaments.

Keyword

Micro-computed tomography; Footprint; Collateral ligaments; Elbow; Collagen; Three-dimensional

Figure

• 

  Fig. 1. The medial collateral ligament (MCL) inserting onto (A) distal humerus and (B) proximal ulna. MCL-H, humeral attachment of the MCL; MCL-UA, ulnar attachment of anterior bundle of the MCL; MCL-UP, ulnar attachment of posterior bundle of the MCL.

• 

  Fig. 2. The lateral collateral ligament (LCL) inserting onto (A) distal humerus and (B) proximal ulna. LCL-H, humeral attachment of the LCL; LCL-U, ulnar attachment of LCL (lateral ulnar collateral ligament, LUCL).

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  Fig. 3. A three-dimensional structural image of the elbow joint (the attachment of MCL [A] and LCL [B]; distal humerus and proximal ulna). MCL, medial collateral ligament; MCL-H, humeral attachment of the MCL; MCL-UA, anterior bundle of ulnar attachment of the MCL; MCL-UP, posterior bundle of ulnar attachment of the MCL; LCL, lateral collateral ligament; LCL-H, humeral attachment of the LCL; LCL-U, ulnar attachment of the LCL.

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  Fig. 4. Analysis of distal humerus topography on coronal and sagittal reconstructed images. (A) IcD, distance between medial and lateral epicondyles; MeW, width of the medial epicondyle; MeH, height of the medial epicondyle; TaD, depth of the trochlea; TaW, trochlea articular width. (B) ApD, anteroposterior diameter of the trochlea; PdD, proximodistal of diamter of the trochlea. (C) SeD, depth of the semilunar notch; ϕ, angle of the olecranon. (D) RD, maximal diameter of the radial head; RH, height of the radial head.

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  Fig. 5. The histological images of the medial collateral ligament under polarized light with picrosirius red staining (200×). Greenish birefringence was type III collagen whereas red-yellow birefringence was type I collagen. Distributions of type I/III were measured in three rectangular areas (6,400㎛²), which were randomly selected (dotted boxes).

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  Fig. 6. Comparison of the collagen I/III ratio between the five lesions of the elbow ligaments. The error bars represented the standard deviation. LCL, lateral collateral ligament; MCL, medial collateral ligament; MCL-H, humeral attachment of the MCL; MCL-UA, ulnar attachment of anterior bundle of the MCL; MCL-UP, ulnar attachment of posterior bundle of the MCL.

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