Radiographic Description of Soft Tissue Attachments Around the Elbow

Overview

Journal Arch Bone Jt Surg

Date 2023 Oct 23

PMID 37868134

Authors

Patrick Moen

Brian Hill

David Teytelbaum

Christopher Kim

Scott Kaar

Affiliations

Soon will be listed here.

Abstract

Objectives: Quantitatively define the radiographic locations of the major soft-tissue attachments about the elbow.

Methods: In 10 cadaveric elbows, the attachments of the medial ulnar collateral ligament, lateral ulnar collateral ligament, annular ligament, triceps, and biceps were marked with radiopaque spheres. Measurements were made on calibrated AP and lateral fluoroscopic images from known osseous landmarks.

Results: On AP radiographs; the anterior bundle of the MUCL (aMUCL) measured 28.6mm (95% CI, 27. 5-29.8mm) from the humeral attachment to the midpoint of the MUCL ridge on the ulna and 14.3mm, (95% CI 13.0-15.5) to the olecranon. The LUCL was 39.9mm (95% CI, 38.6 - 41.1mm) from the humeral attachment to the supinator crest attachment and 8.9mm (95% CI, 8.1-9.8mm) to the lateral epicondyle. On the lateral radiographs, the humeral attachment of the aMUCL to the medial coronoid was 27.1mm (95% CI, 25.9-28.2mm) and 9.3mm (95%CI, 17.5 -21.2mm) to the tip. The LUCL humeral attachment to the supinator crest was 45.4mm (95%CI, 44.1-46.8mm). The LUCL humeral attachment was located 8.9mm (95%CI, 8.0-9.7mm) posterior from the anterior humeral line.

Conclusion: The soft-tissue attachments about the elbow were reproducibly demonstrated on radiographs in relation to osseous landmarks and radiographic lines. The radiographic relationships will allow for improved identification of the ligament and tendon attachment sites of the elbow for intraoperative assessment and postoperative evaluation following reconstruction.

Citing Articles

Elbow Injuries in Baseball Players: An Orthopedic Perspective.

Ghayyad K, Osbahr D Arch Bone Jt Surg. 2025; 12(11):742-745.

PMID: 39850921 PMC: 11756539. DOI: 10.22038/ABJS.2024.82871.3772.

References

Alaia M, Shearin J, Kremenic I, McHugh M, Nicholas S, Lee S . Restoring Isometry in Lateral Ulnar Collateral Ligament Reconstruction. J Hand Surg Am. 2015; 40(7):1421-7. DOI: 10.1016/j.jhsa.2015.03.022. View

Capo J, Collins C, Beutel B, Danna N, Manigrasso M, Uko L . Three-dimensional analysis of elbow soft tissue footprints and anatomy. J Shoulder Elbow Surg. 2014; 23(11):1618-23. DOI: 10.1016/j.jse.2014.05.003. View

Kinaci A, Neuhaus V, Ring D . Surgical procedures of the elbow: a nationwide cross-sectional observational study in the United States. Arch Bone Jt Surg. 2015; 3(1):13-8. PMC: 4322118. View

Frangiamore S, Moatshe G, Kruckeberg B, Civitarese D, Muckenhirn K, Chahla J . Qualitative and Quantitative Analyses of the Dynamic and Static Stabilizers of the Medial Elbow: An Anatomic Study. Am J Sports Med. 2017; 46(3):687-694. DOI: 10.1177/0363546517743749. View

Keener J, Chafik D, Kim H, Galatz L, Yamaguchi K . Insertional anatomy of the triceps brachii tendon. J Shoulder Elbow Surg. 2010; 19(3):399-405. DOI: 10.1016/j.jse.2009.10.008. View

Armstrong A, Dunning C, Ferreira L, Faber K, Johnson J, King G . A biomechanical comparison of four reconstruction techniques for the medial collateral ligament-deficient elbow. J Shoulder Elbow Surg. 2005; 14(2):207-15. DOI: 10.1016/j.jse.2004.06.006. View

Timmerman L, Andrews J . Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow. Am J Sports Med. 1994; 22(5):667-73. DOI: 10.1177/036354659402200515. View

Farrow L, Mahoney A, Stefancin J, Taljanovic M, Sheppard J, Schickendantz M . Quantitative analysis of the medial ulnar collateral ligament ulnar footprint and its relationship to the ulnar sublime tubercle. Am J Sports Med. 2011; 39(9):1936-41. DOI: 10.1177/0363546511406220. View

Hayter C, Adler R . Injuries of the elbow and the current treatment of tendon disease. AJR Am J Roentgenol. 2012; 199(3):546-57. DOI: 10.2214/AJR.11.8325. View

10.

Blair J, Stinner D, Kirby J, Gerlinger T, Hsu J . Quantification of femoral neck exposure through a minimally invasive Smith-Petersen approach. J Orthop Trauma. 2010; 24(6):355-8. DOI: 10.1097/BOT.0b013e3181c675d0. View

11.

Savoie 3rd F, Morgan C, Yaste J, Hurt J, Field L . Medial ulnar collateral ligament reconstruction using hamstring allograft in overhead throwing athletes. J Bone Joint Surg Am. 2013; 95(12):1062-6. DOI: 10.2106/JBJS.L.00213. View

12.

James E, LaPrade C, Ellman M, Wijdicks C, Engebretsen L, LaPrade R . Radiographic identification of the anterior and posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2014; 42(11):2707-14. DOI: 10.1177/0363546514545863. View

13.

Erickson B, Cvetanovich G, Bach Jr B, Bush-Joseph C, Verma N, Romeo A . Should We Limit Innings Pitched After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?. Am J Sports Med. 2016; 44(9):2210-3. DOI: 10.1177/0363546516643813. View

14.

Hannouche D, Begue T . Functional anatomy of the lateral collateral ligament complex of the elbow. Surg Radiol Anat. 1999; 21(3):187-91. DOI: 10.1007/BF01630899. View

15.

Paletta Jr G, Wright R . The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers. Am J Sports Med. 2006; 34(10):1594-8. DOI: 10.1177/0363546506289884. View

16.

Wiley J, Pegington J, Horwich J . Traumatic dislocation of the radius at the elbow. J Bone Joint Surg Br. 1974; 56B(3):501-7. View

17.

Erickson B, Romeo A . The Ulnar Collateral Ligament Injury: Evaluation and Treatment. J Bone Joint Surg Am. 2017; 99(1):76-86. DOI: 10.2106/JBJS.16.01277. View

18.

Jones K, Dines J, Rebolledo B, Weeks K, Williams R, Dines D . Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2013; 42(1):117-21. DOI: 10.1177/0363546513507695. View

19.

Conway J, Jobe F, Glousman R, Pink M . Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992; 74(1):67-83. View

20.

Yeh P, Stephens K, Solovyova O, Obopilwe E, Smart L, Mazzocca A . The distal triceps tendon footprint and a biomechanical analysis of 3 repair techniques. Am J Sports Med. 2010; 38(5):1025-33. DOI: 10.1177/0363546509358319. View