Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study
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ORIGINAL ARTICLE
Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study Cyril Guetari1 · Maud Creze2 · Marc Soubeyrand3 Received: 29 April 2020 / Accepted: 15 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose The proximal radioulnar joint (PRUJ) and the radiocapitellar joint may be destabilized after trauma. Different techniques for stabilization of PRUJ have been proposed, but none of them can stabilize the radiocapitellar joint at the same time. We propose a ligamentoplasty to stabilize the radial head at these two joints by reconstructing the radial head annular ligament and the lateral collateral ulnar ligament (LCUL) with a single graft (palmaris longus or gracilis tendon of the knee). Methods Fifteen cadaveric upper limbs were used to compare the stabilization obtained by performing our ligamentoplasty with the palmaris longus or the gracilis tendon. For each technique, the stabilization obtained was evaluated by measuring the displacement of the radial head in the anterior, lateral and posterior directions when a force of 1 N was applied in maximum supination, neutral rotation and maximum pronation. We also evaluated whether this technique could damage the ulnar nerve or the posterior interosseous nerve by dissecting them and whether it could limit the range of rotation of the forearm. Results Our ligamentoplasty enables to restore PRUJ stability equivalent to the intact ligament condition. The palmaris longus was inconstant (13/15) and too short to allow concomitant reconstruction of the LCUL (except in one case). No nerve damage was found during the dissection, and the range of rotation of the forearm was not limited by the ligamentoplasty. We also report a clinical case with an excellent result and without complications. Conclusion This ligamentoplasty we have described makes it possible to stabilize the radial head with respect to the radial notch of the ulna and with respect to the capitellum of the humerus. The gracilis tendon is more suitable than the palmaris longus because of its constant presence and length. A clinical series is now necessary to better evaluate this technique. Keywords Proximal radioulnar joint · Elbow ligamentoplasty · Radial head · Elbow instability
Introduction
* Marc Soubeyrand [email protected] Cyril Guetari [email protected] Maud Creze [email protected] 1
Public Assistance Hospital of Paris, Ecole de Chirurgie, 7 rue du Fer à Moulin, 75221 Paris, France
2
Department of Radiology, Public Assistance Hospital of Paris, Universitary Hospital of Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin‑Bicêtre, France
3
Department of Orthopaedic Surgery, Clinique Saint Jean L’Ermitage, 272 Av MArc Jacquet, 77000 Melun, France
The radial head is an essential stabilizer of the elbow and forearm [1, 2]. It prevents valgus destabilization of the elbow in case of injury to the medial collateral ligament of the elbow. It also prevents proximal migration o
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