A biomechanical comparison of four reconstruction techniques for the medial collateral ligament-deficient elbow

The initial strength of the intact medial collateral ligament (MCL) of the elbow and the strength of 4 reconstruction techniques were compared. Twenty cadaveric upper extremities were mounted in a custom jig with the elbow at 90°, and a pneumatic cyclic valgus loading protocol was used. The mean peak load to failure was 142.5 ± 39.4 N for the intact ligaments and 53.0 ± 9.5 N for the docking reconstructions, 52.5 ± 10.4 N for the EndoButton reconstructions, 41.0 ± 16.0 N for the interference screw reconstructions, and 33.3 ± 7.1 N for the figure-eight reconstructions. The peak load to failure of the MCL reconstructions was inferior compared with the intact ligament (P <. 001). No difference in strength was found between the docking and single-strand medial collateral reconstruction with the use of an EndoButton for ulnar fixation (P >. 05, β =. 14). Both of these reconstruction methods were stronger than the interference screw or figure-eight technique (P <. 004). The optimal fixation method for a single-strand MCL reconstruction may require improved interference screws or a modified EndoButton procedure.