Highlights
- •Ulnohumeral joint cartilage relaxation contact force can be measured.
- •Ulnohumeral contact force increases with elbow supination and flexion.
- •Radial head arthroplasty overstuffing increases ulnohumeral contact force.
- •Ulnohumeral contact force can be measured without destroying static joint stabilizers.
Abstract
Introduction
Radiocapitellar joint arthroplasty is a commonly performed procedure, which often
leads to early failure or instability. Few studies assess the effect of radiocapitellar
joint arthroplasty on the ulnohumeral joint. We hypothesized that static forces of
contact (compressing cartilage, or cartilage relaxation contact force) would reveal
the effect of varying radial head implant size and elbow position on the ulnohumeral
joint.
Methods
A minimally–invasive method of measuring cartilage relaxation contact force was utilized
in 10 fresh-frozen human cadaveric specimens that did not require significant dissection
or intraarticular sensor placement. Specimens were rigidly fixed in various positions
of elbow flexion and forearm pronosupination with increasing radial head implant lengths.
Uniaxial distracting forces were applied and displacement was repeatedly measured
with resultant best-fit polynomial curves to determine inflections corresponding to
the force required to overcome static cartilage relaxation as in previous work.
Findings
Baseline mean (intra-cadaver) cartilage relaxation contact force was 11.8 N (standard
error of the mean = 0.3) at 90° of elbow flexion and neutral rotation. There was little
variation within specimens (Intraclass correlation coefficient > 0.94). Cartilage
relaxation contact force increased at the ulnohumeral joint with radial head implant
overstuffing (> 4 mm, P < 0.05) and elbow flexion (120°, P < 0.001). Pronosupination altered cartilage relaxation contact force in an implant-length
independent manner (P < 0.05).
Interpretation
Radiocapitellar joint arthroplasty implant length and elbow joint position independently
contribute to increased cartilage relaxation contact force at the ulnohumeral joint.
This further supports attempts at anatomic reconstruction of the radiocapitellar joint
to prevent pathologic ulnohumeral joint loading.
Keywords
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References
- Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact.Am. J. Sports Med. 2004; 32: 1607-1612https://doi.org/10.1177/0363546503263149
- Impact of ulnar collateral ligament tear on posteromedial elbow biomechanics.Orthopedics. 2015; 38: e547-e551https://doi.org/10.3928/01477447-20150701-50
- The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures.J. Hand Surg. 2015; 40: 281-288https://doi.org/10.1016/j.jhsa.2014.11.005
- The effect of radial head excision and arthroplasty on elbow kinematics and stability.J. Bone Joint Surg. Am. 2004; 86-A: 1730-1739https://doi.org/10.2106/00004623-200408000-00018
- A nondestructive, reproducible method of measuring joint reaction force at the distal radioulnar joint.J. Hand. Surg. [Am.]. 2015; 40 (1138 44)https://doi.org/10.1016/j.jhsa.2015.03.005
- Distal Radioulnar joint reaction force following ulnar shortening: diaphyseal osteotomy versus wafer resection.J. Hand. Surg. [Am.]. 2015; 40: 2206-2212https://doi.org/10.1016/j.jhsa.2015.07.036
- Time, stress, and location dependent chondrocyte death and collagen damage in cyclically loaded articular cartilage.J. Orthop. Res. 2003; 21: 888-898https://doi.org/10.1016/S0736-0266(03)00050-0
- A method for measuring joint kinematics designed for accurate registration of kinematic data to models constructed from CT data.J. Biomech. 2001; 34: 377-383https://doi.org/10.1016/S0021-9290(00)00195-0
- Determination of correct implant size in radial head arthroplasty to avoid overlengthening.J. Bone Joint Surg. Am. 2009; 91: 1738-1746https://doi.org/10.2106/JBJS.H.01161
- The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint.Arthrosc. 1992; 8: 166-172
- The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction.J. Orthop. Res. 2009; 27: 989-995https://doi.org/10.1002/jor.20852
- Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius.J. Bone Joint Surg. Am. 1941; 23: 86-92
- Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation.Clin. Biomech. 2019;
- Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation.Clin. Biomech. 2021; https://doi.org/10.1016/j.clinbiomech.2019.07.013
- The effect of radial head implant length on radiocapitellar articular properties and load transfer within the forearm.J. Orthop. Trauma. 2014; 28: 348-353https://doi.org/10.1097/BOT.0000000000000009
- M. Biomechanics.in: Einhorn T.A. O’Keefe R.J. Buckwalter J.A. Orthopaedic Basic Science: Foundations of Clinical Practice. American Academy of Orthopaedic Surgeons, Rosemont, IL2007
- Fractures of the olecranon: an in vitro study of elbow joint stresses after tension-band wire fixation versus proximal fracture fragment excision.J. Trauma. 2002; 53: 1088-1093https://doi.org/10.1097/01.TA.0000033766.65011.D5
- The hip fluid seal--part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction.Knee Surg. Sports Traumatol. Arthrosc. 2014; 22: 730-736https://doi.org/10.1007/s00167-014-2875-y
- Ulnohumeral chondral and ligamentous overload: biomechanical correlation for posteromedial chondromalacia of the elbow in throwing athletes.Am. J. Sports Med. 2010; 38: 2535-2541https://doi.org/10.1177/0363546510376231
- The effect of forearm rotation on laxity and stability of the elbow.Clin. Biomech. 2001; 16: 401-407https://doi.org/10.1016/S0268-0033(01)00021-3
Pressure Measurement Film - Prescale. https://www.pressuremetrics.com/sites/default/files/Overview.pdf. In; 2016.
- Open reduction and internal fixation of fractures of the radial head.J. Bone Joint Surg. Am. 2002; 84-A: 1811-1815https://doi.org/10.2106/00004623-200210000-00011
- Effects of elbow flexion and forearm rotation on valgus laxity of the elbow.J. Bone Joint Surg. Am. 2005; 87: 2065-2074https://doi.org/10.2106/JBJS.D.02045
- Influence of radial head prosthetic design on radiocapitellar joint contact mechanics.J. Shoulder Elb. Surg. 2014; 23: 456-462https://doi.org/10.1016/j.jse.2013.11.028
- The effect of arthroscopic capsulotomy and repair on hip joint contact forces using a non-destructive extra-articular method.J. Hip Preserv. Surg. 2019; https://doi.org/10.1093/jhps/hnz032
- The role of the elbow musculature, forearm rotation, and elbow flexion in elbow stability: an in vitro study.J. Shoulder Elb. Surg. 2009; 18: 260-268https://doi.org/10.1016/j.jse.2008.08.004
- Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty.J. Bone Joint Surg. Am. 2008; 90: 271-280https://doi.org/10.2106/JBJS.F.01535
Tekscan - Pressure Mapping, Force Measurement and Tactile Sensors. https://www.tekscan.com/products-solutions/pressure-mapping-sensors/4000. In; 2016.
- Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow.J. Bone Joint Surg. Am. 2004; 86-A: 2629-2635
- The kinematic importance of radial neck length in radial head replacement.Méd. Eng. Phys. 2005; 27: 336-342https://doi.org/10.1016/j.medengphy.2004.04.011
- The effect of the orientation of the radial head on the kinematics of the ulnohumeral joint and force transmission through the radiocapitellar joint.Clin. Biomech. 2006; 21: 554-559https://doi.org/10.1016/j.clinbiomech.2006.01.006
- Knee joint reaction force during tibial diaphyseal lengthening: a study on a rabbit model.J. Biomech. 2004; 37: 1053-1059https://doi.org/10.1016/j.jbiomech.2003.11.02
Article info
Publication history
Published online: February 03, 2021
Accepted:
January 27,
2021
Received in revised form:
January 22,
2021
Received:
August 15,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Published by Elsevier Ltd.
