Optimizing the Rehabilitation of Elbow Lateral Collateral Ligament Injuries

Elbow lateral collateral ligament (LCL) injuries frequently arise following trauma, and can result in disabling instability. Typically such injuries are managed with immobilization followed by a graduated exercise regime; however there is minimal biomechanical evidence to support current treatment protocols. This investigation examines the in vitro effectiveness of several rehabilitation techniques using a custom elbow motion simulator. It was found that active range of motion is safest in the overhead position (n = 7). Early motion in this position may reduce the incidence of elbow stiffness without compromising ligament healing following LCL injury. Forearm pronation and active motion stabilize the LCL-deficient elbow, while varus positioning worsens instability. It was also found that a hinged elbow orthosis did not significantly improve in vitro elbow stability following LCL injury (n = 7). However, such orthoses may be useful in keeping the forearm in the more stable pronated position. Future research directions are proposed, with suggestions on applying this methodology to other elbow injuries.

Keywords: elbow; lateral collateral ligament; instability; posterolateral rotatory instability; biomechanics; rehabilitation; overhead motion protocol; varus; orthosis; brace; active motion; range of motion

Year	Entry
1979	Amis AA, Dowson D, Wright V. Muscle strengths and musculoskeletal geometry of the upper limb. Eng Med. 1979;8(1):41.
1974	Reilly DT, Burstein AH. The mechanical properties of cortical bone. J Bone Joint Surg. 1974;56A(5):1001-1022.
2004	Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJW. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg. August 2004;86A(8):1730-1739.
1993	King GJW, Morrey BF, An K-N. Stabilizers of the elbow. J Shoulder Elbow Surg. May–June 1993;2(3):165-174.
1996	Cappozzo A, Catani F, Leardini A, Benedetti M, Della Croce U. Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech (Bristol, Avon). March 1996;11(2):90-100.
2001	Thornton GM, Shrive NG, Frank CB. Altering ligament water content affects ligament pre-stress and creep behaviour. J Orthop Res. September 2001;19(5):845-851.
2010	Unger S, Blauth M, Schmoelz W. Effects of three different preservation methods on the mechanical properties of human and bovine cortical bone. Bone. December 2010;47(6):1048-1053.
1997	Rath DA. Design and Development of an Elbow Loading Apparatus and the Determination of Elbow Kinematics [Master's thesis]. University of Western Ontario; May 1997.
2011	Ferreira LM. Development of an Active Elbow Motion Simulator and Coordinate Systems to Evaluate Kinematics in Multiple Positions [PhD thesis]. University of Western Ontario; 2011.
1981	An KN, Hui FC, Morrey BF, Linscheid RL, Chao EY. Muscles across the elbow joint: a biomechanical analysis. J Biomech. 1981;14(10):659-669.
1994	Blevins FT, Hecker AT, Bigler GT, Boland AL, Hayes WC. The effects of donor age and strain rate on the biomechanical properties of bone-patellar tendon-bone allografts. Am J Sports Med. 1994;22(3):328-333.
2000	Piazza SJ, Cavanagh PR. Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment. J Biomech. August 2000;33(8):1029-1034.
1996	Milne AD, Chess DG, Johnson JA, King GJW. Accuracy of an electromagnetic tracking device: a study of the optimal operating range and metal interference. J Biomech. June 1996;29(6):791-793.
1998	Quapp KM, Weiss JA. Material characterization of human medial collateral ligament. J Biomech Eng. December 1998;120(6):757-763.
2001	Dunning CE, Duck TR, King GJW, Johnson JA. Simulated active control produces repeatable motion pathways of the elbow in an in vitro testing system. J Biomech. August 2001;34(8):1039-1048.
1991	Woo SL-Y, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217-225.
2000	Johnson JA, Rath DA, Dunning CE, Roth SE, King GJW. Simulation of elbow and forearm motion in vitro using a load controlled testing apparatus. J Biomech. May 2000;33(5):635-639.
1986	Woo SL-Y, Orlando CA, Camp JF, Akeson WH. Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech. 1986;19(5):399-404.
2005	Wu G, van der Helm FCT, Veeger HEJ, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, II: shoulder, elbow, wrist and hand. J Biomech. May 2005;38(5):981-992.

Year

Entry

1979

Amis AA, Dowson D, Wright V. Muscle strengths and musculoskeletal geometry of the upper limb. Eng Med. 1979;8(1):41.

1974

Reilly DT, Burstein AH. The mechanical properties of cortical bone. J Bone Joint Surg. 1974;56A(5):1001-1022.

2004

Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJW. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg. August 2004;86A(8):1730-1739.

1993

King GJW, Morrey BF, An K-N. Stabilizers of the elbow. J Shoulder Elbow Surg. May–June 1993;2(3):165-174.

1996

Cappozzo A, Catani F, Leardini A, Benedetti M, Della Croce U. Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech (Bristol, Avon). March 1996;11(2):90-100.

2001

Thornton GM, Shrive NG, Frank CB. Altering ligament water content affects ligament pre-stress and creep behaviour. J Orthop Res. September 2001;19(5):845-851.

2010

Unger S, Blauth M, Schmoelz W. Effects of three different preservation methods on the mechanical properties of human and bovine cortical bone. Bone. December 2010;47(6):1048-1053.

1997

Rath DA. Design and Development of an Elbow Loading Apparatus and the Determination of Elbow Kinematics [Master's thesis]. University of Western Ontario; May 1997.

2011

Ferreira LM. Development of an Active Elbow Motion Simulator and Coordinate Systems to Evaluate Kinematics in Multiple Positions [PhD thesis]. University of Western Ontario; 2011.

1981

An KN, Hui FC, Morrey BF, Linscheid RL, Chao EY. Muscles across the elbow joint: a biomechanical analysis. J Biomech. 1981;14(10):659-669.

1994

Blevins FT, Hecker AT, Bigler GT, Boland AL, Hayes WC. The effects of donor age and strain rate on the biomechanical properties of bone-patellar tendon-bone allografts. Am J Sports Med. 1994;22(3):328-333.

2000

Piazza SJ, Cavanagh PR. Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment. J Biomech. August 2000;33(8):1029-1034.

1996

Milne AD, Chess DG, Johnson JA, King GJW. Accuracy of an electromagnetic tracking device: a study of the optimal operating range and metal interference. J Biomech. June 1996;29(6):791-793.

1998

Quapp KM, Weiss JA. Material characterization of human medial collateral ligament. J Biomech Eng. December 1998;120(6):757-763.

2001

Dunning CE, Duck TR, King GJW, Johnson JA. Simulated active control produces repeatable motion pathways of the elbow in an in vitro testing system. J Biomech. August 2001;34(8):1039-1048.

1991

Woo SL-Y, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217-225.

2000

Johnson JA, Rath DA, Dunning CE, Roth SE, King GJW. Simulation of elbow and forearm motion in vitro using a load controlled testing apparatus. J Biomech. May 2000;33(5):635-639.

1986

Woo SL-Y, Orlando CA, Camp JF, Akeson WH. Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech. 1986;19(5):399-404.

2005

Wu G, van der Helm FCT, Veeger HEJ, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, II: shoulder, elbow, wrist and hand. J Biomech. May 2005;38(5):981-992.

Year	Entry
2018	Banayan SM. The Kinematic and Biomechanical Effects of Bracing on the Rehabilitation of the LCL Injured Elbow [Master's thesis]. University of Western Ontario; 2018.

Year

Entry

2018

Banayan SM. The Kinematic and Biomechanical Effects of Bracing on the Rehabilitation of the LCL Injured Elbow [Master's thesis]. University of Western Ontario; 2018.