Three-dimensional analysis of elbow soft tissue footprints and anatomy

BackgroundTendinous and ligamentous injuries commonly occur in the elbow. This study characterized the location, surface areas, and origin and insertional footprints of major elbow capsuloligamentous and tendinous structures in relation to bony landmarks with the use of a precision 3-dimensional modeling system.MethodsNine unpaired cadaveric elbow specimens were dissected and mounted on a custom jig. Mapping of the medial collateral ligament (MCL), lateral ulnar collateral ligament (LUCL), triceps, biceps, brachialis, and capsular reflections was then performed with 3-dimensional digitizing technology. The location, surface areas, and footprints of the soft tissues were calculated.ResultsThe MCL had a mean origin (humeral) footprint of 216 mm2, insertional footprint of 154 mm2, and surface area of 421 mm2. The LUCL had a mean origin footprint of 136 mm2, an insertional footprint of 142 mm2, and a surface area of 532 mm2. Of the tendons, the triceps maintained the largest insertional footprint, followed by the brachialis and the biceps (P < .001–.03). The MCL, LUCL, and biceps footprint locations were consistent, with little variability. The surface areas of the anterior (1251 mm2) and posterior (1147 mm2) capsular reflections were similar (P = .82), and the anterior capsule extended farther proximally.ConclusionRestoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma. This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients.