Coronoid reconstruction using osteochondral grafts: a biomechanical study

Hypothesis The purposes of this study were to test the hypothesis that coronoid deficiency in the setting of posteromedial rotatory instability (PMRI) must be reconstructed to restore articular contact pressures to normal and to compare 3 different osteochondral grafts for this purpose. Methods After creation of a anteromedial fracture, six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow. Mean articular surface contact pressure data were collected and processed using TekScan sensors and software. After testing of the intact specimen (intact condition), a PMRI injury was created (PMRI condition). Testing was repeated after reconstruction of the lateral collateral ligament (LCL) (LCL-only condition), followed by reconstruction of the coronoid with 3 different osteochondral graft techniques (reconstructed conditions). Results Contact pressure was consistently significantly higher in the PMRI elbow compared with the intact, LCL-only, and reconstructed conditions (P <.006). The LCL-only elbow contact pressure was significantly higher than that of the intact and reconstructed conditions from 5° to 55° of flexion (P =.018). The contact pressure of the intact elbow was never significantly different from that of the reconstructed elbow, except at 5° of flexion (P ≤.008). No significant difference was detected between each of the reconstructed techniques (P ≥.15). However, the annular surface of the radial head was the only graft that yielded contact pressures not significantly different from normal at any flexion angle. Conclusion Isolated reconstruction of the LCL did not restore native articular surface contact pressure, and reconstruction of the coronoid using osteochondral graft was necessary. There was no difference in contact pressures among the 3 coronoid reconstruction techniques.