Review Question - QID 4701

In addition to capsular release, the posterior band of the medial collateral ligament (MCL) should be released.

The posterior band of the MCL is attached dorsal to the axis of rotation and has greater variation in length. It increases in length by 9 mm between 60° and 120° of flexion. Posterior band contracture leads to loss of elbow flexion. In contrast, the anterior band of the MCL (AMCL) maintains a constant length (isometric) throughout the entire arc of movement. Anterior capsule contracture leads to loss of extension.

Wada et al. treated 14 elbows with post traumatic contracture. Through a medial incision, the ulnar nerve was freed and the posterior band and posteromedial joint capsule were excised. Mean flexion increased from 89° preop to 127° postop. Anterior capsulectomy was performed for limited extension.

Morrey et al. studied structures providing stability about the elbow. They found that the anterior capsule stabilizes the elbow to varus-valgus stress in extension, not in flexion. The anterior band of the MCL is a primary stabilizer, especially in flexion.

Figures A and B are medial and lateral illustrations of the elbow, respectively, depicting the ligamentous attachments. Illustrations A and B are radiographs are 3D CT reconstruction images of the left elbow, respectively, showing heterotopic ossification around the posterior band of the MCL.

Incorrect Answers:
Answer 1: This is the anterior band of the medial collateral ligament and should not be released. Release of the AMCL leads to valgus instability.
Answer 3: This is the transverse band of the medial collateral ligament. Release of this ligament will not improve elbow ROM.
Answer 4: This is the radial collateral ligament and should not be released.
Answer 5: This is the lateral ulnar collateral ligament (LUCL) and should not be released. Release of the LUCL leads to posterolateral rotatory instability (PLRI).