The effect of forearm rotation on laxity and stability of the elbow

Objective. The purpose of this study was to quantify the relationship between forearm rotation and valgus/varus laxity of the elbow joint over the range of elbow flexion. Background. There is little known about the influence of forearm rotation on the laxity and stability of the elbow joint. The general opinion exists that forearm rotation does not significantly influence the laxity and stability of the elbow joint.Methods. Nine fresh-frozen cadaver elbows were used. Passive elbow flexion with the forearm in neutral rotation and in 40° and 80° of pronation and supination was performed under valgus/varus loads: (1) in intact elbows; (2) after a lateral surgical approach (lateral epicondylar osteotomy of the distal humerus); (3) after release of the anterior bundle of the medial collateral ligament; and (4) after release of the anterior bundle of the medial collateral ligament plus radial head resection. Valgus/varus elbow laxity was quantified using an electromagnetic tracking device. Results. There was a statistically significant effect (P<0.05) of forearm rotation on valgus/varus laxity throughout the range of flexion. The laxity was always greater in pronation than in supination, regardless of the surgical approach or the integrity of the anterior bundle of the medial collateral ligament or radial head. Conclusions. Valgus/varus laxity of the elbow is forearm rotation-dependent. The potential role of this effect should be considered and controlled for in the design of studies examining laxity and stability of the elbow joint. Relevance. The observation that forearm pronation increases valgus/varus laxity, particularly in medial collateral ligament deficient elbows, implies a possible additional factor in throwing kinematics that might put professional baseball pitchers at risk of medial collateral ligament injury due to chronic valgus overload. Our data indicate that forearm rotation should be considered during the clinical examination of elbow instability.