Clinicians › Elbow

Joint Structures

Elbow joint anatomy & biomechanics: humeroulnar, humeroradial, and proximal radioulnar joints, UCL stability, and common fracture patterns.

71 citationsUpdated Oct 2026

Overview

Elbow stability and complex kinematics rely on a combination of bony articulation and soft-tissue stabilizers [9]. The proximal radioulnar joint exhibits a significant negative relationship between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage [6]. Anatomic variations in the ulnar greater sigmoid notch "coverage angle" require further biomechanical and clinical studies to determine their true clinical relevance [7]. Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma [4]. Ligament-preserving surgical approaches to the capitellum enable viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches [1].

Precise knowledge of ligamentous attachments and relationships to the physis and joint surface is important for reconstructive procedures in pediatric elbow collateral and annular ligaments [3]. The insertional anatomy of the anterior medial collateral ligament at the sublime tubercle has been described in detail [27]. Thorough knowledge of distal biceps insertional and footprint anatomy is essential for understanding the biomechanics of rupture and reconstruction and for avoiding nerve injuries [66]. Awareness of the neuroanatomical distribution of sensory receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology [5]. Understanding the unique structural and functional properties of articular cartilage is key to developing chondroprotective agents that can improve its metabolic function [22]. A more thorough understanding of the detailed mechanisms involved in mechanotransduction may lead to novel approaches for enhancing tissue growth or attenuating mechanically driven processes that lead to osteoarthritis [71].

Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to safely access the joint [12]. Clinical evaluation for joint pain, severe cartilage destruction, and chondrolysis should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and in some cases arthroscopic evaluation to minimize risk of inappropriate clinical management [19]. Multiple involvement of various types of cartilage in various parts of the body can result in an obscure clinical picture that does not conform to any known clinical entity [68]. The glenoid labrum's function and pathology are aided by understanding its embryology, anatomy, microscopy, biomechanical properties, and clinical lesions [2].

Osseous Anatomy

Elbow Joint

Significant areas of the articular surface of all three bones in the elbow joint may be overlooked during standard elbow arthroscopy [8]. Osteochondral lesions demonstrate location- and size-dependent consequences regarding valgus angulation and radiocapitellar contact characteristics [32]. The synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure [31].

Proximal Ulna

The ulnar greater sigmoid notch possesses a "coverage angle" defined by bone and cartilage contribution [7]. Further biomechanical and clinical studies are required to determine the true clinical relevance of anatomic variations in this notch [7]. When using the narrowest edge lacking cartilage as a reference to locate the bare area of the proximal ulna, a designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage [15]. Bone volume in the olecranon fossa was statistically greater in patients with primary osteoarthritis compared with a control group [37].

Proximal Radioulnar Joint

The anatomy of the proximal radioulnar joint is characterized by Alpha and Beta Angles [6]. A significant negative relationship exists between the Alpha Angle and the Beta Angle [6]. This relationship emphasizes the biomechanical impact of joint congruence on bony coverage [6].

Glenoid

The glenoid labrum possesses specific embryology, anatomy, microscopy, biomechanical properties, and clinical lesions [2]. The fulcrum axis can be used to obtain information on the version of the glenoid from anatomical landmarks [28].

Pediatric Elbow

Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures in the pediatric elbow [3].

Ligaments and Joint Capsule

General Stability and Function

The elbow joint possesses inherent stability derived from the interlocking shape of its articular surfaces [10]. Static joint constraint is provided by the joint capsule and collateral ligaments [10], while surrounding muscles generate dynamic forces for stability [10]. Ligaments may function as a 'static-dynamic' stabilizer rather than a simple static one [20].

Capsule Anatomy

Excluding the medial and lateral collateral ligaments, the anterior capsule contains 3 distinct bands [16]. Similarly, the posterior capsule contains 3 distinct bands [16]. In shoulder specimens, puncture of the joint capsule results in significant glenohumeral translation during shoulder abduction in both unloaded and loaded conditions [55]. A maximum of 16.6 mm of distal translation was observed at 20° of abduction following joint capsule puncture [55].

Collateral Ligaments

Both collateral ligaments are essential stabilizers of the elbow [34], and their integrity is a prerequisite for stable function [34]. The lateral ulnar collateral ligament (LUCL) contributes to posterolateral rotatory instability as part of the lateral collateral ligament complex with surrounding tissues [42]. However, the LUCL is not considered a major constraint to posterolateral rotatory instability on its own [42].

Annular Ligament

The annular ligament is a wrap-around ligament containing (fibro)cartilaginous tissue [54]. No synovial lining is present on the articulating surface between the annular ligament and the radial head [54]. Interposition of the annular ligament in the radiocapitellar joint is the most frequent factor hindering reduction in irreducible dislocation of the radial head associated with pediatric Monteggia lesions [53].

Surgical Considerations

A combination of two ligament-preserving surgical approaches enables viewing the entirety of the joint surface [1]. These ligament-preserving approaches may represent an alternative to ligament-releasing approaches [1]. Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy [52]. Knowledge of precise ligamentous attachments and relationships to the physis and joint surface is important for reconstructive procedures in pediatric elbow collateral and annular ligament anatomy [3]. Recognizing complex soft tissue injuries is important to restore anatomic attachments and prevent chronic instability in global elbow instability [11].

Muscles and Tendons

Triceps

Arthroscopic double-row repair of triceps tendon avulsion provides anatomic coverage of the triceps footprint [14]. This anatomic coverage allows more surface area for healing [14].

Brachialis

A distally based tendon graft reconstruction of the annular ligament using the tendon of the superficial head of the brachialis muscle is feasible in most patients [79].

Lateral Ulnar Collateral Ligament (LUCL) and Associated Muscles

The annular ligament needs to be supported by the LUCL-muscle complex from the distal side [82]. A minimally-invasive technique for LUCL reconstruction uses a tendon graft with knotless suture anchors in an onlay fashion without violating the articular capsule or the common extensor origin [80]. A modified technique for concomitant internal joint stabilizer augmentation and isometric LUCL repair eliminates footprint competition between the LUCL reconstruction and IJS humeral pin [81]. This modified technique achieves isometric placement of both constructs [81] and provides ligament tensioning without additional drill sites [81]. Arthroscopic-assisted lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability necessitates a long learning curve and experience to work at the posterolateral compartment [21].

Neurovascular Anatomy

Nerves

The neuroanatomical distribution of sensory receptors within the human elbow joint capsule is a factor that may allow for their preservation during surgical procedures for elbow joint pathology [5]. The course of the radial nerve in the distal part of the upper arm exhibits great variety [17]. Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased [73]. A ganglion may play a role in the pathogenesis of ulnar nerve palsy [72]. The unicortical nature of intramedullary repair for distal biceps tendon rupture avoids the rare but devastating complication of posterior interosseous nerve palsy [75]. Surgeons must be vigilant about ulnar nerve complications associated with open reduction and internal fixation for adult distal humerus fractures [77]. Through a four-to-five-centimeter incision used in the elbow flexion test, one is less likely to injure any of the branches of the medial antebrachial cutaneous nerve, which run in an anterior-posterior direction [69].

Surgical Considerations

An appreciation of the relevant neurovascular and ligamentous structures is critical to safely performing surgical procedures about the elbow [13]. Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint [12]. The unilateral technique for interposition arthroplasty of the elbow maintains the integrity of the ulnar nerve [24].

Biomechanics and Function

General Stability and Kinematics

Surrounding muscles generate dynamic forces within the elbow [10]. Elbow joint moments vary in different directions during daily tasks [51].

Load Sharing and Joint Loads

The load sharing ratio for the radiocapitellar and ulnotrochlear joints is 58%:42%, respectively [56].

Radial Head and Radiocapitellar Joint

Insertion of a correctly sized metallic radial head replacement recreates near normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane [60]. Regarding implant design, no significant differences were found between three implant morphologies for contact area, contact location, or joint kinematics [57], suggesting that the shape of a radial head implant may not be important with respect to articular mechanics [57]. However, a nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions [64], while there are orientations where a nonaxisymmetric radial head results in reduced contact area and increased stress [64]. Elbow kinematics deviate increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius [58].

Ulnar and Distal Radioulnar Joint

Elbow position affects the kinematics of the distal radioulnar joint [63]. Distal radioulnar joint kinematics are primarily affected by forearm rotation and secondarily by elbow flexion [63]. A significant negative relationship exists between the Alpha Angle and the Beta Angle in the proximal radioulnar joint [6].

Ligamentous Biomechanics

The anterolateral ligament shows no isometric behavior during the range of motion of the knee [61]. No significant differences were noted between docking reconstruction and repair techniques for load to failure, gapping, or valgus opening angle during cyclic loading at time zero [67]. Suture-augmented lateral ulnar collateral ligament and radial collateral ligament reconstruction may offer enhanced early biomechanical stability [65].

Cartilage Mechanics

Immature-cracked cartilages stress-relaxed faster than mature-cracked cartilages [62]. Immature-cracked cartilages experienced increased tissue strain compared to mature-cracked cartilages [62]. Immature-cracked cartilages had reduced instantaneous stiffness compared to mature-cracked cartilages [62].

Common Sites of Injury

Glenoid Labrum

The glenoid labrum is subject to clinical lesions that involve its function and pathology [2].

Elbow Soft Tissue and Ligaments

Complex soft tissue injuries in the elbow require recognition to restore anatomic attachments and prevent chronic instability [11]. Posttraumatic contracture of the elbow involves pathologic thickening, disorganization of the collagen fiber arrangement, and involvement of cytokines [33]. Anterior bundle injuries of the medial ulnar collateral ligament exhibit heterogeneity with a variety of injury configurations and chronic attritional damage [38]. Different changes in clinical laxity are observed on dynamic ultrasonography with injury of particular bands of the ulnar collateral ligament [41]. Elbow ligament repairs and reconstructions are performed in both acute and chronic settings [50].

Elbow Bony Structures

The intra-articular fracture line distribution in pure transverse acetabular fractures is focused on the superior and middle thirds of the joint surface [23]. For small subtype 2 elbow fractures, ligamentous repair alone may not reliably restore kinematics [39]. Larger elbow fractures should ideally have fragments fixed or reconstructed to restore kinematics [39]. Patients older than 65 years with coronal fractures of the capitellum have a large number of concomitant injuries [44]. Patients older than 65 years with coronal fractures of the capitellum have no substantial risk of complex fracture patterns [44]. Articular shear injuries of the capitellum in adolescents require a high index of suspicion for identification [46]. Early recognition of articular shear injuries of the capitellum in adolescents likely would have changed initial conservative management decisions [46]. The clinical relevance of proximal radioulnar joint anatomy is related to radial head dislocation, fracture pattern, and elbow stability [45].

Radial Head

Traumatic subluxation of the radial head is a rather frequent injury in young children [29]. Documentation of associated injuries occurring with radial head fracture provides an opportunity to standardize communication of fracture type with details of other injuries [40].

Tendons

The triceps tendon avulsion footprint can be covered anatomically using a double-row repair technique to allow more surface area for healing [14]. Surgical anatomical repair is typically performed for acute complete distal biceps and triceps ruptures [47]. Nonoperative treatment is reserved for partial distal biceps and triceps ruptures or patients unfit for surgery [47].

Cartilage and Osteochondral

MRI is recommended if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage in osteochondritis dissecans of the capitellum [48].

Surgical Anatomy

Bony Anatomy

The bare area of the proximal ulna is identified by the narrowest edge lacking cartilage [15]. Utilizing this landmark for a chevron osteotomy designed to enter the joint in the bare area decreases associated damage to the joint cartilage in most specimens [15]. In pure transverse acetabular fractures, the intra-articular fracture line distribution is focused on the superior and middle thirds of the joint surface [23].

Ligaments and Soft Tissue

Resections of the posteromedial aspect of the olecranon greater than 3 mm may jeopardize the function of the anterior bundle of the medial collateral ligament [26]. During double-row repair, the triceps tendon footprint can be covered anatomically to allow more surface area for healing [14]. In cases of global elbow instability, complex soft tissue injuries must be recognized to restore anatomic attachments and prevent chronic instability [11].

Neurovascular Anatomy

No specific evidence is provided for this subsection in the current document.

Arthroscopic Anatomy and Portals

Elbow arthroscopy requires a clear understanding of the anatomy to safely access the joint [12]. A combination of two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches for the capitellum [1]. Using an accessory posterolateral portal instead of the direct posterior portal allows management of pathologies in all areas of the posterior compartment while preventing specific complications [59]. Arthroscopic repair of the triceps tendon avulsion provides anatomic coverage of the triceps footprint [14]. The demanding technique for arthroscopic-assisted lateral ulnar collateral ligament reconstruction necessitates experience to work at the posterolateral compartment [21]. A unilateral technique for interposition arthroplasty of the elbow maintains the integrity of the ulnar nerve as well as the lateral or ulnar collateral ligament [24].

Key Evidence

• [L5] A combination of these two ligament-preserving approaches enables viewing the entirety of the joint surface and may represent an alternative to ligament-releasing approaches. [1] (10.1016/j.jse.2022.01.013)
• [L5] This review presents a concise summary of the embryology, anatomy, microscopy, biomechanical properties and clinical lesions involving the glenoid labrum to aid the clinician in understanding its function and pathology. [2] (10.1111/j.1758-5740.2010.00050.x)
• [L5] Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. [3] (10.1177/2325967120s00264)
• [L5] Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma. [4] (10.1016/j.jse.2014.05.003)
• [L5] Awareness of the neuroanatomical distribution of the receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology. [5] (10.1177/1758573218760245)
• [L4] This study describes anatomical structures of the PRUJ and highlights a significant negative relationship between the Alpha Angle and the Beta Angle, emphasizing the biomechanical impact of joint congruence on bony coverage. [6] (10.1016/j.xrrt.2026.100695)
• [L5] Biomechanical and clinical studies are needed to understand the true clinical relevance of these anatomic variations. [7] (10.1016/j.jse.2015.06.006)
• [L5] There are significant areas of the articular surface of all three bones in the elbow joint which may be overlooked during standard elbow arthroscopy. [8] (10.1016/j.arthro.2015.04.048)
• [L5] This article discusses the basic anatomy of the elbow and the biomechanics of this joint, noting that a combination of bony articulation and soft-tissue stabilizers accounts for the elbow's stability and complex kinematics. [9] (10.1016/j.csm.2004.06.008)
• [Paper] The elbow joint is inherently stable because of the interlocking shape of its articular surfaces, with the joint capsule and collateral ligaments providing static joint constraint and surrounding muscles producing dynamic forces. [10] (10.1016/s1058-2746(09)80053-0)
• [Case_report] The authors highlight the importance of recognizing complex soft tissue injuries to restore anatomic attachments and prevent chronic instability. [11] (10.1016/j.xrrt.2022.08.005)
• [L5] Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint. [12] (10.1016/j.arthro.2019.05.014)
• [L5] An appreciation of the relevant neurovascular and ligamentous structures is critical to safely performing surgical procedures about the elbow. [13] (10.5435/00124635-200905000-00007)
• [L5] The technique provides anatomic coverage of the triceps footprint, allowing more surface area for healing. [14] (10.1016/j.eats.2024.103129)
• [L5] Using the narrowest edge lacking cartilage as a reference to locate the bare area, the designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage. [15] (10.1016/j.jhsa.2017.02.012)
• [L5] This cadaveric study demonstrated the presence of 3 distinct bands present in both the anterior capsule and posterior capsule, excluding the medial and lateral collateral ligaments. [16] (10.1016/j.jhsa.2012.09.031)
• [L5] The course of the radial nerve in the distal part of the upper arm has great variety. [17] (10.1371/journal.pone.0186890)
• [L4] Clinical evaluation should encompass a detailed history including review of all previous surgeries, thorough bilateral examination, orthogonal radiographs, advanced imaging, and, in some cases, arthroscopic evaluation to minimize risk of inappropriate clinical management. [19] (10.1016/j.arthro.2011.03.025)
• [L5] Based on these perspectives, ligaments could function as a 'static-dynamic' stabilizer rather than a simple static one. [20] (10.1016/j.jseint.2024.01.006)
• [L5] However, the demanding technique necessitates a long learning curve and experience to work at the posterolateral compartment. [21] (10.1016/j.eats.2024.103101)
• [L5] Understanding the unique structural and functional properties of articular cartilage is key to developing chondroprotective agents that can improve its metabolic function. [22] (10.5435/00124635-200311000-00006)
• [L4] The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. [23] (10.1186/s13018-022-03148-8)
• [L5] The presented technique provides secure fixation of the interposition graft and maintains the integrity of the ulnar nerve as well as the lateral or ulnar collateral ligament. [24] (10.1016/j.eats.2023.09.010)
• [L5] Resections of the posteromedial aspect of the olecranon of >3 mm may jeopardize the function of the anterior bundle. [26] (10.2106/00004623-200411000-00010)
• [L5] The study presents a detailed description of the insertional anatomy of the anterior medial collateral ligament at the sublime tubercle. [27] (10.1016/j.jse.2018.08.006)
• [L4] The findings of this study were similar to previous studies that concluded that the fulcrum axis could be used to obtain information on the version of the glenoid from the anatomical landmarks. [28] (10.5397/cise.2018.21.3.111)
• [L4] The injury is apparently a rather frequent one and a description should be available to all orthopaedic surgeons. [29] (10.2106/00004623-195436030-00018)
• [L4] The synovial fold of the radiohumeral joint is a consistent and distinct anatomic structure, and ultrasonography can be a useful, non-invasive diagnostic tool for patients presenting with a painful snapping elbow. [31] (10.1016/j.jse.2006.10.019)
• [L5] Osteochondral lesions show location and size dependent consequences in valgus angulation and radiocapitellar contact characteristics. [32] (10.1177/2325967125s00017)
• [L4] This study demonstrates pathologic thickening, disorganization of the collagen fiber arrangement, and involvement of cytokines in the pathology of posttraumatic contracture of the elbow. [33] (10.1016/j.jse.2006.06.018)
• [L5] Both collateral ligaments are essential stabilizers, and their integrity is a prerequisite for stable function. [34] (10.2106/00004623-199509000-00023)
• [L4] Bone volume was also measured in the two groups and was statistically greater in the patients with osteoarthritis compared with the control group. [37] (10.1016/j.jse.2004.02.014)
• [L4] This study shows the heterogeneity of anterior bundle injuries in patients undergoing UCL reconstruction, with a variety of injury configurations and chronic attritional damage observed. [38] (10.1016/j.jse.2019.01.017)
• [L5] For small subtype 2 fractures, ligamentous repair alone may not reliably restore kinematics, and larger fractures should ideally have fragments fixed or reconstructed. [39] (10.1016/j.jse.2018.02.018)
• [L4] This provides an opportunity to standardize the communication of fracture type with further details of other injuries that ultimately can help with better understanding of treatment outcome based on the precise injury complex. [40] (10.1007/s11999-007-0064-8)
• [L5] The results suggest that different changes in clinical laxity are seen on DUS with injury of particular bands of the UCL. [41] (10.1177/2325967113s00016)
• [L5] The authors believe that the LUCL contributes to rather than is a major constraint to the posterolateral rotatory instability as part of the lateral collateral ligament complex with the surrounding tissues. [42] (10.1016/s1058-2746(99)90102-7)
• [L4] Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. [44] (10.1016/j.jse.2015.12.004)
• [L5] The clinical relevance of these observations in relation to radial head dislocation, fracture pattern, and elbow stability is discussed. [45] (10.1016/1058-2746(92)90013-s)
• [L4] A high index of suspicion is necessary to identify this injury pattern, and early recognition likely would have changed the initial conservative management decision in each. [46] (10.1016/j.jse.2016.03.013)
• [Paper] Surgical anatomical repair is typically performed in acute complete ruptures, while nonoperative treatment is reserved for partial ruptures or patients unfit for surgery. [47] (10.1016/j.injury.2013.01.003)
• [Case_report] The authors recommend performing an MRI if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage. [48] (10.1007/s00402-005-0018-0)
• [L4] This study provides evidence for elbow ligament repairs and reconstructions in both acute and chronic settings. [50] (10.1016/j.jseint.2024.02.013)
• [L5] This study analyzed elbow joint moments in different directions during daily tasks. [51] (10.1016/j.jse.2023.07.042)
• [L4] Arthroscopic elbow capsule release is a technically demanding procedure that requires detailed knowledge of 3-D elbow anatomy. [52] (10.1016/j.jse.2010.01.003)
• [L4] The most frequent factor hindering reduction was interposition of the annular ligament in the radiocapitellar joint. [53] (10.5435/jaaosglobal-d-17-00035)
• [L5] The annular ligament is a wrap-around ligament containing (fibro)cartilaginous tissue, with no synovial lining present on the articulating surface between the ligament and the radial head. [54] (10.1016/j.jseint.2025.07.002)
• [L5] Puncture of the joint capsule resulted in significant glenohumeral translation in unloaded and loaded specimens during shoulder abduction, with a maximum of 16.6 mm of distal translation observed at 20° of abduction. [55] (10.1016/1058-2746(93)90064-n)
• [L5] The study establishes a load sharing ratio of 58%:42% for the radiocapitellar and ulnotrochlear joints, respectively, and is the first to comprehensively evaluate loading mechanics across both native joints simultaneously throughout the entire functional range of elbow flexion and forearm rotation. [56] (10.1177/1758573220961025)
• [L5] No significant differences were found between the three implant morphologies for contact area or contact location, and joint kinematics suggesting that the shape of the implant may not be that important with respect to articular mechanics. [57] (10.1016/j.jse.2012.12.022)
• [L5] The kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius. [58] (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
• [L5] This can be prevented by using an accessory posterolateral portal instead of the direct posterior portal, while still being able to manage pathologies in all the area of the posterior compartment. [59] (10.1016/j.eats.2023.07.047)
• [L5] Insertion of a correctly sized metallic radial head replacement recreates near normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane. [60] (10.1302/0301-620x.95b10.31844)
• [L5] The ALL shows no isometric behavior during the range of motion of the knee. [61] (10.1177/2325967114562205)
• [Paper] Functionally, the immature-cracked cartilages stress-relaxed faster, experienced increased tissue strain, and had reduced instantaneous stiffness, compared to the mature-cracked cartilages. [62] (10.1002/jor.25243)
• [L5] Elbow position affects the kinematics of the distal radioulnar joint, which are primarily affected by forearm rotation and secondarily by elbow flexion. [63] (10.1016/j.jhsa.2009.04.025)
• [L5] Whereas a nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions, there are also orientations where contact area is reduced and stress is increased. [64] (10.1016/j.jse.2014.12.011)
• [L5] This technique may offer enhanced early biomechanical stability, simplify revision cases, and support improved return to function in high-demand patients. [65] (10.1016/j.eats.2025.103797)
• [L4] Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. [66] (10.1007/s00167-014-3322-9)
• [L5] No significant differences were noted between docking reconstruction and repair techniques for load to failure, gapping, or valgus opening angle during cyclic loading at time zero. [67] (10.1177/0363546518803771)
• [Paper] Through this incisionn, four to five centimeters long, one is less likely to injure any of the branches of the MACN, which run in an anterior-posterior direction. [69] (10.1016/s1058-2746(95)80079-4)
• [L5] A more thorough understanding of the detailed mechanisms involved in mechanotransduction may lead to novel approaches for enhancing tissue growth, or attenuating the mechanically driven processes that lead to osteoarthritis. [71] (10.5435/jaaos-d-16-00938)
• [L4] The ganglion may play a role in the pathogenesis of ulnar nerve palsy. [72] (10.1016/0363-5023(90)90033-n)
• [L5] Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. [73] (10.1016/j.jse.2009.03.004)
• [L4] The unicortical nature of the technique avoids the rare but devastating complication of posterior interosseous nerve palsy while providing robust fixation. [75] (10.1016/j.xrrt.2021.12.002)
• [L3] Surgeons must be vigilant about ulnar nerve complications. [77] (10.1186/s13018-022-03292-1)
• [L5] A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. [79] (10.1016/j.jhsa.2013.04.008)
• [L5] This technical note describes a minimally-invasive technique using a tendon graft to perform a reconstruction of the LUCL using knotless suture anchors in an onlay fashion, without violating both the articular capsule and the common extensor origin. [80] (10.1002/atn2.70135)
• [L4] The modified technique eliminates footprint competition between the LUCL reconstruction and IJS humeral pin, achieves isometric placement of both constructs, and provides ligament tensioning without additional drill sites, producing good results in the authors' experience. [81] (10.1016/j.xrrt.2024.01.003)

See Also

• Elbow Arthroscopy
• Elbow Instability
• Radial head arthroplasty
• Radial Head Fracture
• Osteochondritis Dissecans of the Capitellum

References

[1] Surgical Approaches To The Capitellum: A Comparative Anatomic Study. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.013

[2] The Glenoid Labrum. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00050.x

[3] PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00264

[4] Three-dimensional analysis of elbow soft tissue footprints and anatomy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.05.003

[5] Neuroanatomical distribution of sensory receptors in the human elbow joint capsule. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218760245

[6] Functional shape of the proximal radioulnar joint: anatomical characterization through Alpha and Beta Angles. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100695

[7] The ulnar greater sigmoid notch “coverage angle”: bone and cartilage contribution. Magnetic resonance imaging anatomic study on 78 elbows. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.006

[8] Quantification of The Articular View of The Elbow Afforded by Standard Arthroscopy Portals. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.048

[9] Elbow anatomy and structural biomechanics. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.06.008

[10] Stabilizers of the elbow. Journal of Shoulder and Elbow Surgery. 1993. DOI: 10.1016/s1058-2746(09)80053-0

[11] Global elbow instability: a case report. JSES Reviews, Reports, and Techniques. 2023. DOI: 10.1016/j.xrrt.2022.08.005

[12] Elbow Arthroscopy Made Simple: Indications and Techniques. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.014

[13] Surgical Approaches to the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200905000-00007

[14] Arthroscopic Repair of the Triceps Tendon Avulsion—Double‐Row Repair. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103129

[15] The Bare Area of the Proximal Ulna: An Anatomic Study With Relevance to Chevron Osteotomy. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.02.012

[16] Gross Anatomy of the Elbow Capsule: A Cadaveric Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.09.031

[17] The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment. PLOS ONE. 2017. DOI: 10.1371/journal.pone.0186890

[19] Joint Pain, Severe Cartilage Destruction, and Chondrolysis: Guidelines for Improving Diagnostic Differentiation and Clinical Management (SS‐22). Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.025

[20] Elbow anatomy in perspective of joint capsule and surrounding aponeuroses: a narrative review. JSES International. 2024. DOI: 10.1016/j.jseint.2024.01.006

[21] Arthroscopic‐Assisted Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Technical Note. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103101

[22] Articular Cartilage Biology. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200311000-00006

[23] Three-dimensional mapping study of pure transverse acetabular fractures. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03148-8

[24] Unilateral Technique for Interposition Arthroplasty of the Elbow—A Technical Note. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.09.010

[26] Medial Collateral Ligament Strain with Partial Posteromedial Olecranon Resection: A Biomechanical Study. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00010

[27] Insertional anatomy of the anterior medial collateral ligament on the sublime tubercle of the elbow. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.006

[28] Are the Anatomical Landmarks Adequate for Central Guide Insertion in Shoulder Arthroplasty?. Clinics in Shoulder and Elbow. 2018. DOI: 10.5397/cise.2018.21.3.111

[29] TRAUMATIC SUBLUXATION OF THE RADIAL HEAD IN YOUNG CHILDREN. The Journal of Bone & Joint Surgery. 1954. DOI: 10.2106/00004623-195436030-00018

[31] Ultrasonographic examination of the synovial fold of the radiohumeral joint. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.019

[32] Osteochondral Defects Show Location and Size Dependent Adverse Consequences in Valgus Angulation and Radiocapitellar Contact Characteristics with an intact UCL. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00017

[33] Structural and biochemical evaluation of the elbow capsule after trauma. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.018

[34] Motion and laxity of the capitellocondylar total elbow prosthesis.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199509000-00023

[37] The histologic changes of the olecranon fossa membrane in primary osteoarthritis of the elbow. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/j.jse.2004.02.014

[38] The pathoanatomy of the anterior bundle of the medial ulnar collateral ligament. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.01.017

[39] Posteromedial Rotatory Incongruity of the Elbow: A Computational Kinematics Study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.018

[40] Documentation of Associated Injuries Occurring With Radial Head Fracture. Clinical Orthopaedics & Related Research. 2008. DOI: 10.1007/s11999-007-0064-8

[41] Sequential Sectioning of the Ulnar Collateral Ligament of the Elbow in Cadaveric Arms with Ulnohumeral Laxity Assessed by Dynamic Ultrasonography. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00016

[42] Anatomic and histologic studies of lateral collateral ligament complex of the elbow joint. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90102-7

[44] Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.004

[45] The anatomy of the proximal radioulnar joint. Journal of Shoulder and Elbow Surgery. 1992. DOI: 10.1016/1058-2746(92)90013-s

[46] Articular shear injuries of the capitellum in adolescents. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.03.013

[47] Distal biceps and triceps ruptures. Injury. 2013. DOI: 10.1016/j.injury.2013.01.003

[48] Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s00402-005-0018-0

[50] A clinical review of elbow ligament repairs and reconstructions in the acute and chronic settings. JSES International. 2024. DOI: 10.1016/j.jseint.2024.02.013

[51] Elbow joint loads during simulated activities of daily living: implications for formulating recommendations after total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.07.042

[52] Arthroscopic capsular release of the elbow. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.01.003

[53] Irreducible Dislocation of the Radial Head Associated With Pediatric Monteggia Lesions. JAAOS: Global Research and Reviews. 2018. DOI: 10.5435/jaaosglobal-d-17-00035

[54] The nature of the annular ligament: a scoping review and histological analysis using a dual approach. JSES International. 2025. DOI: 10.1016/j.jseint.2025.07.002

[55] Glenohumeral movement patterns after puncture of the joint capsule: An experimental study. Journal of Shoulder and Elbow Surgery. 1993. DOI: 10.1016/1058-2746(93)90064-n

[56] Biomechanics of axial load transmission across the native human elbow. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220961025

[57] The Effect of Radial Head Implant Design on Radiocapitellar Contact and Kinematics. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.12.022

[58] Elbow kinematics with increased lengthening of a radial head arthroplasty evaluated with dynamic radiostereometric analysis. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b10.bjj-2024-0405.r1

[59] Avoidance of Direct Posterior Portal During Elbow Arthroscopic Surgery in Posterior Compartment. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.07.047

[60] The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b10.31844

[61] Evaluation of the Length and Isometric Pattern of the Anterolateral Ligament With Serial Computer Tomography. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114562205

[62] Deformation behaviors and mechanical impairments of tissue cracks in immature and mature cartilages. Journal of Orthopaedic Research. 2021. DOI: 10.1002/jor.25243

[63] Elbow Position Affects Distal Radioulnar Joint Kinematics. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.04.025

[64] Contact analysis of the native radiocapitellar joint compared with axisymmetric and nonaxisymmetric radial head hemiarthroplasty. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.011

[65] Suture‐Augmented Lateral Ulnar Collateral Ligament and Radial Collateral Ligament Reconstruction for Subacute and Chronic Posterolateral Rotatory Instability. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103797

[66] Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3322-9

[67] Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With the Docking Technique Versus Repair With Internal Bracing. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518803771

[68] Diffuse inflammation of cartilage; a case report of a hitherto unreported entity.. The Journal of bone and joint surgery. American volume. 1948.

[69] The elbow flexion test. Journal of Shoulder and Elbow Surgery. 1995. DOI: 10.1016/s1058-2746(95)80079-4

[71] Mechanical Signals as Regulators of Cartilage Degeneration and Regeneration. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00938

[72] Hypoplasia of the humeral trochlea. The Journal of Hand Surgery. 1990. DOI: 10.1016/0363-5023(90)90033-n

[73] Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.004

[75] Intramedullary, unicortical repair of distal biceps tendon rupture. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2021.12.002

[77] Complications associated with open reduction and internal fixation for adult distal humerus fractures: a multicenter retrospective study. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03292-1

[79] Annular Ligament Reconstruction Using the Distal Tendon of the Superficial Head of the Brachialis Muscle: An Anatomical Feasibility Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.008

[80] Lateral Ulnar Collateral Ligament Reconstruction Through a Mini‐Invasive Approach. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70135

[81] Concomitant internal joint stabilizer augmentation with isometric lateral ulnar collateral ligament repair for unstable elbow dislocations: a surgical technique. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.01.003

[82] 10_2535_ofaj_79_55. 2001.